Child abuse potential among mothers of substance-exposed and nonexposed infants and toddlers

OBJECTIVE: The purpose of this longitudinal study was to determine whether there were differences in child abuse potential among mothers who were nonusers, drug users who accepted treatment, and drug users who rejected offers of treatment, over the first 2 years of their children's lives. METHOD: Participants were mothers of 140 infants, classified into Nonuser (n = 48), Treatment (n = 72), or Refuser (n = 20) groups. The Child Abuse Potential (CAP) Inventory [Milner, J. S. 1980. The Child Abuse Potential Inventory: Manual. Webster, NC: Psytec Corporation] was administered when infants were 4, 9, 12, 18, and 24 months. RESULTS: Results of mixed-model analyses of variances showed no group differences on CAP Inventory abuse scale scores. There were significant group differences in lie scale scores on the CAP Inventory, such that lie scale scores for the Nonuser group were significantly higher than lie scale scores for the Treatment group. CONCLUSIONS: Overall, results support the position that low-income women with many risk factors in their lives are at high risk for potential child abuse, but that their drug use status and drug treatment status does not differentiate them from their nonuser peers from a similar social and demographic background.     

Child abuse potential in parents with histories of substance use disorder

OBJECTIVE: To examine the relationship between parental history of substances use disorders (SUDs) and abuse potential. METHOD: Milner's (1986) Child Abuse Potential Inventory (CAPI) was administered to fathers and mothers (with and without histories of SUDs) of 10- to 12-year-old boys. RESULTS: Fathers and mothers with lifetime histories of SUDs had higher Abuse Scale scores and were more likely to score in the Elevated range (as determined by clinically significant cutoff scores) than parents without such histories. No differences were found between parents with current diagnoses of SUD and those with past (but not current) histories of SUD. Fathers and mothers with a partner who had a history of SUD were more likely to score in the Elevated range, regardless of their own SUD histories. Separate regression models revealed that, for both fathers and mothers, emotional dysregulation (positive and negative affectivity) predicted Abuse Scale scores. Additional contributors to Abuse Scale scores were SUD status in fathers, and lack of involvement with the child in mothers. CONCLUSIONS: History of SUDs in both fathers and mothers increases abuse potential. Contributors to abuse potential differed in fathers and mothers, underscoring the importance of examining parents separately in child maltreatment research.     

Perinatal complications and child abuse in a poverty sample

OBJECTIVE: Perinatal medical illness has been associated with child maltreatment. Using a Child Protective Service (CPS) report as the defining event, this study explores to what extent perinatal morbidity is a risk factor for maltreatment. METHOD: Medical charts of 206 children ages 0-3 years were reviewed. Data regarding birth history were collected and analyzed in three groups of children: children whose medical record indicated a report to CPS based on prenatal findings (Early Maternal Inadequacy group [EMI]), children whose medical record indicated a report to CPS based only on postnatal findings (Child Maltreatment group [CM]), and a control group without CPS report (NM). RESULTS: Compared to the CM and the NM groups, children in the EMI group showed significantly lower birth weight and higher neonatal morbidity as measured by Apgar scores, frequency of oxygen requirement and intubation at birth, frequency of admission to Neonatal Intensive Care unit, and frequency of neonatal medical problems. There was no significant difference between the CM and the NM groups in birth weight, gestational age, and other measures of morbidity. CONCLUSION: The results of the study suggest that perinatal complications are associated with prenatal maltreatment. Previously reported strong associations between neonatal morbidity and child abuse are more likely a result of antecedent prenatal maternal behaviors (early maternal inadequacy). Early maternal inadequacy, a clinically and demographically distinct phenomenon, is important due to serious health, development and financial implications and deserves further exploration.     

Confirmatory factor analysis of the Child Abuse Potential Inventory: results based on a sample of Chinese mothers in Hong Kong

OBJECTIVES: To evaluate whether or not the original six-factor structure of the Child Abuse Potential (CAP) Inventory suggested by [Milner, J.S. (1986). The Child Abuse Potential Inventory: Manual (2nd ed.). DeKalb, IL: Psytec. Inc.] can be confirmed with data from a group of Chinese mothers in Hong Kong. METHOD: Eight hundred and ninety-seven mothers from 13 child care centers in Hong Kong successfully completed a set of structured questionnaires consisting, among others, of the 77-item Abuse Scale of the CAP Inventory. A confirmatory factor analysis (CFA) was performed to determine whether the data fits the factorial structure of the CAP Inventory identified by Milner (1986). RESULTS: The root mean square error of approximation (RMSEA) of the model epsilona) is 0.031, indicating a close fit of the model in relation to the degrees of freedom. On testing the close fit against the null hypothesis that Ho: epsilona相似文献   

Influence of negative childhood experiences on psychological functioning, social support, and parenting for mothers recovering from addiction.

OBJECTIVE: This study was conducted with mothers recovering from drug and alcohol addiction and had three aims: first, to understand the range of negative childhood events these mothers experienced; second, to understand their current level of distress and their parenting experiences; and third, to examine the relationships between negative childhood events and parenting experiences. METHOD: Forty-six mothers participated in a cross-sectional exploratory study and completed a range of self-report measures, including the Child Abuse & Trauma Scale, Social Support Inventory, CES-D, Parenting Stress Index, and the Parenting Scale. RESULTS: When compared to norming samples these mothers reported significantly higher levels of aversive childhood experiences, psychological distress, parenting stress and use of problematic parenting behaviors along with lower levels of social support. Higher levels of neglect and growing up in a negative home environment were significantly correlated with lower levels of social support from the family, higher levels of distress and parenting stress, and greater use of problematic parenting behaviors. CONCLUSION: For this sample there is a greater incidence of aversive childhood experiences and greater problems with maternal functioning. Mothers recovering from addiction have an additional need for clinical attention towards issues of recovery from childhood abuse and responding to parenting difficulties with their own children.     

The influence of support and stress on maternal attitudes

OBJECTIVES: This study examines an expanded version of Belsky's (1984) multi-dimensional process model of parenting to determine whether changes in stress and support influence maternal attitudes during the first year of a child's life. METHOD: Data were collected from mothers of newborns eligible for Hawaii's Healthy Start program who had been randomly assigned to home visitation (n=108) or control (n=104) status. Multiple regression analyses were used to test hypotheses regarding the influence of change in contextual sources of support and stress on parenting attitudes as measured by the Child Abuse Potential Inventory (CAPI) Abuse Scale. A post hoc analysis of variance was conducted to explore interactions among the predictor variables and home visitation. RESULTS: Stress in the form of change in public assistance status led to more punitive parenting attitudes while increased support from the partner and from close associates emerged as significant predictors of less punitive parental attitudes. The exploratory analyses suggest that home visitation may moderate the impacts of stress and support on maternal attitudes. CONCLUSIONS: In line with Belsky's (1984) process model of parenting, increased stress adversely impacted maternal attitudes regarding physical punishment while increased support exerted favorable effects. The results also support further elaboration of Belsky's model including the expansion of marital support to include unmarried partners and the need to consider the impact of formal support sources on parenting.     

Childhood history of abuse and child abuse screening.

Although a childhood history of abuse is related to parental child abuse, many parents with a history of abuse are not abusive. To determine the effects of a childhood history of abuse on adult child abuse potential, a modified Conflict Tactics Scale (CTS) and the Child Abuse Potential (CAP) Inventory were administered to matched groups of physically abusive mothers with a childhood history of abuse, nonabusive comparison mothers with a childhood history of abuse, and nonabusive comparison mothers without a childhood history of abuse. The modified CTS asked about childhood events and was used to confirm a childhood history of abuse. As expected, the CTS verbal and violence scales were higher for the abusive and nonabusive mothers with a childhood history of abuse. None of the CTS scores were different for the abusive and nonabusive mothers with a childhood history of abuse. In contrast, the CAP abuse scores distinguished between all three study groups. However, on the CAP factor scales, only the rigidity and unhappiness factors discriminated between abusive and nonabusive mothers with a childhood history of abuse. Nonabusive mothers with a childhood history of abuse were less rigid in their child expectations and were happier in their interpersonal relationships than abusive mothers with a childhood history of abuse.     

Parents’ perception of child behavior,parenting stress,and child abuse potential: Individual and partner influences

Based on the Social Information Processing model of parenting risk for child abuse, the present study examined the associations between mothers’ and fathers’ perception of child behavior and child abuse potential, as well as whether parenting stress mediates the association between these constructs. Two hundred and fifty-nine mother-father couples raising preschool children answered the Child Behavior Checklist (CBCL), the Parenting Stress Index (PSI), and the Child Abuse Potential Inventory (CAPI). The results of dyadic path analysis showed that perception of child behavior was related to heightened parenting stress and abuse potential in both mothers and fathers. Concerning partner effects, we found that mothers’ perception of child behavior problems was positively associated with fathers’ parenting stress and that the higher the mothers’ distress, the higher the fathers’ risk of physical abuse. Finally, parenting distress partially mediated the association between parents’ perception of child behavior and child abuse potential, with mothers’ perception of their children as problematic showing a significant indirect effect through distress on their own abuse risk and on fathers’ CAP as well. These findings suggest that parental distress may represent a critical mechanism by which parents’ negative views of their children contribute to abuse potential. Moreover, mothers seem to influence fathers’ tendency towards abusive behaviors.     

Gender differences in empathy in parents at high- and low-risk of child physical abuse

OBJECTIVES: The present research was designed to study empathy in high-risk parents for child physical abuse. The main objective was to study if high-risk mothers and fathers, compared to low-risk mothers and fathers, presented more Personal distress, less Perspective-taking, less Empathic concern and a deficit in dispositional empathy toward their partner and children. METHOD: Based on their scores on the Abuse Scale of the CAP Inventory [J.S. Milner, The Child Abuse Potential Inventory: Manual, 2nd ed., Psytec Corporation, Webster, NC], 19 (9 fathers and 10 mothers) high- and 26 (12 fathers and 14 mothers) low-risk parents for child physical abuse were selected from a total sample of 331 parents of the Spanish general population. Both groups were statistically matched on sociodemographic variables. The Interpersonal Reactivity Index (IRI) [Catalog of Selected Documents in Psychology 10 (1980) 85] and the Parent/Partner Empathy Scale (PPES) [N.D. Feshbach, N. Caskey, A new scale for measuring parent empathy and partner empathy: factorial structure, correlates and clinical discrimination, 1985] were used to assess dispositional empathy. RESULTS: An interaction between risk status and gender for "Personal distress" and "Perspective-taking" was found. High-risk mothers for child physical abuse showed more "Personal distress" than low-risk mothers and low-risk fathers. High-risk fathers for child physical abuse showed less "Perspective-taking" than low-risk mothers and low-risk fathers. No difference between both groups was found for the IRI "Empathic concern" dimension. Moreover, high-risk, compared to low-risk, parents showed lower scores both on the "Empathy toward the partner" and on the "Empathy toward the child" dimensions of the PPES. No interaction between risk status and gender was found for the PPES dimensions. CONCLUSIONS: Findings of the present study supported the hypothesis that high-risk parents for child physical abuse show a deficit both in general empathy and in empathy toward their family members. Moreover, findings suggested the existence of a different pattern of deficits in empathy for high-risk fathers and high-risk mothers.     

Predictors of Behavior Problems in Preschool Children of Inner-City Afro-American and Puerto Rican Adolescent Mothers

Maternal reports on the Child Behavior Checklist/2-3 (CBCL/2-3) were used to evaluate child, maternal, and environmental predictors of behavior problems in 83 preschool children of disadvantaged adolescent mothers. CBCL/2-3 scores correlated modestly with independent ratings of child difficult behaviors observed in videotaped mother-child play interactions. 13% of children had scores in the clinical range. Significant correlations were consistently found between CBCL/2-3 ratings and maternal depressive symptoms, social supports, and life stress—assessed 3 times during the first year postpartum. In hierarchical regression analyses, maternal depressive symptoms, residence with the adolescent's mother, and perceived emotional support from friends contributed most to the explained variance. A significant ethnicity and child gender interaction term also suggested that African American mothers of male children reported more behavioral problems. Findings evidence the heterogeneity of outcomes for children of disadvantaged adolescent mothers but also demonstrate how correlates of poverty negatively affect their socioemotional development.     

Child abuse potential inventory and parenting behavior: Relationships with high-risk correlates

The primary purpose of this research was to examine the construct validity of the Child Abuse Potential Inventory by comparing maltreating and high-risk parents' CAP Inventory abuse scores to their behavior during interactions with their children. A second purpose was to determine the degree to which CAP Inventory scores and parenting behavior were related to several known correlates of abuse, as measured by parent and teacher reports. Participants (n = 41) included abusive and high-risk parents and their children referred to a treatment group. Correlational analyses revealed that CAP Inventory scores and observed parenting style yielded highly related findings, supporting construct validity of the CAP Inventory. However, the CAP Inventory and observed behavior index showed a different pattern of relationships to the risk correlates. Implications for assessment of risk status are discussed and recommendations are provided for continued research.     

Early motherhood and harsh parenting: The role of human,social, and cultural capital

ObjectiveThis study examined the role of maternal human, social, and cultural capital in the relationship between early motherhood and harsh parenting behavior.MethodsThis study used data from the Fragile Families and Child Wellbeing (FFCW) Study. Harsh parenting behaviors by mothers who were 19 years or younger at birth of the focal child (n = 598) were compared with that of adult mothers 26 years or older (n = 1,363). Measures included: For harsh parenting behavior, three proxies were created from the Parent to Child version of the Conflict Tactics Scales (CTS-PC) and self-reports of maternal spanking. For maternal human capital, education, employment, and depression were used. For maternal social capital, expected-social support, paternal support, and lone caregiver status were included. For maternal cultural capital, religious attendance and attachment to race/ethnic heritage were used.ResultsMultivariate analyses indicated that adolescent motherhood has a significant impact on all three harsh parenting behavior outcomes even after controlling for demographic and maternal capital characteristics. Working since the birth of the focal child, depression scores, paternal support, expected-social support, and attendance at religious services made independent contributions to the prediction of harsh parenting behavior.ConclusionsFindings emphasize the importance of the prevention of adolescent motherhood and suggest intervention strategies for reducing the risk of maternal harsh parenting behavior. Further study is necessary to examine the complicated relationships among maternal capital and parenting. One method may be to focus on the development of measures of maternal capital, notably measures of expectations regarding and perceptions of received capital.Practice implicationsFindings from this study have implications for social work practice, particularly for the prevention of adolescent pregnancy and intervention with adolescent mothers and their children. First, the study calls for more recognition of school social work and intervention programs in school settings as important components of prevention services. Second, the importance of identifying fathers and helping them become involved and connected with their young families are highlighted. Finally, practitioners should become more aware of the role of culture in young families as the effect of cultural capital on parenting behavior becomes better understood.     

Maternal smoking behavior, background and neonatal health in Finnish children subsequently placed in foster care

OBJECTIVE: The purpose of this study was to investigate retrospectively neonatal health and maternal background among a sample of children taken into custody and placed in foster care and to investigate the relation between medical and social risk in the neonatal period. METHOD: The data-linkage study combined two registries: the Finnish Medical Birth Registry (MBR), from January 1, 1987 to December 31, 1989, and the Finnish Child Welfare Registry (CWR) from January 1, 1987 to December 31, 1997 using personal identification numbers (n=1,668). As controls all Finnish children born in 1987 were chosen (n=59,727). Infant neonatal health was estimated using the following indicators: birth-weight and birth-length, birth-weight by gestational age, 1-minute Apgar scores, and discharge age from the nursery. Maternal background characteristics included maternal age, parity, marital status, number of antenatal visits at maternity clinics and smoking during pregnancy. RESULTS: We found that the 1,668 children in the study had a lower birth-weight and birth-length, shorter gestational age, lower 1-minute Apgar scores and later discharge from the nursery than the population-based controls. The proportion of teen-age mothers was about four times higher and the proportion of unmarried women was twice as high. A majority of the women (56%) reported smoking during pregnancy, compared with only 15% of the population-based comparisons. Children subsequently taken into custody had poorer health at the time of birth than other children and these differences could only partly be explained by the differences in smoking habits during pregnancy. The women in the study made use of the free health controls at maternity clinics as much as the population-based comparisons. CONCLUSIONS: Our findings indicate that social and medical risks are related in the neonatal period. Since almost all mothers visit maternity clinics, there are possibilities for early intervention.     

Dynamic prediction characteristics of the Child Abuse Potential Inventory

OBJECTIVES: Risk measures are commonly used to evaluate outcomes in child abuse prevention and intervention programs. This study examined whether pre-intervention to post-intervention changes on the Child Abuse Potential Inventory (CAP) Abuse Scale corresponded to actual changes in risk for future reports of maltreatment and evaluated the validity of several algorithms for classifying clinically significant change. METHOD: Participants in the study were 459 parents participating in any one of 27 community-based family preservation and family support programs. Most parents were low-income mothers with a variety of social risk indicators, about a third of whom would be classified as high-risk by the CAP Abuse Scale. Participants were administered the CAP at program enrollment, then at completion of the intervention (median time=150 days), then followed for an average of approximately 2 years for future official maltreatment reports. Dynamic predictive validity of the CAP Abuse Scale was modeled by comparing survival models using a time-dependent structure of pre- and post-intervention scores to identically structured models using only a pre-intervention score. RESULTS: Pre-intervention CAP Abuse Scale scores demonstrated incremental future predictive validity. However, score changes failed to correspond to changes in likelihood of future abuse. Models using pre-intervention scores only were more predictive than time-dependent score models, and pre-intervention scores were better predictors than post-intervention scores of post-intervention CPS referrals. Common algorithms for classifying clinically significant change yielded results that could be counter-intuitive and misleading. For example, participants classified as improved on these algorithms were actually at similar or even higher risk than those classified as unchanged or worse. CONCLUSIONS: The results strongly supported the static predictive validity of the CAP and the use of the CAP for screening purposes. The results did not support the dynamic predictive validity of the CAP. Results of exploratory analyses suggested the possibility that the changes observed on the CAP Abuse Scale reflected changes in subscales assessing subjective distress or parenting attitudes, which may be markers for initial risk but when changed, do not necessarily translate into actual changes in future maltreatment behavior. Although replication and extension are needed before drawing firm conclusions, the current study raises questions about the common practice of using risk instruments as proxy measures for child maltreatment risk in intervention and prevention programs.     

Child abuse potential and work satisfaction in day-care employees

The Child Abuse Potential (CAP) Inventory and a Work Satisfaction Questionnaire were administered to 228 day-care employees at 40 centers to investigate the relationship between potential for child abuse and degree of job satisfaction. In addition, the ability of the CAP abuse scale to distinguish between groups of day-care employees thought to differ in the quality of child care provided was studied. Small, albeit significant, inverse correlations were observed between abuse scores and two job satisfaction items. As clarity of job expectations and as overall job satisfaction increased, abuse scores decreased. Although abuse scores for all day-care employees were not significantly different from norm scores, significantly lower scores were found for employees from "superior" day-care centers and for employees rated "high" by center directors. Abuse scores for employees rated "high" were also significantly below scores for employees rated "low." While these data indicate only limited relationships between child abuse and job satisfaction, the findings suggest the CAP abuse scale can distinguish some subgroups of day-care employees thought to differ in quality of child care provided.     

Parental family stress during pregnancy and cognitive functioning in early childhood: The Generation R Study

We investigated whether parental family stress during pregnancy is associated with cognitive functioning in early childhood in a population-based cohort (n = 3139). Family stress was assessed using the Family Assessment Device at the 20th week of pregnancy and was reported by mothers and fathers. Mothers completed the MacArthur Communicative Development Inventory, measuring children's verbal cognitive functioning, when children were 18 months and they completed the Parent Report of Children's Abilities, measuring nonverbal cognitive functioning, when children were 2 years old. Maternal prenatal family stress was related to children's low word comprehension and poorer nonverbal cognitive development independent of paternal reports. In a subset of 639 children, maternal prenatal family stress was also associated with observational assessments of poor effortful control at age 37 months. Paternal prenatal family stress was only related to poorer nonverbal cognitive development, independent of the mother. When both parents had high levels of prenatal family stress, children displayed particularly poor nonverbal cognitive development. These findings emphasize the significance of parental prenatal family stress for child developmental outcomes.     

Childhood history of abuse and child abuse potential: The role of parent's gender and timing of childhood abuse

It has been suggested that being physically abused leads to someone becoming a perpetrator of abuse which could be associated to parents’ gender, timing of the physical abuse and specific socio-demographic variables. This study aims to investigate the role the parents’ gender, timing of childhood abuse and socio-demographic variables on the relationship between parents’ history of childhood physical abuse and current risk for children. The sample consisted of 920 parents (414 fathers, 506 mothers) from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect who completed the Childhood History Questionnaire and the Child Abuse Potential Inventory. The results showed that fathers had lower current potential risk of becoming physical abuse perpetrators with their children than mothers although they did not differed in their physical victimization history. Moreover, the risk was higher in parents (both genders) with continuous history of victimization than in parents without victimization. Prediction models showed that for fathers and mothers separately similar socio-demographic variables (family income, number of children at home, employment status and marital status) predicted the potential risk of becoming physical abuses perpetrators. Nevertheless, the timing of victimization was different for fathers (before 13 years old) and mothers (after 13 years old). Then our study targets specific variables (timing of physical abuse, parents’ gender and specific socio-demographic variables), which may enable professionals to select groups of parents at greater need of participating in abuse prevention programs.     

Disposition and health outcomes among infants born to mothers with no prenatal care

ObjectiveThis study assessed infant disposition and health outcomes among offspring born to mothers without prenatal care, based on maternal characteristics and the reason for lack of prenatal care (i.e., denial of pregnancy, concealment of pregnancy, primary substance use, financial barriers and multiparity).MethodsA retrospective record review was completed at an urban academic medical center. Subjects were women who presented at delivery or immediately postpartum with no history of prenatal care (N = 211), and their infants.ResultsInfants of mothers with substance use problems had the highest rates of referral to child protective services and out-of-home placement at discharge, though mothers with other reasons for no prenatal care also experienced both referral and placement. Infants born to mothers using substances experienced the highest rates of neonatal intensive care unit admission, and the lowest mean birth weight.ConclusionsThough those without prenatal care experienced a variety of adverse outcomes, substance use problems were most frequently correlated with adverse infant outcomes. Mothers who either had lost custody of other children or with substance use problems were at highest risk of losing custody of their infants. Those who denied or concealed their pregnancy still frequently retained custody.Practice implicationsAmong mothers without prenatal care, those with substance use problems were least likely to retain custody of their infant at hospital discharge. Custody status of the mother's other children was also independently associated with infant custody. Mothers who denied or concealed their pregnancy still often retained custody. Referrals of mothers with no prenatal care for psychiatric evaluation were rare, though referrals to social work were frequent. Child protective services occasionally did not investigate referrals in the denial and concealment groups. Healthcare providers should be aware of the medical and psychological needs of this vulnerable population of infants and mothers.     

Convergent validity of the preliminary Spanish version of the Child Abuse Potential Inventory: depression and marital adjustment]

This paper studies the "convergent validity" of the preliminary spanish version of the Child Abuse Potential (CAP) Inventory. In relation to the ecological-systemic model of child maltreatment, this inventory evaluates individual, family, and social factors which facilitate the occurrence of physical child abuse. Depression and marital adjustment were measured in three groups of mothers: one group of mother-perpetrators of physical child abuse (n = 20), another group of mothers with a rate superior to cut-off (percentile = 95) in the CAP Inventory (n = 15), and a group of mothers with low punctuation (under percentile 25) in the CAP Inventory (n = 15). The two last groups (High CAP and Low CAP) come from a larger sample of 829 subjects which are a demographically representative sample of the population of País Vasco (in Spain). Because of variations in the detection of social services, the physically abused group is formed by the most extreme and severe cases. The three groups of mothers were matched as to socio-economic family status, education, civil status, age of the mother, sex of the child, number of children. It was expected that in these variables, depression and marital adjustment, the group with physical abuse would resemble the High CAP group and that both groups would be significantly different from the Low CAP group. Results partially confirm these hypothesis, supporting the possibilities of developing a Spanish version of the CAP Inventory for detection of physical child abuse.     

Inconsistent response patterns and the prediction of child maltreatment

Inconsistent response patterns have been used with other measures to screen for child maltreatment. To date the inconsistency (IC) scale, a validity scale on the Child Abuse Potential (CAP) Inventory, has not been used as a screening criterion for physical child abuse. The present study examined the responses of 89 physical child abusers and 108 comparison subjects to determine if the CAP Inventory IC scale has any utility in the screening for physical child abuse. While results indicated the CAP Inventory IC scale scores were significantly higher for the physical child abuse group, a series of discriminant analyses indicated that the IC scale did not account for any meaningful variance after variance related to child abuse factors was removed. Further, the results indicated that dependence on the IC scale alone for physical child abuse screening purposes could be expected to produce excessive false positive and false negative classifications.