Childhood maltreatment and alcohol-related problems in young adulthood: The protective role of parental warmth

BackgroundAlcohol use among young adults is highly prevalent. Individuals exposed to childhood maltreatment are particularly vulnerable to alcohol use and alcohol-related problems. Few studies have examined family protective factors, such as parental warmth, that may mitigate the effects of childhood maltreatment on alcohol-related problems.ObjectiveThe current study seeks to examine the extent to which parental warmth reduces the effect of childhood exposure to maltreatment on alcohol-related problems in young adulthood.Participants and settingParticipants were young adults (N = 337; mean age = 21.7), who were recruited from an urban community and completed in-person interviews assessing childhood maltreatment, parental warmth, and alcohol-related problems.MethodsMultiple hierarchical linear regression models were used to examine whether maternal and paternal warmth reduced the impact of childhood exposure to maltreatment on alcohol-related problems in young adulthood. Common risk factors for alcohol-related problems, including psychological symptoms and peer and parental alcohol use, were also entered into the models.ResultsWe found a significant moderating effect of paternal warmth on the associations between childhood emotional abuse and alcohol-related problems (β= -0.29, p < .05). Specifically, the association between emotional abuse and alcohol-related problems was weaker among individuals with higher levels of paternal warmth. Moderating effects of maternal warmth on the maltreatment-problematic alcohol use relation were not supported.ConclusionThe results of this research suggest that parental warmth may not only relate to fewer alcohol-related problems among offspring, but may also modify the associations between childhood emotional abuse and alcohol-related problems during young adulthood.     

Identifying children at high risk for a child maltreatment report

Objective

To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect.

Method

The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models.

Results

Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education ≤ high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, CI = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, CI = 1.07-1.47, p < .01).

Conclusions

Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.     

Parental substance abuse as a predictor of child maltreatment re-reports

This longitudinal study of child abuse and neglect cases closed after investigation examined the impact of parental substance abuse on family functioning and on subsequent referrals to child protective services. The findings support the hypothesis that parental substance abuse would have a negative impact on family functioning, which, in turn, would result in a higher rate of re-reports. As expected, substance abuse also had a direct impact on re-reports. It is critical that the child welfare system recognize and respond to parental substance abuse problems in these families through expanded and improved voluntary, and perhaps, mandatory services.     

Prenatal and early postnatal depression and child maltreatment among Japanese fathers

We investigated the association of paternal depression in the prenatal and early postnatal period with child maltreatment tendency at two months postpartum among Japanese fathers. This population-based longitudinal study recruited Japanese perinatal women and their partners living in Nishio City, Aichi, Japan. Of the 270 fathers who participated, 196 were included in the analysis. All data were collected via self-administrated questionnaires at four time points: 20 weeks’ gestation and in the first few days, one month, and two months postpartum. Paternal depression was assessed using the Edinburgh Postnatal Depression Scale. Three definitions of paternal depression were coded based on participants’ scores on this measure: prenatal, prior, and current. Child maltreatment tendency was evaluated using the Child Maltreatment Scale at two months postpartum. The associations of the three definitions of paternal depression and child maltreatment tendency were separately analyzed using logistic regression analysis. The prevalence of prenatal, prior, and current paternal depression was 9.7%, 10.2%, and 8.8%, respectively. According to the multivariate analysis, current paternal depression was significantly associated with child maltreatment tendency at two months postpartum (adjusted odds ratio: 7.77, 95% CI: 1.83–33.02). The other two types of depression, however, were not related to child maltreatment tendency. Thus, current paternal depression increased the risk of child maltreatment tendency in the postnatal period, suggesting that early detection and treatment of paternal depression might be useful for the prevention of child maltreatment.     

Risk terrain modeling predicts child maltreatment

As indicated by research on the long-term effects of adverse childhood experiences (ACEs), maltreatment has far-reaching consequences for affected children. Effective prevention measures have been elusive, partly due to difficulty in identifying vulnerable children before they are harmed. This study employs Risk Terrain Modeling (RTM), an analysis of the cumulative effect of environmental factors thought to be conducive for child maltreatment, to create a highly accurate prediction model for future substantiated child maltreatment cases in the City of Fort Worth, Texas. The model is superior to commonly used hotspot predictions and more beneficial in aiding prevention efforts in a number of ways: 1) it identifies the highest risk areas for future instances of child maltreatment with improved precision and accuracy; 2) it aids the prioritization of risk-mitigating efforts by informing about the relative importance of the most significant contributing risk factors; 3) since predictions are modeled as a function of easily obtainable data, practitioners do not have to undergo the difficult process of obtaining official child maltreatment data to apply it; 4) the inclusion of a multitude of environmental risk factors creates a more robust model with higher predictive validity; and, 5) the model does not rely on a retrospective examination of past instances of child maltreatment, but adapts predictions to changing environmental conditions. The present study introduces and examines the predictive power of this new tool to aid prevention efforts seeking to improve the safety, health, and wellbeing of vulnerable children.     

Variation in prevention of child maltreatment by Dutch child healthcare professionals

Child maltreatment (CM) is a common condition with a large impact on the victim and society. In the Netherlands, the preventive child healthcare (CHC) aims to protect children against such threats. However, several studies indicate that the efficacy in this area may be suboptimal for many CHC professionals. Therefore, this study aims to map the practice variation in the primary and secondary prevention of CM, by CHC physicians and nurses. This mixed-methods study used interviews to identify relevant topics and develop an online questionnaire. All CHC organizations in the Netherlands (n = 45) were asked to forward this questionnaire to their professionals. Practice variation was described with domain scores and item response distributions. Multi-level analysis was used to assess case mix-corrected variance between organizations. Interview participants (n = 11) expected suboptimal care in 35 topics which they considered important for prevention of CM, resulting in a 15 min questionnaire. Nearly two-thirds of the organizations (n = 29) agreed to forward the questionnaire to their employees. The response rate was 42% (n = 1104). Suboptimal care and practice variation was found in all domains (i.e. communication, medical expertise, collaboration, involvement in prevention of CM, and improvement opportunities), mostly caused by intra-organization variance. Significant inter-organization variance was found for collaboration (variance partition coefficient 6–7%) and involvement (2–3%). Furthermore, the majority of the respondents (96%) reported fear in acting upon suspicions of CM. Substantial suboptimal care and practice variation in prevention of CM warrant action from authorities, CHC training institutes, CHC organizations, and professionals.     

Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents

Although child maltreatment exposure is a recognized risk factor for self-harm, mechanisms underlying this relationship remain unclear. Self-harm may function as a compensatory strategy to regulate distressing emotions. This cross-sectional study examines if emotion dysregulation mediates between the severity of maltreatment exposure and self-harm, adjusting for demographic variables and depressive symptoms. Participants were 108 adolescent patients recruited from a psychiatric hospital in Singapore (mean age 17.0 years, SD = 1.65; 59.3% female). Study measures included the Childhood Trauma Questionnaire (CTQ-SF), Functional Assessment of Self-Mutilation (FASM), Difficulties in Emotion Regulation Scale (DERS), and the Patient Health Questionnaire (PHQ-8). Path analysis was conducted to examine the direct and indirect effects of maltreatment exposure on self-harm via emotion dysregulation, controlling for demographic variables and depressive symptoms. Indirect effects were tested using bootstrapped confidence intervals (CI). Results showed that self-harm was highly prevalent in our sample (75.9%). Emotion dysregulation and depressive symptoms were found to be associated with higher self-harm frequency. In addition, results from path analysis showed that the association between the severity of maltreatment exposure and self-harm frequency was significantly mediated by emotion dysregulation B = 0.07, p < 0.05, 95% CI [0.02, 0.16]. Thus, emotion dysregulation may be a proximal mechanism linking maltreatment exposure and adolescent self-harm. Notably, self-harm may represent maladaptive attempts to manage emotion dysregulation that may have resulted from maltreatment. Findings from the study have implications for the prevention and treatment of self-harm in maltreated youth.     

Fatal child maltreatment in England, 2005-2009

Objective

This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.

Methods

Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment).

Results

A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death.

Conclusions

Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.     

Adolescent risk factors for child maltreatment

We investigate adolescent risk factors, measured at both early and late adolescence, for involvement in child maltreatment during adulthood. Comprehensive assessments of risk factors for maltreatment that use representative samples with longitudinal data are scarce and can inform multilevel prevention. We use data from the Rochester Youth Development Study, a longitudinal study begun in 1988 with a sample of 1,000 seventh and eighth graders. Participants have been interviewed 14 times and, at the last assessment (age 31), 80% were retained. Risk factors represent 10 developmental domains: area characteristics, family background/structure, parent stressors, exposure to family violence, parent–child relationships, education, peer relationships, adolescent stressors, antisocial behaviors, and precocious transitions to adulthood. Maltreatment is measured by substantiated reports from Child Protective Services records. Many individual risk factors (20 at early adolescence and 14 at later adolescence) are significantly, albeit moderately, predictive of maltreatment. Several developmental domains stand out, including family background/structure, education, antisocial behaviors, and precocious transitions. In addition, there is a pronounced impact of cumulative risk on the likelihood of maltreatment. For example, only 3% of the youth with no risk domains in their background at early adolescence were involved in later maltreatment, but for those with risk in 9 developmental domains the rate was 45%. Prevention programs targeting youth at high risk for engaging in maltreatment should begin during early adolescence when risk factors are already at play. These programs need to be comprehensive, capable of addressing the multiple and interwoven nature of risk that is associated with maltreatment.     

Community interaction and child maltreatment

The way in which parents interact with their environment may have implications for their likelihood of abuse and neglect. This study examines the parent–environment relationship through community involvement and perception, using social disorganization theory. We hypothesize mothers who participate in their communities and have positive perceptions of them may be less likely to maltreat their children because of the potential protective capacity of neighborhood supports. Using information from the 5 year Fragile Families and Child Wellbeing Study (n = 2991), the mother's self-reported acts of psychological and physical maltreatment and neglect are measured. A mother's community involvement index is the number of community activities a mother was involved in, and community perception is measured by two five-item Likert scales assessing perception of community collective efficacy. We analyze the relationship between community variables and each of mother's maltreatment behaviors as well as the interaction between community factors using a series of nested logistic regressions. Higher levels of community involvement are associated with lower levels of psychological aggression. More positive perception of community social control is associated with lower levels of physical assault. A moderation effect of community perception suggests that a mother's perception of her community changes the relationship between community involvement and psychological child abuse. The results provide important policy and empirical implications to build positive and supportive communities as a protective factor in child maltreatment. Getting parents involved in their communities can improve the environment in which children and families develop, and decrease the likelihood that maltreatment will occur.     

How neighborhoods influence child maltreatment: a review of the literature and alternative pathways

OBJECTIVE: To review the literature on the relationships between neighborhoods and child maltreatment and identify future directions for research in this area. METHOD: A search of electronic databases and a survey of experts yielded a list of 25 studies on the influence of geographically defined neighborhoods on child maltreatment. These studies were then critically reviewed by an interdisciplinary research team. RESULTS: Numerous studies demonstrate that child maltreatment cases are concentrated in disadvantaged areas. A number of socio-economic characteristics of neighborhoods have been shown to correlate with child maltreatment rates as measured by official reports to child protective service agencies. Only a few studies examine direct measures of parenting behaviors associated with maltreatment, and these show a weaker relationship with neighborhood disadvantage. Moreover, the processes that link neighborhood conditions to either maltreatment reports or parenting behaviors are not yet confirmed by the research literature. Selection bias, neighborhood definitions and spatial influences are largely uncontrolled in the existing research. CONCLUSIONS: We propose a framework for pursuing further study of neighborhoods and child maltreatment that addresses the gaps in the current literature. Neighborhood-based strategies to prevent and reduce child maltreatment will be enhanced by research that provides a better understanding of how neighborhood conditions act as stressors or supports for families at risk of child maltreatment.     

Neighborhood views on the definition and etiology of child maltreatment

OBJECTIVE: The purpose of this study, as part of a larger study on neighborhoods and child maltreatment, was to determine how parents residing in neighborhoods with differing profiles of risk for child maltreatment reports defined child abuse and neglect and viewed its etiology. METHOD: Parents (n = 400) were systematically selected from neighborhoods (n=20) with different profiles of risk for child maltreatment report rates. As part of a larger interview, parents were asked to generate lists of behaviors that they would define as child abuse and neglect and to rate 13 etiological factors on a 10 point scale as to their contribution to the occurrence of child maltreatment. RESULTS: While there were differences in definitional emphases, with African-American parents including behaviors of neglect and European-American parents including behaviors of physical abuse, there was marked congruence on the catalogue of behaviors that parents would define as child abuse and neglect. Four factors were identified that explained almost two-thirds of the variance in parents' etiological explanations: poverty and family disruption, substance abuse and stress; lack of moral and family values; and individual pathology. These factors were related to neighborhood conditions, individual perceptions of neighborhood and individual characteristics. CONCLUSIONS: Community-based programs aimed at preventing or ameliorating child maltreatment must have at their very core an understanding of how populations being served define child maltreatment and why they believe that it occurs.     

The prevalence of child maltreatment in the Netherlands across a 5-year period

The prevalence of child maltreatment in the Netherlands was in 2005 first systematically examined in the Netherlands’ Prevalence study on Maltreatment of children and youth (NPM-2005), using sentinel reports and substantiated CPS cases, and in the Pupils on Abuse study (PoA-2005), using high school students’ self-report. In this second National Prevalence study on Maltreatment (NPM-2010), we used the same three methods to examine the prevalence of child maltreatment in 2010, enabling a cross-time comparison of the prevalence of child maltreatment in the Netherlands. First, 1,127 professionals from various occupational branches (sentinels) reported each child for whom they suspected child maltreatment during a period of three months. Second, we included 22,661 substantiated cases reported in 2010 to the Dutch Child Protective Services. Third, 1,920 high school students aged 12–17 years filled out a questionnaire on their experiences of maltreatment in 2010. The overall prevalence of child maltreatment in the Netherlands in 2010 was 33.8 per 1,000 children based on the combined sentinel and CPS reports and 99.4 per 1,000 adolescents based on self-report. Major risk factors for child maltreatment were parental low education, immigrant status, unemployment, and single parenthood. We found a large increase in CPS-reports, whereas prevalence rates based on sentinel and self-report did not change between 2005 and 2010. Based on these findings a likely conclusion is that the actual number of maltreated children has not increased from 2005 to 2010, but that professionals have become more aware of child maltreatment, and more likely to report cases to CPS.     

Parental cognitive impairment and child maltreatment in Canada

Objectives

The aim of this study was to determine the prevalence of parental cognitive impairment in cases opened for child maltreatment investigation in Canada, and to examine the relationship between parental cognitive impairment and maltreatment investigation outcomes including substantiation, case disposition and court application.

Methods

The method was secondary analysis of the Canadian Incidence Study of Child Abuse and Neglect (CIS-2003) core-data, which is derived from a multi-stage stratified cluster sample of 11,562 child maltreatment investigations.

Results

Parental cognitive impairment was noted in 10.1% of sampled cases that were opened for child maltreatment investigation in 2003, and in 27.3% of sampled cases that resulted in child welfare court application. Neglect was the most common cause of concern. With child and case characteristics held constant, parental cognitive impairment predicted investigation outcomes. The data further suggest that the relationship between parental cognitive impairment and investigation outcomes was partially mediated by perceived parent non-cooperation, mental health issues and low social support.

Conclusions

The number of children who are living with a parent with cognitive impairment and who are referred for protective services is thought to be increasing. Building systems capacity to support parents with cognitive impairment and promote child wellbeing is therefore essential to containing the human and economic costs of maltreatment and out-of-home care.

Practice implications

A broad-spectrum approach is needed to support parents with cognitive impairment and their children. Equipping services with the knowledge, skills, and mandate they need to deliver evidence-based parent training is vital. However, strategies are also needed to tackle discrimination, alleviate family poverty, strengthen the social ties of parents with cognitive impairment and in turn, improve the life chances of their children.     

Less money,more problems: How changes in disposable income affect child maltreatment

A number of research studies have documented an association between child maltreatment and family income. Yet, little is known about the specific types of economic shocks that affect child maltreatment rates. The paucity of information is troubling given that more than six million children are reported for maltreatment annually in the U.S. alone. This study examines whether an exogenous shock to families’ disposable income, a change in the price of gasoline, predicts changes in child maltreatment. The findings of a fixed-effects regression show that increases in state-level gas prices are associated with increases in state-level child maltreatment referral rates, even after controlling for demographic and other economic variables. The results are robust to the manner of estimation; random-effects and mixed-effects regressions produce similar estimates. The findings suggest that fluctuations in the price of gas may have important consequences for children.     

Longitudinal association of child maltreatment and cognitive functioning: Implications for child development

Although research investigating associations among child maltreatment, cognitive functioning, and academic achievement has grown in recent years, important questions remain. In particular, assessing the influence of maltreatment apart from that of other co-occurring and confounding factors remains difficult. This study was developed to further the field’s understanding by investigating cognitive functioning in association with time-variant maltreatment patterns. Using multiple time-variant linear mixed models, we investigated the relationships between maltreatment timing and three domains of cognitive functioning (i.e., knowledge, comprehension, and analysis). In general, the cognitive functioning of students who experienced maltreatment was lower than that of their peers who had yet to experience maltreatment at the time of testing. Results of LMM indicated that the cognitive functioning of students who experienced maltreatment concurrent with the testing year fluctuated over time whereas the cognitive functioning of students who experienced maltreatment prior to or after the testing year remained stable. Students who experienced concurrent maltreatment showed the lowest functioning of any group. While maltreatment timing was a significant predictor of cognitive functioning over time, the addition of poverty into the model resulted in a non-significant effect of maltreatment timing. Additional research is needed to disentangle the longitudinal effect of maltreatment on cognitive functioning and address the interacting role of poverty and chronic maltreatment.     

The intergenerational transmission of child maltreatment: A three-level meta-analysis

A parental history of experiencing child maltreatment is an important risk factor in several etiological theories of child maltreatment. In the past, two reviews have been conducted on the available evidence for intergenerational continuity in child maltreatment, but were only qualitative in nature. Therefore, the present review aimed to provide a quantitative summary of the current knowledge on intergenerational transmission of child maltreatment. In our 3-level random-effects meta-analysis, we included 84 studies reporting on 285 effect sizes and found a medium summary effect of r = 0.289; 95% CI [0.257, 0.337], with significant variation in effect sizes within (level 2) and between (level 3) studies. This implies that in families of parents who experienced maltreatment in their own childhood, the odds of child maltreatment are almost three times the odds of child maltreatment in families of parents without a history of experiencing child maltreatment (OR = 2.990). However, as indications for bias were found, caution is warranted in interpreting this effect. Moderator analyses revealed that the effect of intergenerational transmission was the smallest in children who experienced physical abuse. Further, study quality was negatively associated with effect size magnitude. We highlight the need for an improvement in quality of primary research, and discuss implications of our findings for clinical practice.     

Assessing child maltreatment prevention via administrative data systems: A case example of reproducibility

Critical issues about scientific reproducibility have been raised about biomedical research, including the reliability of data and analyses within a given study. The case example in this article examined a reproducibility issue pertaining to the use of administrative data systems for evaluation of child maltreatment (CM) prevention, making use of a prevention study conducted over a decade ago that provided a unique opportunity. The place-randomization study, which randomized counties to condition, found that community-wide implementation of a parenting and family support intervention produced positive impact on county-wide rates for substantiated CM cases and out-of-home placements, documented through a state information system. The key consideration is whether and to what extent the administrative record data re-examined retroactively a decade later for the original study’s time period would yield comparable results to those based on data acquired at the time of the study. The results indicated that despite small changes over time, the same data patterns and statistical effects were reproducible for the two archival outcome variables. For substantiated CM, the reproduced analyses reflected higher effect sizes and a clear pattern of reduction as a function of intervention. For out-of-home placements, effect sizes were quite comparable to the original ones, reflecting preventive impact. Overall, this case study illustrated the verifiability of data reproducibility in the context of a population outcome evaluation, which underscores the importance of reliable population-prevalence measurement as an essential part of a comprehensive public health strategy aimed at the prevention of CM.     

The Great Recession and the risk for child maltreatment

This study draws on the Fragile Families and Child Wellbeing Study (N = 2,032), a birth cohort study of families with children from 20 U.S. cities. Interviews occurred between August 2007, and February 2010, when the children were approximately 9 years old. Macro-economic indicators of the Great Recession such as the Consumer Sentiment Index and unemployment and home foreclosure rates were matched to the data to estimate the links between different measures of the Great Recession and high frequency maternal spanking. We find that the large decline in consumer confidence during the Great Recession, as measured by the Consumer Sentiment Index, was associated with worse parenting behavior. In particular, lower levels of consumer confidence were associated with increased levels of high frequency spanking, a parenting behavior that is associated with greater likelihood of being contacted by child protective services.