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.     

The maltreatment of adolescents

Official reports of maltreatment involving adolescent victims were compared to those involving younger children in a representative sample of protective services' reports drawn from New York State in 1985. Specific case characteristics, including age, gender, ethnicity of the victim, and source of report, are described and their relation to case substantiation is examined. Analyses revealed that adolescents represent a substantial proportion of all victims of official child maltreatment reports. The impact of age on substantiation varied as a function of the type of maltreatment, where for adolescents sexual abuse reports were more likely to be substantiated, while neglect and physical abuse reports were less likely to be substantiated. Reports involving adolescents were significantly more likely to involve a female victim. Significant gender differences in substantiation rate were found only for sexual abuse reports involving adolescents. White children were also found to be under-represented in this sample, while blacks were over-represented relative to their numbers in the population. The impact of minority status on substantiation was significant for neglect and physical abuse reports involving children. The majority of adolescent reports came from mandated sources, which had a significantly higher substantiation rate than reports from non-mandated sources.     

Child health and maltreatment

Children who are abused have been said to have more illnesses than children who are not maltreated. The relationship between abuse and illness has been hypothesized to function in 2 ways: (1) that abuse precedes the illnesses and children from abusive homes become ill because of the damaging environment they endure, or, conversely, (2) that the illnesses precede the abuse, with the fussy behavior of ill children eliciting abuse. This study was intended to clarify the temporal relationship between illnesses and maltreatment. Health data were collected on a sample of 80 children: 11 from abusive families, 31 with nonorganic failure to thrive (NOFT), 14 from neglectful families, and 24 from control families. Hospital records (both inpatient and outpatient) for these children from the time of birth until they were 3 years old were searched by data collectors unaware of the child's classification. Children from abusive families or with NOFT appeared to be ill more often than control children, particularly during the first few months after birth, before abuse had been reported, but not necessarily before NOFT had been discovered. Health records of neglected children were not significantly different from those of controls. In addition to the abused. These 6 children also had more illnesses than control children, again particularly during the first few months after birth. Having ill children is described as a source of stress that may trigger abuse in an already stressed family.     

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.     

Trends in child maltreatment literature

INTRODUCTION: To identify possible gaps in the child maltreatment literature the present study examined the development of the child maltreatment literature over a 22-year period, including temporal trends for child maltreatment types, the characteristics of the research participants, and sources of participant recruitment. METHOD: Child maltreatment articles (N=2090) published from 1977 to 1998 (inclusive) in six specialty journals were coded on type of article, type of child maltreatment, gender and parental status of participants, abuse role of participants, and recruitment source of participants. RESULTS: Across the period studied the annual percentage of quantitative articles (articles with inferential statistics) increased, whereas the annual percentage of theoretical articles decreased. The annual percentage of articles examining child physical abuse (CPA) decreased, whereas the annual percentage of articles examining child sexual abuse (CSA) increased. The percentages of articles examining child neglect (CN) or child emotional abuse (CEA) remained consistently low. Distinguishing child maltreatment types in research articles increased. Males were underrepresented in CPA perpetration and CPA adult victimization articles, but adequately represented in CSA perpetration and CPA child victimization articles. Females were adequately represented in CPA perpetration and CSA child and adult victimization articles. Recruitment from universities and outpatient mental health facilities increased; recruitment from medical settings decreased. CONCLUSIONS: CN and CEA literatures need to be developed first by theoretical, then by quantitative works. In addition, the publication of more research on male subjects for CPA perpetration and adult CPA victimization is needed.     

Identifying maltreatment subgroups with patterns of maltreatment subtype and chronicity: A latent class analysis approach

Maltreatment experiences are complex, and it is difficult to characterize the heterogeneity in types of maltreatment. Subtypes, such as emotional maltreatment, sexual abuse, physical abuse, and neglect commonly co-occur and may persist across development. Therefore, treating individual maltreatment subtypes as independently occurring is not representative of the nature of maltreatment as it occurs in children’s lives. Latent class analysis (LCA) is employed herein to identify subgroups of maltreated children based on commonalities in maltreatment subtype and chronicity. In a sample of 674 low-income urban children, 51.6% of whom experienced officially documented maltreatment, our analyses identified four classes of children, with three distinct classes based on maltreatment subtypes and chronicity, and one group of children who did not experience maltreatment. The largest class of maltreated children identified was the chronic, multi-subtype maltreatment class (57% of maltreated children); a second class was characterized by only neglect in a single developmental period (31% of maltreated children), and the smallest class was characterized by a single subtype of maltreatment (emotional maltreatment, physical, or sexual abuse) occurring in a single developmental period (12% of maltreated children). Characterization of these groups confirms the overlapping nature of maltreatment subtypes. There were notable differences between latent classes on child behavioral and socio-emotional outcomes measured by child self-report and camp counselors report during a one-week summer camp. The largest differences were between the non-maltreated class and the chronic maltreatment class. Children who experienced chronic, multi-subtype maltreatment showed higher levels of externalizing behavior, emotion dysregulation, depression, and anxiety.     

The dimensions of maltreatment: introduction

This special issue includes an introduction and seven papers exploring dimensions of maltreatment including type, severity, chronicity, and substantiation status of referrals to CPS, utilizing a subsample of the LONGSCAN studies. Each paper examines one of the dimensions of maltreatment from various perspectives to determine if different conceptualizations of a dimension, examined in isolation, account for different amounts of variation in child outcomes. A final paper assesses the relationship of the combined maltreatment dimensions, including interactions, on a single sample of maltreated children from the LONGSCAN study. This final paper explores the individual contribution of the "best" conceptualizations of the maltreatment dimensions in relation to each other, and to the 10 child outcomes of interest. Implications of the findings from these papers for future research on dimensions of child maltreatment are discussed in two independent commentaries.     

Child maltreatment and adult socioeconomic well-being

ObjectiveLittle empirical research has examined the impact that child maltreatment may have on victims’ long-term socioeconomic well-being. The current study sought to address this gap by exploring the relationship between childhood experiences of abuse and neglect and several indicators of socioeconomic well-being in adulthood.MethodData from the nationally representative National Comorbidity Survey (NCS) (n = 5004) were analyzed using logistic regression models to examine whether maltreatment in childhood (any maltreatment, physical abuse, sexual abuse, severe neglect, and multiple types of maltreatment) affected employment status, income, and health care coverage in adulthood. Several potential confounds of this relationship were included as covariates in the models, including race, sex, age, and several indicators of childhood socioeconomic status (SES).ResultsThe results show that adults who had experienced maltreatment differed significantly from non-maltreated adults across each of the socioeconomic domains examined. Effects were additionally found to differ depending on the number of types of maltreatment experienced.ConclusionsIncreased rates of unemployment, poverty, and Medicaid usage indicate the significant long-term personal impact of early victimization. They also suggest a substantial societal cost from this problem through lost economic productivity and tax revenue, and increased social spending. Low socioeconomic status among parents has also been identified as a salient risk factor for the perpetration of maltreatment, and, as such, these results indicate a potential mechanism in the intergenerational transmission of violence.Practice implicationsThe findings from this study suggest that victims of child maltreatment are at increased risk for financial and employment-related difficulties in adulthood. Approximately one million children are identified each year by state agencies as victims of maltreatment in the United States. Many maltreated children, furthermore, go undetected by protective service agencies, indicating the high prevalence of this problem, and underscoring its large economic costs to society. By highlighting the long-term socioeconomic costs of maltreatment, this research should encourage policy makers to focus on improving prevention, intervention, and treatment efforts for victims of abuse and neglect.     

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.     

Child maltreatment in European- and Hawaiian-Americans

The purpose of this study was to investigate the patterns and possible determinants of child abuse and neglect in European- and Hawaiian-Americans. Abuse was overrepresented in the Hawaiian-Americans while neglect was over-represented in the European-Americans. There were several significant results regarding stress and personal factors that played roles in the maltreatment of the children within each culture. For example, family discord, new baby/continuous child care, loss of control and lack of tolerance were important correlates of abuse for Hawaiian-Americans. The stresses of recent relocation, social isolation and family discord as well as the personal factors of mental health problems and alcohol/drug dependence were important correlates of neglect for European-Americans. The results indicate that to understand the patterns, causes, treatment and prevention of child maltreatment, cultural as well as individual factors must be assessed.     

Child psychological maltreatment in Palestinian families

OBJECTIVES: This study was designed to identify predictors of child psychological maltreatment (CPM) in Palestinian families. It examined the relative contributions of child characteristics, parents' sociodemographics, and economic hardship, in addition to family's characteristics such as family values, family ambiance, gender inequities, parental support, harsh discipline, and other forms of maltreatment, to psychological maltreatment. METHOD: The sample consisted of 1000 school age children who ranged in age from 12 to 16 years. Two school counselors carried the interviews with children at school, and with the available parent at home. RESULTS: Child school performance was specifically associated with CPM. The two-parent families and parents from refugee camps appeared to employ more psychological maltreatment of their children than single-parent families and parents from urban and rural areas. Parents who perceived that the family did not have enough money to meet the child's needs were more likely to abuse their children psychologically. Gender inequities, harsh discipline, family ambiance, and lack of parental support were the most salient predictors of CPM. Child psychological maltreatment occurred concurrently with other forms of maltreatment such as physical abuse and child's labor. Parental psychological maltreatment proved to be weakened with high traditional family values. CONCLUSION: A significant proportion of the sample could be considered psychologically maltreated. Intervention and prevention efforts should be focused on child welfare, educational programs aimed at high-risk parents, and mobilization of the community and social services agencies.     

Measuring the severity of child maltreatment

OBJECTIVE: The purpose was to identify different operational definitions of maltreatment severity, and then to examine their predictive validity. METHOD: Children and their primary caregivers participating in a consortium of ongoing longitudinal studies were interviewed when they were approximately 4 and 8 years of age to assess behavior problems, and developmental and psychological functioning. Four different severity definitions were identified and applied to 519 children who were reported for alleged maltreatment between Birth and the Age 8 interview. A taxonomy for defining maltreatment characteristics (Barnett, Manly, & Cicchetti, 1993) was applied to Child Protective Service records to define severity as (a) Maximum Severity within each of five maltreatment types, (b) Overall Maximum Severity across the five types, (c) Total Severity or the sum of the maximum severity for each of five types, and (d) Mean Severity or the average severity for those types of maltreatment alleged, during each of two time periods-Birth to Age 4, and Age 4 to Age 8. RESULTS: Regression analyses that controlled for socio-demographic factors, early maltreatment (Birth to Age 4), prior functioning (Age 4), and site revealed that (a) all four severity definitions for maltreatment reports between Age 4 and Age 8 predicted Age 8 behavior problems, (b) Maximum Severity by Type and Mean Severity predicted adaptive functioning at Age 8, and (c) only Maximum Severity by Type was related to anger, at Age 8. Follow-up regression analyses indicated that only Maximum Severity by Type, specifically physical abuse, accounted for outcomes, beyond maltreatment occurrence versus non-occurrence. CONCLUSION: The results suggest that maltreatment severity definitions that preserve ratings within types of maltreatment may be the optimal approach to measure the severity of children's experiences.     

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.     

Child maltreatment in Taiwan for 2004–2013: A shift in age group and forms of maltreatment

Cases of child maltreatment are being increasingly reported in Taiwan. However, the trend or changes of child maltreatment in Taiwan are fragmentary and lack empirical evidence. This study analyzed the epidemiological characteristics of substantiated child maltreatment cases from the previous decade, using mortality as an indicator to investigate the care of children who experienced substantiated maltreatment in the past to determine any new developments. Data for analysis and estimates were retrieved from the Department of Statistics in the Ministry of the Interior from 2004 to 2013. Trend analyses were conducted using the Joinpoint Regression Program. The child maltreatment rate in Taiwan was found to have nearly tripled from 2004 to 2013. A greater increase in the maltreatment of girls than boys and the maltreatment of aboriginal children than non-aboriginal children was noted from 2004 to 2013. When stratified by age group, the increase in maltreatment was most pronounced in children aged 12–17 years, and girls aged 12–17 years experienced the greatest increase in maltreatment. In terms of the proportional changes of different maltreatment forms among substantiated child maltreatment cases, child neglect was decreasing. The increase in sexual abuse was higher than for any other form of maltreatment and surpassed neglect by the end of 2013. Furthermore, the mortality rate of children with substantiated maltreatment record is increasing in Taiwan, whereas the mortality rate among children without any substantiated maltreatment record is decreasing. The results of this study highlight the need for policy reform in Taiwan regarding child maltreatment.     

Not all bad treatment is psychological maltreatment

One of the conceptual and definitional issues that has plagued the study of child maltreatment is the relationship between intention and outcome. This paper flows from the finding that the common developmentally destructive element in all forms of child maltreatment is psychological maltreatment, that the study of child abuse and neglect is the study of child maltreatment in a fundamental way. The key is to find a way to embrace the dynamic character of defining “psychological maltreatment,” by creating and sustaining a model that locates that dynamic in the conceptual space between science and professional practice on the one hand, and culture and community norms on the other.