Making a difference with evidence

In this column, the editor of The Journal of Perinatal Education describes how, despite the many challenges confronting childbirth educators today in our complex health-care environment, there is still a ray of hope that committed individuals translating evidence into practice can make a difference. The editor also describes the contents of this special issue, which celebrates the 50th anniversary of Lamaze International and offers a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth.     

True and false memories in maltreated children

Differences in basic memory processes between maltreated and nonmaltreated children were examined in an experiment in which middle-socioeconomic-status (SES; N = 60), low-SES maltreated (N = 48), and low-SES nonmaltreated (N = 51) children (ages 5-7, 8-9, and 10-12 years) studied 12 Deese-Roediger-McDermott lists. Using recall and recognition measures, the results showed that both true and false memories increased with age and, contrary to some speculation, these trends did not differ as a function of maltreatment status. However, there were differences in overall memory performance as a function of SES. These results are discussed in the broader framework of children's memory development and the effects of the chronic stress associated with child maltreatment on basic memory processes.     

Perceived and actual academic competence in maltreated children

OBJECTIVE: The aims were twofold: 1) to determine whether maltreated and nonmaltreated children differed in the accuracy of their self-assessments of academic achievement; and 2) to determine whether discrepancies between perceived and actual academic competence were related to perceptions of social support from mothers, teachers, and peers. METHOD: A sample of 195 maltreated children known to a state protective service agency was compared to a control group of 179 nonmaltreated children. The groups were matched on child's gender, age, ethnicity, and birth order; socioeconomic ranking of neighborhood; and family structure. RESULTS: Although maltreated children had significantly lower achievement scores than did nonmal-treated children, the two groups did not differ on perceived academic competence. With regard to discrepancies between perceived and actual competence, maltreated children were more likely than nonmaltreated children to overestimate their level of competence, particularly for reading and arithmetic. Overall, children who reported low maternal support were more likely to overestimate reading competence than were those who reported average or high maternal support. When maltreatment status was considered, maltreated children with low support seemed likely to overestimate abilities, whereas nonmaltreated children with low support seemed likely to underestimate competence. CONCLUSIONS: Maltreated children may overestimate their academic abilities in order to compensate for self-perceptions of low self-worth. Efforts to improve academic performance in maltreated children should focus not only on increasing academic skills but also on enhancing self-esteem.     

Dissociation in maltreated versus nonmaltreated preschool-aged children.

OBJECTIVE: Dissociation is linked to the experience of child maltreatment for adults and for school-aged children. The goals of the current paper were: First, to extend existing research and examine the link between child maltreatment and preschool-aged children; and second, to examine which subgroups of maltreated preschoolers are most likely to evidence dissociation. METHOD: A well-validated measure of dissociation in children, The Child Dissociative Checklist (CDC; Putnam, Helmers, & Trickett, 1993), was utilized in a sample of low SES maltreated and nonmaltreated preschoolers (N = 198). A measure of internalizing and externalizing symptoms was also utilized. The maltreated children were assessed for sexual abuse, physical abuse, neglect, and also for severity, chronicity, and multiple subtypes of maltreatment. RESULTS: The sexually abused, physically abused, and neglected groups each demonstrated more dissociation than did the nonmaltreated group. Dissociation in the clinical (psychopathological) range was associated with physical abuse. Moreover, maltreatment severity, chronicity, multiple subtypes, and internalizing and externalizing symptomatology were each related to dissociation. CONCLUSIONS: Child maltreatment is a factor in dissociation in preschool-aged children as it is in older children and in adults. Sexual abuse, physical abuse, neglect, severity, and chronicity are all implicated. Developmentally sensitive interventions that look beyond comorbidity with behavioral symptoms for dissociative preschool-aged children are needed.     

Computers for Literacy: Making the difference?

Starting from the premise that literacy is a set of practices situated within particular contexts, and that any practice of literacy always involves technologies which affect its forms and use, this paper draws on three diverse examples of classroom and curricular practice, in order to explore how particular forms of cultural difference are being produced through different practices of literacy pedagogy. One form of literacy pedagogy uses drill-forskill programs via information and communication technologies (ICTs) for reasons of efficiency. Where such programs are used, they may promote assimilation in several overlapping forms. In a second form of pedagogy ICTs are used for enhancement or amplification. But even a liberal constructivist environment may lead to the reproduction of a schooled sameness - of information, types of text, and the literacy practices that teachers and students accept as the norm. A third pedagogical approach encourages transformation through new genres and new hypermedia literacy practices. Where a curriculum is driven by teachers' intentions to negotiate difference explicitly, they and their students may use ICTs to manipulate texts, knowledge and positions for comprehending and composing. Nonetheless, given the complex relationships among teachers, students, classrooms and ICTs, no practice is likely to be 'pure' or certain in its effects. Partly for these reasons teacher educators need to help pre- and in-service teachers to be scrupulous in analysing the role of ICTs in pedagogic work with least-advantaged groups of students.     

Enhancing attachment organization among maltreated children: results of a randomized clinical trial

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.     

Coping resources of maltreated children in the family: a salutogenic approach.

OBJECTIVE: Most research in child maltreatment within family focuses mainly on the pathological damage caused to the battered child. This study, based on a salutogenic approach, focuses on the resources that may help maltreated children to cope with their state and stay well. METHOD: Resilience was measured by two variables: perceived competence and psychological distress. The moderating or buffering variables that may contribute to better coping were: sense of family coherence, psychological sense of school membership, and social support. Two hundred and twenty-six 8th graders answered an anonymous self-report inventory. Based on the students' answers, they were divided into two groups: those who reported that they had been maltreated (MC) (n = 81) and those who did not (NMC) (n = 145). RESULTS: The study revealed a significantly high percentage of adolescents (35.6%) who reported having been maltreated within their families. A significant difference was found between the MC and the NMC in levels of perceived competence (higher for the NMC) and psychological distress (higher for the MC group). The moderating variables were found to have a differential effect on the dependent variables within the two groups. Sense of family coherence was found to be the main contributor to variance explanation of perceived competence among the MC, while sense of school membership had the main effect among NMC. CONCLUSIONS: The findings support a salutogenic approach in studying maltreated children. Implications on the possible detection of maltreated children in the community and on their coping resources that may contribute to resilience are discussed.     

Experiences in day care and social competence among maltreated children

The experience of 39 preschool-age maltreated children from 13 child care facilities was examined to determine the extent to which the children's social development was related to the quality of day-care service. Maltreated children assigned by the Arkansas Department of Social Services to three different types of child care facilities were observed: specialized day-care programs, regular day-care centers and family day homes. The children scored below average in intelligence and were rated by their parents as displaying higher than normal rates of disturbed behavior. While no comparison group of non-maltreated children was included in the study, observations of the maltreated children in the child care setting revealed substantially more positive than negative social behavior. The children were reasonably effective in interacting with adult caregivers in day care. The maltreated children were also productive in most encounters with peers. Ratings of the quality of care received in day care were significantly correlated with the children's social competence in child care. Aspects of social behavior in maltreated children were related to the organization of the program, the physical facilities, traits of the caregiver, and caregiver expectations for the children.     

Making a difference online: Facilitating service-learning through distance education

Development in the understanding and education of responsible citizenship is an important priority for higher education institutions. Evidence of this importance is expressed in the mission statements of many colleges and universities throughout the United States. As increasing numbers of students take advantage of distance education, it is essential to consider both the ways students can engage in experientially based learning environments that promote civic engagement as well as the manner by which institutions can fulfill this aspect of their missions. This article explores service-learning pedagogy delivered in an online format, specifically a case study describing the way one institution, University of Illinois at Springfield, successfully uses the Internet to provide such instruction.     

The timing of academic difficulties among maltreated and nonmaltreated children.

OBJECTIVE: In this study we examined the relationship between child maltreatment and the timing of academic difficulties. METHOD: This study uses survival analysis to investigate the timing of risk of experiencing an academic difficulty for the first time. Three types of academic difficulties were examined-grade repetitions, poor English grades, and poor math grades. The sample included approximately 300 maltreated and 300 nonmaltreated children aged 5-18. RESULTS: Maltreated children displayed greater risk than nonmaltreated children of repeating a grade and receiving a poor English and mathematics grade for the first time across most elementary years. Maltreated and nonmaltreated children share the same peaks in risk: first grade for their first grade repetitions and kindergarten for their first poor English and math grade. The best-fitting discrete time hazards models suggested underlying temporal patterns of risk vary according to the type of academic difficulty. For instance, maltreated children were at substantially higher risk than nonmaltreated children of repeating kindergarten and first grade. From second through sixth grade, maltreated and nonmaltreated children were indistinguishable in their risk of repeating a grade for the first time. In contrast, discrete-time hazards modeling showed that while the absolute risk of receiving a poor English or mathematics grade changes across the elementary years, the relative risk by maltreatment status does not. CONCLUSIONS: While maltreated and nonmaltreated children share the same peaks in risk, the relative risk changes across time for grade repetitions but not for the first occurrence of a poor English or mathematics grade. In summary, this study highlights the importance of time in understanding the relationship between child maltreatment and academic difficulties.     

The protective effects of religiosity on maladjustment among maltreated and nonmaltreated children

OBJECTIVE: The aim of this study was to investigate the role of child religiosity in the development of maladaptation among maltreated children. METHODS: Data were collected on 188 maltreated and 196 nonmaltreated children from low-income families (ages 6-12 years). Children were assessed on religiosity and depressive symptoms, and were evaluated by camp counselors on internalizing symptomatology and externalizing symptomatology. RESULTS: Significant interactions indicated protective effects of religiosity. Child reports of the importance of faith were related to lower levels of internalizing symptomatology among maltreated girls (t=-2.81, p<.05). Child reports of attendance at religious services were associated with lower levels of externalizing symptomatology among nonmaltreated boys (t=1.94, p=.05). CONCLUSION: These results suggest that child religiosity may largely contribute to stress coping process among maltreated and nonmaltreated children from low-income families. The results also indicate that the protective roles of religiosity varied by risk status and gender. PRACTICAL IMPLICATIONS: The results indicate that a range of child religiosity behaviors and practices can be assessed in translational prevention research. It is recommended that healthcare professionals, psychologists, and social workers working with maltreated children and their families assess for salience of religiosity and may encourage them to consider the role religiosity plays in the development of prevention and intervention programs to alleviate distress and enhance stress coping.     

Racial/ethnic differences in Medicaid expenditures on psychotropic medications among maltreated children

This study quantifies racial/ethnic differences in Medicaid expenditures on psychotropic drugs among a national sample of children with suspected maltreatment. We linked 4,445 child participants in the National Survey of Child and Adolescent Well-Being (NSCAW) – consisting of children investigated for suspected abuse and neglect – to their Medicaid claims obtained from 36 states. We used propensity score matching to construct a comparison group of children without known child welfare involvement, and estimated two-part generalized linear models to examine differences in annual psychotropic drug expenditures per child between children of different races/ethnicities. When compared to a matched sample of children, African American and Latino children incur $292 and $144 less expenditures on psychotropic drugs, respectively, than white children. Among NSCAW children alone, African American children display $614 less spending on psychotropic drugs when compared to white children. Racial/ethnic differences in expenditures on psychotropic drugs occur among all children on Medicaid, but the differences are especially pronounced among African American children in contact with the child welfare system. These findings demonstrate that policymakers will need to pay special attention to the needs of children of color as Medicaid expansions proceed nationwide.     

Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children

This study used latent growth modeling to investigate longitudinal relationships between self-system processes and depressive symptoms among maltreated (n = 142) and nonmaltreated children (n = 109) aged 6-11 years. On average, self-esteem and self-agency increased and depressive symptoms decreased over time. Multivariate growth modeling indicated that, regardless of gender, physical abuse was negatively related to initial levels of self-esteem, and physical abuse and physical neglect were positively associated with initial levels of depressive symptoms. Emotional maltreatment was predictive of changes in self-esteem and changes in depressive symptoms. Initial levels of self-esteem were negatively associated with initial levels of depressive symptoms. The findings contribute to enhancing our understanding of the developmental processes whereby early maltreatment experiences are linked to later maladjustment.     

Recognition of facial emotions among maltreated children with high rates of post-traumatic stress disorder

OBJECTIVE: The purpose of this study is to examine processing of facial emotions in a sample of maltreated children showing high rates of post-traumatic stress disorder (PTSD). Maltreatment during childhood has been associated independently with both atypical processing of emotion and the development of PTSD. However, research has provided little evidence indicating how high rates of PTSD might relate to maltreated children's processing of emotions. METHOD: Participants' reaction time and labeling of emotions were measured using a morphed facial emotion identification task. Participants included a diverse sample of maltreated children with and without PTSD and controls ranging in age from 8 to 15 years. Maltreated children had been removed from their homes and placed in state custody following experiences of maltreatment. Diagnoses of PTSD and other disorders were determined through combination of parent, child, and teacher reports. RESULTS: Maltreated children displayed faster reaction times than controls when labeling emotional facial expressions, and this result was most pronounced for fearful faces. Relative to children who were not maltreated, maltreated children both with and without PTSD showed enhanced response times when identifying fearful faces. There was no group difference in labeling of emotions when identifying different facial emotions. CONCLUSIONS: Maltreated children show heightened ability to identify fearful faces, evidenced by faster reaction times relative to controls. This association between maltreatment and atypical processing of emotion is independent of PTSD diagnosis.     

An evaluation of favorite kind of day drawings from physically maltreated and non-maltreated children

OBJECTIVE: This study aimed to replicate Manning's (1987) research that looked at Favorite Kind of Day drawings produced by children who had been maltreated in comparison to non-maltreated children. The hypothesis of the study was that the maltreated children's drawings would consistently differ from drawings produced by non-maltreated children over time. METHOD: Eighteen children aged between 4 and 8 years old were individually asked to draw their Favorite Kind of Day (FKD). The drawings from six physically maltreated participants were compared to 12 non-maltreated children matched for age, sex, socio-economic and educational background. The drawings were compared on three criteria: inclement weather, size, and movement of weather. RESULTS: The results showed that over a period of 18 months, maltreated and non-maltreated children consistently drew similar drawings, and no significant differences were found between the groups. CONCLUSIONS: The implications of these findings cannot be underestimated, as clinical use of the FKD technique suggested by Manning's findings, for English children at least, would lead to incorrect identification of children as having suffered maltreatment when they may in fact not have.     

Determinants of foster care placement for the maltreated child

This study examined the records of the North Carolina Central Registry of Child Abuse and Neglect to determine which social, family, and child characteristics were most influential in the decision to place a child in foster care. These records contained all theoretically relevant factors as well as demographic data. Analysis included the computation of odds ratios for foster care for each of 250 variables. A maximum likelihood logistic regression model was constructed to obtain the independent and cumulative contribution of each factor. Some expected variables such as parental stress factors (substance abuse) and types of abuse (burns and scalds) placed a child at a significant risk for placement in foster care (p < 0.01). However, less obvious factors such as referral source (law enforcement agencies) or geographic area also placed children at risk. Overall, the model explained little of the variance of these decisions (R² = 0.168) and poorly predicted placement (sensitivity 66.3 per cent, specificity 74.6 per cent). Using existing data. we were unable to adequately describe the decision process in selecting foster care.