Cumulative stress and substantiated maltreatment: the importance of caregiver vulnerability and adult partner violence

OBJECTIVE: Our goal is to assess the effect of caregiver vulnerabilities, singly and in combination, on the substantiation of child abuse (physical, sexual) and neglect, while controlling for relevant background variables. We test the moderator role of adult partner violence in qualifying the relationship between caregiver vulnerabilities and maltreatment substantiation. METHOD: Secondary analyses of the 1998 Canadian Incidence Study of Reported Child Maltreatment (CIS) are used to predict child protective service investigation substantiation versus non-substantiation from a range of caregiver vulnerability factors. Involvement in partner violence was examined as a moderator in the relation between caregiver vulnerabilities and maltreatment substantiation. The CIS is an epidemiological survey of first-reported cases to child protective services, using a random sample of child welfare agencies across Canada. Child welfare workers completed a research form on the child, primary caregiver, family, perpetrator, severity and type of maltreatment, as well as services and court outcomes. All maltreatment classifications were assigned according to the Canadian legal definition of child abuse and neglect. Hierarchical logistic regression analyses were used, with stepped entry of: (1) demographic factors, socioeconomic disadvantage, and caregiver's own history of maltreatment; (2) caregiver vulnerability factors; (3) involvement in partner violence; (4) the interaction between caregiver vulnerability and partner violence. RESULTS: Caregiver substance abuse was found to be the single most potent kind of caregiver vulnerability in predicting maltreatment substantiation. When the total number of vulnerabilities was used as the predictor, prediction across all types of maltreatment increased, especially for substantiated neglect. Analyses also showed that the presence of partner violence in the home exacerbated the effect of caregiver vulnerability on substantiation. CONCLUSIONS: The total number of caregiver vulnerabilities was the best predictor of the substantiation of child abuse and neglect. This relationship was moderated by the existence of partner violence: high caregiver vulnerability and high partner violence increased the likelihood of substantiation versus non-substantiation. These results suggest that caregiver issues should be considered in tandem with partner relationships. Among child welfare cases, caregiver vulnerability and partner violence are critical targets for child maltreatment prevention and early child protective services intervention.     

Substance use, substance abuse, and LD among adolescents with a childhood history of ADHD

A clinic-referred sample of 109 children with attention-deficit/hyperactivity disorder (ADHD) was followed into adolescence for the ascertainment of alcohol and other drug use and abuse. Learning disability (reading or math) in childhood was examined as a predictor of adolescent substance use and substance use disorder for alcohol and marijuana. No statistically significant group differences for children with LD versus those without LD emerged even after using different methods to compute LD. IQ/achievement discrepancy scores were similarly not predictive of later use or abuse. However, children with ADHD who had higher IQs and higher levels of academic achievement in childhood were more likely to try cigarettes, to smoke daily, and to have their first drink of alcohol or first cigarette at an early age. Children with ADHD who had higher reading achievement scores were less likely to have later alcohol use disorder. Although these findings are necessarily preliminary, due to the small number of children interviewed, the pattern of results suggests that level of cognitive functioning--rather than discrepancy between IQ and achievement--is important for the prediction of later substance use and abuse, at least in this clinic-referred sample of children with ADHD. Further, different mechanisms of risk related to cognitive functioning may be operating for experimentation with legal drugs such as alcohol and tobacco, regular cigarette smoking, and problematic alcohol use.     

Children’s sexual behavior problems: An ecological model using the LONGSCAN data

BackgroundAlthough prior research has indicated that sexual behavior problems (SBPs) are present among maltreated and non-maltreated children, risk factors for SBPs remain understudied. Further, few studies have examined multiple forms of trauma such as exposure to community violence and several likely important familial and environmental factors have yet to be investigated in the context of SBPs. The use of a more comprehensive ecological model of child, trauma-related, family, and environmental risk factors may help to further delineate the factors that contribute to the development of SBPs.ObjectiveThe aim of the current study was to build upon previous research by utilizing an ecological model that includes child, trauma-related, caregiver and familial, and environmental factors as potential predictors of SBPs.Participants and SettingThe present study was conducted with 1,112 8-year-old children (51.6% female; 48.9% Black) and their primary caregivers from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study.ResultsSeveral child, caregiver, and familial factors, as well as sexual and physical abuse demonstrated bivariate associations with SBPs. A number of these factors remained significant in a regression model, such as child’s living arrangement, child’s aggressive behaviors and posttraumatic stress symptoms (PTSS), sexual and physical abuse, caregiver’s psychological difficulties, and children’s perceptions of family health.ConclusionsThe findings highlight the role of select child, trauma-related, caregiver and familial, and environmental factors in the context of SBPs and also demonstrate the need to examine multiple levels of children’s environments when investigating SBPs.     

A history of prolonged childhood sexual abuse is associated with more severe clinical presentation of borderline personality disorder in adolescent female inpatients – A naturalistic study

BackgroundBorderline personality disorder (BPD) is associated with high rates of suicidal and self-injurious behaviors and a substantial proportion of BPD patients have a history of trauma, particularly childhood sexual abuse (CSA).ObjectiveTo compare the clinical presentation severity in female adolescent inpatients with BPD with and without history of prolonged CSA.Participants and settingFemale adolescent BPD patients admitted to a psychiatric inpatient unit.MethodsA retrospective analysis of records of the inpatients, divided into two groups: with (n = 38) and without (n = 40) a history of prolonged CSA. Prolonged CSA was defined as sexual abuse continuing for at least 3 months. Demographic and clinical data, including number and duration of psychiatric hospitalizations until the age 19, non-suicidal self-injury (NSSI), suicide attempts, cigarette smoking, alcohol and drug use, and sexual impulsivity were compared between the two groups.ResultsThe BPD + prolonged CSA group had a larger duration of the first psychiatric hospitalization, number of hospitalizations and cumulative length of hospitalizations compared with the control group. Furthermore, the BPD + prolonged CSA group had a higher number of suicidal attempts, and higher rates of severe NSSI events, cigarette smoking, alcohol use, and sexual impulsivity.ConclusionsThis study demonstrated for the first time that adolescent female BPD inpatients with a history of prolonged CSA, manifest more severe clinical presentation compared to those without prolonged CSA. Hence, it appears essential to encourage therapists to inquire about history of CSA and refer adolescent female BPD inpatients with prolonged CSA to appropriate intensive therapy.     

Substance abuse and behavioral correlates of sexual assault among South African adolescents

OBJECTIVE: The aim of this article is twofold: first, to examine the prevalence of being the victim of actual and attempted rape among a large representative sample of Cape Town high school students; and second, to identify the correlates of sexual assault for both boys and girls, including alcohol, tobacco and other drug use, behavioral problems, and suicidality. METHOD: Data for this study were derived from the 1997 South African Community Epidemiology Network on Drug Use (SACENDU) school survey. A stratified sampling procedure was used to select students in Grades 8 and 11 at non-private high schools in Cape Town. A total of 2,946 students completed a survey consisting of socio-demographic questions and items about substance abuse, sexual activity, and other adolescent health risk behaviors. A subsample of 939 was randomly selected to complete items about sexual violence. RESULTS: The results revealed that 8.4% of respondents were victims of attempted rape, while 5.8% were victims of actual rape. Ordinal logistic regression showed that girls were 3.9 times more likely than boys to have been victims of sexual abuse. Family structure was also significantly related to rape as persons who lived with a single parent (OR = 1.74, CI = 1.00-3.04) and those who resided with one biological parent and one step parent (OR = 2.59, CI = 1.34-5.01) were more likely to have been have been victims of sexual abuse than those living with both biological parents. Alcohol use (OR = 2.0, CI = 1.10-3.62), anti-social behavior (stolen property, caused physical damage to property, bullied others, or been in physical fights) (OR = 1.44, CI = 1.12-1.86), suicidal dialogue (OR = 2.48, CI = 1.19-5.19), and suicidal attempts (OR = 3.2, CI = 1.65-6.30) were also significant predictors of sexual abuse victimization. Racially classified social groups (RCSG), age, drug use, and cigarette smoking were not significant predictors of sexual abuse victimization, while socioeconomic status was found to be marginally significant. CONCLUSION: This study reinforces the importance of multiple factors including alcohol use, anti-social behavior, suicidal thoughts and actions, and family structure with respect to sexual assault of adolescents in South Africa. Establishing and strengthening intervention programs, school based child protective protocols, professional education of teachers and school personnel, community prevention programs, and initiatives could help prevent adolescent sexual violence and reduce the sequelae associated with this problem.     

Childhood maltreatment experiences and problematic sexual outcomes in adult males who have sexually offended: Further evidence of the potency of male caregiver psychological abuse

BackgroundAlthough research on the developmental antecedents of sexual offending has tended to focus on sexual abuse, recent research in juveniles and adults who have sexually offended suggests that psychological abuse perpetrated by a male caregiver may be a particularly important factor in the development of problematic sexual interests and behaviors.ObjectiveThis study aimed to extend previous findings by investigating the association between psychological abuse by a male caregiver and problematic sexual outcomes in a sample of adult males who had sexually offended.ParticipantsParticipants were 529 adult males incarcerated for sexual offenses, 21% of whom were civilly committed.MethodsChildhood maltreatment and problematic sexual outcomes were assessed using the Multidimensional Assessment of Sex and Aggression, a contingency-based inventory that assesses domains related to sexual aggression. Hierarchical regressions were calculated examining the association between childhood abuse types and sexual outcomes.ResultsChildhood sexual abuse was associated with child sexual (β = .247, p < .001) and other paraphilic interests (β = .189, p < .001). Male caregiver psychological abuse also emerged as marginally associated with child sexual interest (β = .100, p = .059), even after controlling for other abuse types.ConclusionsThese results partially replicate recent findings in a juvenile sample and challenge conventional developmental theories of sexual offending, by suggesting that male caregiver psychological abuse may play a role in the etiology of child sexual interest among males who have sexually offended. This study also suggests a possible gender symmetry effect moderating the developmental consequences of abuse.     

The effects of exposure to violence and victimization across life domains on adolescent substance use

This study uses longitudinal data from the Project on Human Development in Chicago Neighborhoods (PHDCN) to examine the effects of exposure to school violence, community violence, child abuse, and parental intimate partner violence (IPV) on youths’ subsequent alcohol and marijuana use. We also examine the cumulative effects of being exposed to violence across these domains. Longitudinal data were obtained from 1,655 adolescents and their primary caregivers participating in the PHDCN. The effects of adolescents’ exposure to various forms of violence across different life domains were examined relative to adolescents’ frequency of alcohol and marijuana use three years later. Multivariate statistical models were employed to control for a range of child, parent, and family risk factors. Exposure to violence in a one-year period increased the frequency of substance use three years later, though the specific relationships between victimization and use varied for alcohol and marijuana use. Community violence and child abuse, but not school violence or exposure to IPV, were predictive of future marijuana use. None of the independent measures of exposure to violence significantly predicted future alcohol use. Finally, the accumulation of exposure to violence across life domains was detrimental to both future alcohol and marijuana use. The findings support prior research indicating that exposure to multiple forms of violence, across multiple domains of life, negatively impacts adolescent outcomes, including substance use. The findings also suggest that the context in which exposure to violence occurs should be considered in future research, since the more domains in which youth are exposed to violence, the fewer “safe havens” they have available. Finally, a better understanding of the types of violence youth encounter and the contexts in which these experiences occur can help inform intervention efforts aimed at reducing victimization and its negative consequences.     

Childhood sexual abuse and substance abuse: A gender paradox?

We examine associations between childhood sexual abuse (CSA) and substance abuse, the role of mental health indicators as mediators in these associations and whether or not associations differ by gender. Data are from 14,063 respondents aged 18–76 years from the 2004–2005 Canadian Gender, Alcohol, and Culture: An International Study (GENACIS). Multiple logistic regression models were used to examine associations between CSA and substance abuse variables, controlling for socio-demographic factors. Odds were adjusted by indicators of mental health to assess if these variables mediated associations between CSA and substance abuse. Tests of interactions between sex and CSA were conducted to see if gender differences exist in associations. In 2004/2005, CSA was reported by 14% of women and 5% of men. CSA was associated with heavy drinking, hazardous drinking, and the use of marijuana, other illicit drugs, and off-label drugs. Associations were only very marginally attenuated when controlling for depression and self-perceived emotional/mental health. In all cases previously observed significant associations persisted. Evidence of gender differences in associations between CSA and substance abuse was negligible. Preventing CSA may also reduce substance abuse.     

School and program related factors influencing disclosure among children participating in a school-based childhood physical and sexual abuse prevention program

BackgroundSchool-based child abuse prevention programs were created to provide knowledge so that children can recognize abuse, teach skills that decrease children’s risk for abuse, normalize the disclosure process, and provide a pathway for children who may be experiencing abuse to report the abuse.ObjectiveThe purpose of this study was to explore school and program factors that trainers in a school-based prevention program believed were associated with disclosure among youth from kindergarten through 12th grade.Participants and settingThis study is based on eighteen trainers and administrators who work with the Play it Safe!® school-based program in Dallas-Fort Worth area.MethodsUsing the qualitative case study method, in-depth interviews were conducted.ResultsData analysis revealed three factors that influenced disclosure: school, school personnel, and program features. The school-related factor was time allotted to the training. The school personnel-related factors were disengagement, ambiguity concerning abuse, prior history with children, and professionals’ personal history of abuse. Finally, the program-related factors were the core messages of the training, providing specific examples, and repetition of the program. To date, there is a dearth of studies that explore the role that schools and school personnel play in the disclosure process.ConclusionChild abuse has devastating effects on children’s physical, social, emotional, and psychological well-being. Understanding more about schools, personnel, and program-related factors that lead to disclosure, which are more amenable to change, is critical to ensuring the safety of children.     

Prevalence of child abuse in Kerala,India: An ICAST-CH based survey

BackgroundChild abuse is a major concern in India with frequent reports of extreme maltreatment and fatalities. A dearth of robust and methodologically sound studies has resulted in ambiguity regarding the extent of child abuse in the general population.ObjectivesTo estimate the one-year and lifelong prevalence of exposure to violence, physical abuse, emotional abuse, sexual abuse, and neglect using a validated instrument—the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool – Child, Home Version (ICAST-CH).Participants and Setting: Adolescents (n = 6957) attending randomly selected schools in one city in Kerala, India.MethodsCross-sectional survey using self-report instrument.ResultsThe one-year prevalence of any abuse was 89.9% (95% CI: 89.1–90.7) suggesting that child maltreatment was widespread. Physical and emotional abuses were also very common. Although sexual abuse was least common, a considerable proportion of adolescents reported it; one-year prevalence of sexual abuse was 16.7% and lifetime prevalence was 19.9%. Boys reported more abuse than girls across all the categories of abuse (including sexual abuse). Abuse was more frequent in the higher age groups and classes at school. Abuse was also more frequent in nuclear families and families that reported alcohol use. Children who reported an abusive experience usually faced more than one category of abuse; abuse in one category was significantly associated with abuse in other categories.ConclusionsAbuse of children is alarmingly common. There is an urgent need for improving the awareness surrounding this issue as it is a major public health challenge faced by the country. The priority should be on setting up easily accessible support services for children.     

Drug use,the transition from school to work and occupational achievement in the United States

To determine the effects of drug use on entry into the labor force and subsequent socioeconomic achievement, we estimated duration models of the time elapsed since first leaving school to the first fulltime civilian job and jobs held at ages 24–25 and 28–29. The duration models show inconsistent drug effects: women who use illicit drugs other than marijuana delay entry into the labor force while men who use alcohol daily experience a somewhat more rapid entry. Blacks and those with a lower level of educational attainment enter the labor force more slowly than non-blacks and those with higher educational levels. The more important determinants of occupational outcomes at entry and later points in the work career are the human capital variables, i.e. educational attainment and experience. Duration of time since leaving school to first job has a statistically significant and negative impact on earnings, which increases over time for men but not for women. Being black is consistently associated with higher earnings among women. Holding constant other determinants of socioeconomic achievement, such as family background factors, marital status, race, and participation in different activities and roles during high school, effects of drug use among men and women and across earnings and prestige of the job are weak and inconsistent. The only statistically significant effect is the positive impact of marijuana use on males’ earnings at age 29. The findings lead us to conclude that drug use has only minor impact on occupational achievement in early adulthood.     

Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination

BackgroundChildhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination. Telemedicine has emerged as an innovative way to provide subspecialty care to this population. Despite the growing popularity of telemedicine, no literature exists describing patient and caregiver perceptions of telemedicine for this sensitive exam.ObjectiveTo explore caregiver and adolescent perspectives of the use of telemedicine for the child sexual abuse examination and discover factors that drive satisfaction with the technology.Participants and SettingCaregivers and adolescents who presented for a child sexual abuse medical evaluation at our county’s child advocacy center.MethodsWe completed semi structured interviews of 17 caregivers and 10 adolescents. Guided by the Technology Acceptance Model interviews assessed perceptions about: general feelings with the exam, prior use of technology, feelings about telemedicine, and role of the medical team. Interviews were audio-recorded, transcribed, coded and analyzed using content analysis with constant comparative coding. Recruitment ended when thematic saturation was reached.ResultsThere was an overwhelming positive response to telemedicine. Participants reported having a good experience with telemedicine regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team and professionalism demonstrated by those using the telemedicine system.ConclusionTelemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination.     

Predicting resilience in sexually abused adolescents

This research examined factors that predicted resilience in sexually abused adolescents. Using Bronfenbrenner's Process-Person-Context-Time (PPCT) ecological model, this study considered the proximal and distal factors that would contribute to adolescents' reactions to sexual victimization. This correlational study used hierarchical regression analysis (n=237) with cross-sectional data from the National Survey of Child and Adolescent Well-Being Wave I (NSCAW, Dowd et al., 2002). This study found that school engagement, caregiver social support, hope and expectancy, caregiver education and SES predicted resilience. In line with the PPCT model, findings suggest that placing a greater emphasis on the contextual environment could improve support for adolescent resilience. Augmenting interventions that focus on individual change with those that address environmental factors may increase the benefits to adolescents affected by sexual abuse.     

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

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

Evaluation of drug-endangered children: The yield of toxicology and skeletal survey screening

BackgroundDrug endangerment is known to be associated with child maltreatment. However, even with the high association between physical abuse and drug endangerment there is no standard for screening in this population. Skeletal survey screening may facilitate the identification of children in this population who have also been physically abused.ObjectiveOur objective was to determine the characteristics of drug endangered children and specifically the yield of skeletal survey screening.Participants and settingThe participants in this study were children referred by Child Protective Services (CPS) due to concerns of drug exposure. They were seen in a child abuse outpatient clinic by a child abuse pediatrician or pediatric nurse practitioner.MethodsThis study is a retrospective chart review of the Child Advocacy Resource and Evaluation (C.A.R.E.) Team records between January 1, 2011 and December 31, 2017. We measured the yield of toxicology, additional abuse endured, and skeletal survey findings.ResultsOver the 6-year period, 1252 cases were referred to C.A.R.E. Team for drug endangerment. 1150 cases had hair toxicology performed with 595 cases (52%) testing positive for at least one illegal substance. The compound most frequently identified was methamphetamine followed by marijuana and cocaine. In addition to drug endangerment, other forms of abuse were identified in 162 cases including sexual, physical, and neglect. Using the American Academy of Pediatrics (AAP) and American College of Radiology (ACR) guidelines, 340 skeletal surveys were performed. Twelve cases (4%) had occult skeletal injuries none of which had cutaneous findings. Of those with skeletal injury, 11 cases out of 11 tested by hair toxicology were positive for at least one illegal substance.ConclusionsThe application of the AAP and ACR guidelines for skeletal survey screening to those children referred for drug endangerment is useful in identifying children with physical abuse.     

Latent Class Analysis for Multiple Discrete Latent Variables: A Study on the Association Between Violent Behavior and Drug-Using Behaviors

This article proposes a new type of latent class analysis, joint latent class analysis (JLCA), which provides a set of principles for the systematic identification of the subsets of joint patterns for multiple discrete latent variables. Inferences about the parameters are obtained by a hybrid method of expectation-maximization and Newton–Raphson algorithms. We apply JLCA in an investigation of adolescent violent behavior and drug-using behaviors. The data are from 4,957 male high-school students who participated in the Youth Risk Behavior Surveillance System in 2015. The JLCA approach identifies the different joint patterns of 4 latent variables: violent behavior, alcohol consumption, tobacco cigarette smoking, and other drug use. The JLCA uncovers 4 common violent behaviors and 3 representative behavioral patterns for each of 3 other latent variables. In addition, the JLCA supports 3 common joint classes, representing the most probable simultaneous patterns for being violent and being a drug user among adolescent males.     

社会支持系统与青少年吸毒现象述评

青少年是物质滥用的敏感人群,受社会环境因素,个人心理因素的影响,目前我国青少年吸毒者人数呈逐年上升。从社会支持对青少年吸毒者的影响出发,建立学校、家庭和社会三位一体的社会支持系统,提出有效对策,全面预防青少年吸毒现象。     

Overcrowded housing: One of a constellation of vulnerabilities for child sexual abuse

BackgroundEffective prevention of child abuse depends on an understanding of factors associated with the abuse. Increased risk of child sexual abuse has been associated with parental substance use and adverse socio-economic factors such as living in poverty and parental unemployment. This study investigated overcrowding as a potential socio-economic risk factor in child sexual abuse taking into account other socio-economic, child and parental factors.MethodThis study used de-identified linked data from health and child protection data collections for the cohort of children born in Western Australia from 1990 to 2009 (n = 524,478). Cox regression was used to estimate adjusted and unadjusted hazard ratios and 95% confidence intervals for time to first sexual abuse allegation and first substantiated allegation, relative to the level of overcrowding and controlling for other risk factors.ResultsHigher levels of household overcrowding were associated with a 23%–46% increase in the risk of child sexual abuse allegations. Only the highest level of overcrowding was associated with a 40% increased risk of substantiated sexual abuse.ConclusionThe findings suggest that overcrowded living conditions are associated with an increased risk of sexual abuse for some children. This factor needs to be considered alongside other risk factors when assessing and improving child safety.