Child maltreatment in the children of the nineties: a cohort study of risk factors

AIM: To analyze the multiple factors affecting the risk of maltreatment in young children within a comprehensive theoretical framework. METHODS: The research is based on a large UK cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14,256 children participating in the study, 293 were investigated by social services for suspected maltreatment and 115 were placed on local child protection registers prior to their 6th birthday. Data on the children have been obtained from obstetric data and from a series of parental questionnaires administered during pregnancy and the first 3 years of life. Risk factors have been analyzed using an hierarchical approach to logistic regression analysis. RESULTS: In the stepwise hierarchical analysis, young parents, those with low educational achievement, and those with a past psychiatric history or a history of childhood abuse were all more likely to be investigated for maltreatment, or to have a child placed on the child protection register, with odds ratios between 1.86 and 4.96 for registration. Examining strength of effect, the highest risks were found with indicators of deprivation (3.24 for investigation and 11.02 for registration, after adjusting for parental background factors). Poor social networks increased the risk of both investigation (adjusted OR 1.93) and registration (adjusted OR 1.90). Maternal employment seemed to reduce the risk of both outcomes but adjusted odds ratios were no longer significant for registration. After adjusting for higher order confounders, single parents and reordered families were both at higher risk of registration. Reported domestic violence increased the risk of investigation and registration but this was no longer significant after adjusting for higher order variables. Low birthweight children were at higher risk of registration as were those whose parents reported few positive attributes of their babies. CONCLUSIONS: This study supports previous research in the field demonstrating that a wide range of factors in the parental background, socio-economic and family environments affect the risk of child maltreatment. By combining factors within a comprehensive ecological framework, we have demonstrated that the strongest risks are from socio-economic deprivation and from factors in the parents' own background and that parental background factors are largely, but not entirely, mediated through their impact on socio-economic factors.     

Child maltreatment in the children of the nineties a longitudinal study of parental risk factors.

OBJECTIVE: To identify and validate factors within the parental background affecting risk of child maltreatment. METHOD: A nested case-control study based on the Avon Longitudinal Study of Parents and Children (Children of the Nineties), a cohort of children born in Avon in 1991 through 1992. Data on the childhood and psychiatric histories of the parents, along with other data on the social and family environments, have been collected through postal questionnaires from early antenatal booking onwards. RESULTS: Out of 14,138 participating children, 162 have been identified as having been maltreated. Using logistic regression analysis, significant risk factors within the mothers' backgrounds were age < 20; lower educational achievement; history of sexual abuse; child guidance or psychiatry; absence of her father during childhood; and a previous history of psychiatric illness. Significant factors in the fathers' backgrounds were age < 20; lower educational achievement; having been in care during childhood; and a history of psychiatric illness. Significant factors on univariate, but not multivariate analysis included a parental history of childhood physical abuse; divorce or separation of the mother's parents; a maternal history of having been in care, or separated from her mother; parental alcohol or drug abuse; and a maternal history of depression. CONCLUSIONS: This study, the first of its kind in the UK, supports the findings of others that parental age, educational achievement, and a history of psychiatric illness are of prime importance in an understanding of child maltreatment. With the exception of maternal sexual abuse, a history of abuse in childhood is not significant once adjusted for other background factors. The study suggests that psychodynamic models are inadequate to explain child maltreatment, and wider models incorporating other ecological domains are needed.     

Child maltreatment among school children in the Kurdistan Province, Iran

OBJECTIVE: This study examines the determinants of three types of child maltreatment: physical maltreatment, mental maltreatment, and child neglect among school children in the Kurdistan Province of Iran. The analysis examines the impact of socioeconomic, familial, demographic, and household dynamic factors on the three child maltreatment outcomes, and compares the differential impact of these factors across the three types of child maltreatment. A greater understanding of the factors associated with child maltreatment has the potential to inform public health interventions aimed at reducing specific forms of maltreatment and at identifying at risk populations. METHODS: Data were collected from 1,370 school students, age 11-18. Separate logistic models are fitted for six binary outcomes examining self-reported experiences of physical maltreatment in the home or school, mental maltreatment in the home or school, and child neglect in the home or school. RESULTS: Male children were more likely to report experiencing any kind of child maltreatment than girls. Residency in a rural area, poor parental relationships and the use of addictive substances by household members were associated with increased odds of reporting child maltreatment. Poor school performance was associated with the reporting of experiencing maltreatment at school. CONCLUSION: Each of the forms of child maltreatment is highly correlated with socioeconomic, demographic, and living condition factors. The results point to the strong influence that familial factors have in shaping a child's likelihood of reporting maltreatment. Characteristics of the mother were associated with maltreatment, but not characteristics of the father. The results highlight a number of mechanisms through which public health interventions may seek to reduce the prevalence of child maltreatment in Kurdistan; different approaches are needed to reduce child maltreatment in the home and school environments.     

Parenting stress and child maltreatment in drug-exposed children.

This study was conducted to examine the relationship between prenatal exposure to drugs and parenting stress and child maltreatment. The sample was comprised of 48 subjects including 24 drug-exposed children and a comparison group of 24 non-drug-exposed children matched on age, race, gender and socioeconomic status. The subjects' age ranged from 1 to 33 months with a mean of 13 months. As predicted, mothers who used drugs during pregnancy reported higher levels of stress than foster mothers and comparison mothers on total parenting stress, child related stress, and parent related stress as measured by the Parenting Stress Index (Abidin, 1990). Biological mothers and foster mothers of drug-exposed infants scored higher than comparisons on child-related stress, most notably in the areas of hyperactivity, distractability and adaptability. A strong association was found between maternal use of drugs and child maltreatment serious enough to necessitate removal of the children by CPS. Over 40% of the drug-exposed children were in foster care, most often with maternal grandmothers. Most mothers who used drugs during pregnancy were polysubstance abusers and 21% were intravenous drug users increasing the risk of HIV infection for mothers and children. Implications for intervention are discussed.     

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.     

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.     

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.     

Intimate partner violence among female caregivers of children reported for child maltreatment

OBJECTIVE: The purpose of this study was to determine the prevalence and correlates of intimate partner violence among female caregivers of children reported to child protective services. METHOD: Data were derived from the National Survey of Child and Adolescent Well-Being, a national probability study of children investigated for child abuse and neglect in the United States. Caregivers were interviewed about demographic characteristics, mental health, substance use, and physical violence by a partner. RESULTS: The lifetime and past year prevalence of intimate partner violence was 44.8 and 29.0%, respectively. Caregiver major depression and history of prior reports of child maltreatment were strongly associated with violence against women. CONCLUSIONS: The findings highlight the need for effective screening and identification of intimate partner violence in families in which child maltreatment has occurred.     

Child maltreatment: social representation of the general population and the professionals working with children in the Caribbean area of Colombia

OBJECTIVE: The main objective was to know social representations about child maltreatment (severity, etiology, and intervention strategies) of the general population and the professionals working with children in the Caribbean area of Colombia. METHOD: Sample was composed for 402 participants. From this pool of participants, 111 of them were working in child protection, 95 worked with children but not in the child protection system and 196 pertained to the general population. All participants answered to a questionnaire composed by 86 items. The questionnaire was developed to assess (1) the perceived severity of different typologies of child abuse, (2) opinions about risk factors for child maltreatment and sexual abuse, and (3) opinions about the most adequate ways of intervention with perpetrator of child abuse. RESULTS: Sexual abuse is considered as the most severe typology of child maltreatment and emotional abuse is considered as more severe than physical abuse. No differences between groups were found in perceived severity of typologies of child maltreatment. Differences in the social representation about the etiology of child maltreatment were found. Professionals working in the child protection system give more value to characteristics of parents and to the socio-economic and familiar environment in the etiology of child maltreatment than participants from the general population. Prevention and treatment programs for abusers were considered as the more relevant strategies against child maltreatment. DISCUSSION: Findings of present study suggest that social representations about child maltreatment of general population and professionals from the Caribbean area of Colombia are similar than social representation observed in other regions and countries. It is important to take into account that child labor and child poverty were considered as non-severe typologies of child maltreatment. Moreover, findings suggest that people from general population in the Caribbean area of Colombia have a relevant knowledge about agencies working for child protection.     

Predicting child maltreatment among Puerto Rican children from migrant and non-migrant families

ObjectivesThe objectives of the present study were to (1) describe the prevalence of child maltreatment among migrant and non-migrant Puerto Rican families and (2) identify socio-demographic and cultural (i.e., acculturation pattern, familismo) predictors of maltreatment within these two samples.MethodRepresentative community samples of Puerto Rican children (ages 5–13 at baseline) and their adult caretakers were interviewed at two sites: the South Bronx in New York City (n = 631 families) and the Standard Metropolitan Areas of San Juan and Caguas in Puerto Rico (n = 859 families). Participants were re-interviewed 1 and 2 years following the baseline assessment.ResultsWhile prevalence rates of maltreatment (physical abuse, 10%; sexual abuse 1%; neglect, 10%; and multi-type, 6%) did not differ between the two sites at baseline assessment, site differences emerged over time. Rates of physical abuse at follow-up were significantly higher in the Bronx compared to Puerto Rico. Further, for families living in the Bronx, living in poverty predicted chronic maltreatment, whereas living above the poverty line predicted new cases of maltreatment at follow-up. For families living in Puerto Rico, those who experienced physical abuse or multi-type maltreatment at baseline were more likely to report chronic maltreatment at follow-up regardless of poverty level. Cultural factors were not related to baseline or follow-up maltreatment at either site.ConclusionFindings suggest that while rates of child maltreatment may be similar in migrant and non-migrant Puerto Rican families and when compared to prevalence rates in the US, predictors of maltreatment may differ.Practice implicationsSince predictors of maltreatment may vary across population subgroups, studying homogenous samples will lead to more effective and targeted interventions.     

Repeated reports for child maltreatment among intimate partner violence victims: Findings from the National Survey of Child and Adolescent Well-Being

ObjectivesTo determine the prevalence of intimate partner violence (defined as any physical violence during the last 12 months or previously) among mothers who maltreat their children, and to examine whether mothers’ experiences of intimate partner violence (IPV) are associated with repeated reports (rereports) of children to Child Protective Services (CPS) during the following 18 months.MethodsData for the analyses were from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children investigated for child maltreatment. The sample of 5,501 children (ages 0–14) was randomly selected from the families who entered the US child welfare system between October 1999 and December 2000. The analysis sample was restricted to 1,236 families in which caregivers were: (1) the alleged perpetrators of the child maltreatment at baseline (independently of substantiation status) and (2) the biological mothers (n = 1,212 or 98.6%), adoptive mothers (n = 17 or 1%), or stepmothers (n = 7 or 0.3%) of children not placed in out-of-home care.ResultsChildren of mothers physically abused by an intimate partner during the last 12 months or previously at the intake interview (44%) were twice as likely as children of mothers who had not experienced such violence to be rereported to CPS (29% vs. 14%, Odds Ratio = 2.0, 95% Confidence Interval = 1.1–3.4). Rereports occurred almost twice as quickly for children of mothers who experienced IPV compared to children of mothers who had not experienced IPV (Hazard Ratio = 1.9, 95% Confidence Interval = 1.1–3.0).ConclusionsThe higher risk and speedier rereports of child maltreatment associated with intimate partner violence highlights the need for universal assessment and provision of services for IPV among families that are investigated by CPS.     

Fatal and non-fatal child maltreatment in the US: An analysis of child,caregiver, and service utilization with the National Child Abuse and Neglect Data Set

The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national-comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. We discuss the results with regard to child welfare practice and research.     

Social support and child maltreatment: a review of the evidence

Parents who maltreat their children have long been thought to lack support from informal and social networks. Recent writers have taken the position that this relationship is a proven, causal one, with social isolation seen as a necessary antecedent condition for the occurrence of child abuse. Concurrently, initial enthusiasm for social support as a powerful explanatory variable in other areas of psychological and health research is giving way to cautious reevaluation of the evidence. The present review was undertaken to bring into sharper focus what is now known regarding the relationship between child maltreatment and parental isolation from informal helping networks. Existing research is fraught with both conceptual and methodological problems. There is, at present, little research evidence that lack of social support plays a significant role in the etiology of physical abuse. Stronger evidence exists that neglectful parents are socially isolated, but the data are consistent with the hypothesis that this is one manifestation of the character problems of these parents. Future research must give closer attention to clearly defining social support and using reliable and valid instruments to measure it, while exploring multivariate models of child maltreatment.