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Maltreatment

Maltreatment. What constitutes maltreatment?. Medical-diagnostic definition ( Aber & Zigler , 1981) Overt signs of maltreatment from individual abuser Highlights physical abuse, minimizing psychological maltreatment Legal definition (Juvenile Justice Standards Project, 1977)

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Maltreatment

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  1. Maltreatment

  2. What constitutes maltreatment? • Medical-diagnostic definition (Aber & Zigler, 1981) • Overt signs of maltreatment from individual abuser • Highlights physical abuse, minimizing psychological maltreatment • Legal definition (Juvenile Justice Standards Project, 1977) • Demonstrable physical and emotional harm (as evidence for prosecution) • Ecological approach (Cicchetti et al., 2000) • Parental acts and society’s role in perpetuating maltreatment

  3. Researchers have focused on • specific acts endangering child in some way (Barnett et al., 1993) • Identifiable behaviors that compromise child’s maladaptive caretaking environment

  4. Issues of definition • Maltreatment largely influenced by legal matters • Identified and defined by social service systems, not researchers/ mental health professionals • No clear standard on distinction between acceptable parental disciplinary practice and maltreatment (Black & Dubowitz, 1999) • Lack of agreement on whether definition based on • Actions of perpetrator • Effects on child • Combination (Barnett et al., 1993) • Debate whether parental intent should be considered

  5. Issues raise methodological concerns • For instance • Greater challenge to measure parental intent than parental behavior • Linking maltreatment to child outcome leads to difficulty in separating child maltreatment from subsequent sequelae (Cicchetti & Manly, 2001) • Operation definition! • Replication (Cicchetti & Manly, 2001)

  6. Is this maltreatment? • Example 1: http://www.annawahlgren.com/index.php/view/svenska/filmer-vagning • Discussion: What’s acceptable parental discipline?

  7. Corporal punishment • 90% of American adults smacked when young • majority think no bad consequences & is necessary at times (Straus & Stewart 1999) • Outlawed in 24 countries (mostly Europe/Latin) • Legal in UK and North America, although controversial • Attempts to ban in MA and CA defeated

  8. Data from the UK, similar results for US (see Straus & Stewart 1999)

  9. Corporal punishment in US • 6 types of CP examined in large study by Straus & Stewart (1999) • Slaps on hand or leg, spanking on buttocks, pinching, shaking, hitting on buttocks with belt/paddle, slapping in face • Prevalence • 35% for infants • Peak of 94% at age 3 and 4 • Decline after age 5, but still over half hit children at age 12, one third at age 14, and 13% at age 17 • Chronicity and severity • Average 6 times during year • Severity greatest for children age 5-12

  10. Corporal punishment in US • CP more prevalent among • African-American • low SES parents (in the South) • Boys, and mothers

  11. Other forms of Corporal • School corporeal punishment • outlawed in UK/Europe • legal in US, but rarely used • Still used in many Asian and African countries

  12. Paddling

  13. Other forms of Corporal • Judicial/quasi-judicial punishment • Abolished in most of Western world • Remains a penalty in some Asian, African, Middle East countries

  14. Quasi-judicial punishment or Maltreatment? • Example 2: • http://www.judgerc.org/

  15. Four general categories • Sexual abuse • Actual/attempted sexual contact between child and caregiver/other responsible adult • For caregiver’s sexual gratification or financial benefit • Physical abuse • Injuries inflicted on child by nonaccidental means • Neglect • Failure to provide minimum standards of care/ adequate supervision • Emotional maltreatment • Persistent and extreme thwarting (hinder) of a child’s basic emotional needs

  16. Psychological maltreatment (McGee & Wolfe, 1991) • Both psychologically abusive and psychologically neglectful experiences • Subtypes rarely occur in isolation from each other (Cicchetti & Manly, 2001) • Majority of maltreated children experience more than one subtype

  17. Maltreatment Classification System (MCS) (Barnet et al., 1993) • Operational definition of subtypes • Inclusion/exclusion criteria • Exemplars of each of 5 levels of severity • Measurement of onset, frequency, chronicity • Developmental periods(s) during which occurred • Perpetrator(s) of each subtype

  18. Interaction between severity and frequency = significant predictor of maladaption(Manly et al., 1994) • Chronicity predicts peer rejection and aggression (Bolger & Patterson, 2001) • Timing important impact on self-perception and relationships with peers (Bolger et al., 1998) • Interaction severity of subtype and developmental period predicting internalizing and externalizing symptomatology(Manly et al., 2001) • Chronic maltreatment with onset in infancy-toddlerhood/preschool most maladaptive outcomes

  19. Further methodological challenges • Identification and operationalization of neglect • Strategy of assessment • Other

  20. The ‘neglect of neglect’ • Child neglect relatively understudied (Wolock & Horowitz, 1984) • However, neglect = most commonly reported form of maltreatment in US (USDHHS, 2007) • Consequences often as sever as those of physical/sexual abuse • Difficulties • often chronic, but with little visible evidence • Difficult to study in isolation from other subtypes • Accumulating effect over time • Physical neglect closely related to poverty • difficult to identify neglect over and above economic disadvantage

  21. Strategy of assessment • Self-report (by perpetrator and/or victim) • Observational paradigms • Official Child Protective Services reports (Manly et al., 1994)

  22. Other methodological weaknesses • Using case status alone to define subjects • Adopting dichotomous perspective of maltreatment • Operational definitions that fail to differentiate among subtypes • Using adult retrospective reports • Childhood Trauma Questionnaire (Bernstein et al., 1994, 1997)

  23. Study on concordance between self-report and court record (Swahn et al., 2006) • Northwestern Juvenile Project • N=1829 youths aged 10-18 years • Only 16.6% of self-reported maltreatment had a also court record of abuse or neglect • 22.2% of those with highest level of maltreatment • 25.1% of those requiring medical treatment • Official records seriously underestimate prevalence

  24. Prevalence(USDHHS, 2007) • 5.8 million children referred to Child Protective Services • 62% investigated • 25% of investigations found child to be victims (24.1% substantiated) • Off remaining ‘non victim’ 61.3% unsubstantiated • 794,000 children determined to be victims of abuse or neglect • Children birth to 1 year highest rate of victimization (21.9 per 1,000 children) • 51.5% girls • 46.1% White, 21.7% African American, 20.8% Hispanic

  25. Prevalence continued(USDHHS, 2007) • Most common types • 59% neglect • 10.8% physical abuse, • 7.6% sexual abuse, • 4.2% psychological maltreatment • Child fatalities • 1,760 died • 2.35 deaths per 100,000 children • 75.7% younger than 4 years • boys younger than 1 year highest rate (18.85 per 100,000)

  26. Prevalence continued(USDHHS, 2007) • Perpetrators • 79.9% parents • 6.6% other relatives • 56.5% women, 42.4% men • 74.8% younger than 40 years • Services • 62.1% of victims receive post-investigative service • 20.7% of victims placed in foster care

  27. Some special sever forms • Shaken-baby-syndrome (Kelly & Farrant, 2007) • Non-accidental head injury • Result of violent shaking • 24-33% of children less than 2 years admitted to hospital (42% require intensive care) • Munchhausen-by-proxy-syndrome • Caregiver stimulations or fabricates illness (lying, poisoning, suffocation, specimen tampering and chart falsification (Venneman et al., 2005)

  28. Etiology • Social-psychological phenomenon (Belsky, 1980) • Bronfenbrenner’s ecological theory

  29. Bronfenbrenner’s Ecological Theory • Microsystem (everyday immediate environment) • Mesosystem (connects parts of the microsystem) • Exosystem (represents broad influences) • Macrosystem (represents larger cultural influences)

  30. Etiology • Etiological model based on Bronfenbrenner’s ecological theory, Belsky suggests 4 levels of analysis: • Macro, exo, micro and ontogenic (individual) • Risk factors closer to individual more direct influence • Ecological-transactional model (Cicchetti & Lynch, 1993) • Reciprocal interactions of environment, caregiver and child • Potentiating and compensatory risk factors • Four classes of determinates for occurrence • (1) Enduring vulnerability factors, (2) transient challengers, (3) enduring protective factors, (4) transient buffers

  31. Intergenerational Transmission • Individuals with history of maltreatment more likely to maltreat their own children • Exact rates unclear • 7.4% of parents with abuse history (Brown & Herbert, 1997) • 33% of sexually abuse men, 50% of sexually abusive women (Collin-Vezina & Cry, 2003) • Variations maybe due to methodological problems

  32. Intergenerational Transmission • Three risk factors (Dixon, Brown et al., 2005) • Becoming a parent before age 21 • Residing with a violent adult • Having a history of mental illness • Deficits in personal resources (Azar, 2002) • Less psychologically complex and integrated • Psychopathology, specifically depression • Lack impulse control, especially when aroused or stressed

  33. Family dynamics • Family dynamic systems (e.g. Trickett & Sussman, 1988) • Maladaptive and disruptive relationships • Inter-parental aggression (affects children’s beliefs about close relationships) • Abuse: Interpersonal conflict, neglect: social isolation

  34. Marital conflict(Sprung & Batlogg, 2009) • Children’s understanding of conflict • Afterschool program for children with divorced parents • Children in regular after school program • Video of conflict situations • 4 conditions • Results • Children with more marital conflict were more likely and quicker in identifying conflict

  35. Parenting Styles • Maltreating parents are • Less satisfied with children • Perceive child rearing as more difficult and less enjoyable • Use more controlling disciplinary techniques • Do not encourage development of autonomy • Promote isolated lifestyle (Azar, 2002; Rogosch et al., 1995; Tricket et al., 1991)

  36. Parenting Styles • Specifically abuse parents tend to • Show fewer physical and verbal behaviors to direct children’s attention • More unrealistic expectations • Attribute more negative intentions to child’s behavior • Less positive affect • Low reciprocity during dyadic interactions • Less supportive, playful and responsive to children (Alessandri, 1992; Outallaz et al., 1998; Dixon et al., 1989; Burgess & Conger, 1978)

  37. Mental health of maltreated children(Cohen et al., 2001) • Depression • Adolescents with sexual abuse • Anxiety disorder (i.e., complex PTSD) • All subtypes and ages (highest when official record, not for self-reported physical abuse) • Disruptive behavior (i.e., conduct disorder, opposition-defiant disorder) • All subtypes and ages (highest when official record) • Personality disorder (e.g., Schizotypal, Paranoid, Narcissistic, Borderline, etc.) • All subtypes and ages (only with official record, not for self-reported physical abuse)

  38. Impact on Child DevelopmentEmotional development and regulation • Expression(e.g., Gaensbauer, 1982) • As early as 3 months • Increased rates of fearfulness, anger, sadness during mother-infant interaction (Gaensbauer et al., 1981) • Recognition(e.g., Camras et al., 1996; Pollak et al., 2000) • Understanding (Shipman et al., 2000; Pears & Fisher, 2005) • Communication (e.g., Beeghly & Cicchetti, 1994)

  39. Emotion Understanding: Pears & Fisher’s Study • Young maltreated foster children 3-5 years (N=60) and control (N=31) • Maltreatment determined via CPS case files • 9=sexual abuse, 9=physical abuse, 40=neglect, 2=emotional abuse • Measures • Emotion understanding tasks (Denham, 1986)

  40. Emotion Understanding Tasks(in study by Pears & Fisher, 2005) • Expressive and receptive emotion recognition • Line drawings of happy, sad, angry and scared faces • Expressive: ‘How does s/he feel?’ • Receptive: e.g. ‘Point to the happy face’ • Affective perspective-taking • Puppet characters (main/child, sibling/opposite gender, mother) • Performing emotion provoking scenes (with stereotypical and atypical reactions) • Child asked to indicate how puppet was feeling (from among line drawings)

  41. Results (Pears & Fisher, 2005) • Control children outperform maltreated foster care group on all emotion understanding tasks • Expressive = 6.40 (CC) vs. 4.71 (FC) • Receptive= 7.65 vs. 6.44 • Perspective taking (stereotypical)= 13.42 vs. 10.47 • Perspective taking (stereotypical)= 13.77 vs. 10.44 • Even when controlling for age, intelligence and EF

  42. Development of Attachment relationships • Insecure attachment (Types A or C) (Youngblade & Belsky, 1989) • Disorganized attachment (Type D) (Main & Solomon, 1990) • Avoidant-resistant (Type A-C) (Crittenden, 1988, 1992) • Atypical attachment patterns linked to • Having caregiver with depression, substance abuse, unresolved loss or trauma from parent’s own childhood attachment (e.g., Ainsworth & Eichberg, 1991) • Preponderance of atypical or insecure attachment in maltreated children • 80% to 90% disorganized (Carlson et al., 1989)

  43. “Strange Situation” Laboratory Test(Mary Ainsworth) 1) Mother, baby, experimenter 2) Mother, baby alone 3) Stranger enters - sits, talks with mum, play baby 4) Mother leaves - stranger withdraws to seat 5) Mother returns, stranger leaves 6) Mother leaves - baby alone 7) Stranger returns 8) Mother returns -stranger leave • Repeated separations and reunions place infant and mother under increasing stress. • Last REUNION most important for coding

  44. Development of Autonomous self • Visual self-recognition (Rouge test) (Lewis & Brooks-Gunn, 1979) • http://www.youtube.com/watch?v=z6WP6JKZRoE • http://video.google.com/videoplay?docid=-5980976466387737630 • No difference in ability • BUT display neutral or negative affect in response to their rouge-marked self (Schneider-Rosen & Cicchetti, 1984, 1991)

  45. Development of Autonomous self • Tool-use (autonomy/independent exploration) • More angry, frustrated, noncompliant (Egeland & Sroufe, 1981) • Overt expression of self-representation • Less talk about internal states, especially emotional states

  46. Symbolic Development • Language • Multiple signs of language impairment (Coster et al., 1989) • Play • In infants no difference in complexity, but in play style (more imitation, less independent) (Valentino et al., 2006) • In preschoolers less cognitively and socially mature (Alessandri, 1991) • Representational Models • Theory of mind (e.g. Cicchetti et al., 2003)

  47. Maltreatment, Emotion Understanding and Theory of Mind • False Belief Understanding (Cicchetti et al., 2003) • Emotion Understanding and Theory of Mind (Pears & Fisher, 2005) • Knowledge about thinking (Sprung, Lindner & Thun-Hohenstein, 2009)

  48. False Belief Understanding (Cicchetti et al., 2003) • 203 maltreated children 3- to 8-years compared with non-maltreated control groups (143 low SES, 172 middle SES) • Measures • False belief tasks • Unexpected-content (Perner et al., 1987; Gopnik & Astington, 1988)

  49. Child Experimenter False Belief Task Test question ~ 4 yrs < 4 yrs Where will he look first for his book? After that, Mum comes to tidy up the room Then she leaves to do some work in the kitchen. Then he leaves to play in the garden Maxi puts his book in the cupboard Mum takes the book out of the cupboard, Now, Maxi returns looking for his book and puts it in the bookshelf Striking development around 4 years of age (for review see Wellman et al, 2001)

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