From child maltreatment to adolescent cannabis abuse and dependence: a developmental cascade model

A developmental cascade model tested associations among child maltreatment, internalizing and externalizing psychopathology, social competence, and cannabis abuse and dependence symptoms in a longitudinal cohort (N = 415). Nested structural equation models evaluated continuity and cross-domain influences among broad multi-informant constructs across four developmental periods: age 7 to 9, 10 to 12, 13 to 15, and 15 to 18. Results indicated significant paths from child maltreatment to early externalizing and internalizing problems and social competence, as well as to cannabis abuse and dependence (CAD) symptoms in adolescence. Youth CAD symptoms were primarily related directly to child maltreatment and externalizing problems. Childhood internalizing symptoms contributed to later childhood decreases in social competence, which predicted increases in late adolescent externalizing problems. Using a developmental psychopathology framework, results are discussed in relation to cascade and transactional effects and the interplay between problem behaviors during childhood and development of CAD symptoms during early and late adolescence.     

The timing of child physical maltreatment: a cross-domain growth analysis of impact on adolescent externalizing and internalizing problems.

In a sample of 578 children assessed in kindergarten through the eighth grade, we used growth modeling to determine the basic developmental trajectories of mother-reported and teacher-reported externalizing and internalizing behaviors for three physical maltreatment groups of children-early-harmed (prior to age 5 years), later-harmed (age 5 years and over), and nonharmed--controlling for SES and gender. Results demonstrated that the earlier children experienced harsh physical treatment by significant adults, the more likely they were to experience adjustment problems in early adolescence. Over multiple domains, early physical maltreatment was related to more negative sequelae than the same type of maltreatment occurring at later periods. In addition, the fitted growth models revealed that the early-harmed group exhibited someswhat higher initial levels of teacher-reported externalizing problems in kindergarten and significantly different rates of change in these problem behaviors than other children, as reported by mothers over the 9 years of this study. The early-harmed children were also seen by teachers, in kindergarten, as exhibiting higher levels of internalizing behaviors. The later-harmed children were seen by their teachers as increasing their externalizing problem behaviors more rapidly over the 9 years than did the early- or nonharmed children. These findings indicate that the timing of maltreatment is a salient factor in examining the developmental effects of physical harm.     

Preventing child maltreatment: an evidence-based update

Child maltreatment is a significant public health problem associated with a broad range of negative outcomes in children and adolescents that can extend into adulthood. This review summarizes information about programs aimed at the prevention of child maltreatment evaluated by controlled trials, with a focus on home visitation programs. It does not include programs aimed at prevention of child sexual abuse, the subject of a separate review in this series. We discuss those programs that include one or more measures of child maltreatment and related outcomes (reports of abuse and neglect, injuries, hospitalizations and emergency room visits). Most programs targeting at-risk families have not shown evidence of effectiveness in preventing abuse or neglect. An important exception is the Nurse Family Partnership (NFP), a program provided by nurses to first-time socially disadvantaged mothers beginning prenatally that has undergone rigorous evaluation in three randomized controlled trials. It has shown consistent effects in reducing reports of maltreatment and associated outcomes as well as additional benefits in maternal and child health in high-risk families. A second exception is the promising Early Start program provided by nurses and social workers to at-risk families beginning postnatally. One randomized controlled trial of the program has shown reduced rates of parental reports of severe abuse and hospital attendance for injuries and poisonings, based on records. The characteristics of the NFP and Early Start programs are discussed with special emphasis on ways in which they differ from other home visitation programs.     

Collaboration for child adjustment: issues for school- and clinic-based child psychologists.

Therapeutic gains for children may be maximized if the important systems serving their mental health needs develop sophisticated collaborative relationships. School- and clinic-based psychologists may overlook important ways in which they can cooperate. School-based psychologists may not be aware of how to extend or support the therapeutic interventions suggested by other psychologists. Clinic-based child therapists may lack a full understanding of both the promise of school-based programs and the constraints under which schools operate. Collaborative efforts between clinic- and school-based practitioners may increase ecologically valid treatment options. This article explores both the gains and the potential pitfalls that may arise when school- and clinic-based practitioners work together.     

Multiple maltreatment, attribution of blame, and adjustment among adolescents.

The study examined the predictive utility of blame attributions for maltreatment. Integrating theory and research on blame attribution, it was predicted that self-blame would mediate or moderate internalizing problems, whereas other-blame would mediate or moderate externalizing problems. Mediator and moderator models were tested separately. Adolescents (N = 160, ages 11-17 years) were randomly selected from the open caseload of a child protection agency. Participants made global maltreatment severity ratings for each of physical abuse, psychological abuse, neglect. sexual abuse, and exposure to family violence. Participants also completed the Attribution for Maltreatment Interview (AFMI), a structured clinical interview that assessed self- and perpetrator blame for each type of maltreatment they experienced. The AFMI yielded five subscales: self-blaming cognition, self-blaming affect, self-excusing. perpetrator blame, and perpetrator excusing. Caretaker-reported (Child Behavior Checklist) and self-reported (Youth Self Report) internalizing and externalizing were the adjustment criteria. Controlling for maltreatment severity, the AFMI subscales explained significant variance in self-reported adjustment. Self-blaming affect was the most potent attribution, particularly among females. Attributions mediated maltreatment severity for self-reported adjustment but moderated it for caretaker-reported adjustment. The sophistication and relevance of blame attributions to adjustment are discussed, and implications for research and clinical practice are identified.     

The impact of child maltreatment and psychopathology on neuroendocrine functioning.

Cortisol regulation was investigated in a sample of school-aged maltreated (n = 167) and demographically comparable low-income nonmaltreated (n = 204) boys and girls in the context of a day camp research program. The presence of clinical-level internalizing and clinical-level externalizing symptomatology was determined through adult report and child self report. Children who exhibited clinical-level internalizing problems only, clinical-level externalizing problems only, and comorbid clinical-level internalizing and extemalizing problems were identified. Clinical-level cases were more prevalent among the maltreated children. Maltreated children with clinical-level internalizing problems were distinguished by higher morning, afternoon, and average daily cortisol levels across the week of camp attendance. In contrast, nonmaltreated boys with clinical-level externalizing problems emerged as distinct in terms of low levels of morning and average daily levels of cortisol. Maltreated children with comorbid clinical-level internalizing and externalizing problems were more likely not to show the expected diumal decrease in cortisol. The findings are discussed in terms of the joint impact of maltreatment and different forms of psychopathology on neuroendocrine regulation.     

Chronic and discrete stress as predictors of children's adjustment.

Diabetes, as a chronic stressor, and negative life events (NLEs), as a discrete stressor, were related to children's behavioral adjustment, along with moderating effects of the family environment. Diabetes and NLEs predicted both higher internalizing (INT) and externalizing (EXT) behavior problems, suggestive of nonspecific distress. Higher family conflict and lower cohesion each predicted more behavior problems (INT-EXT). However, conflict was the sole moderator of the stressors. Higher family conflict and diabetes exacerbated children's EXT behavior problems, with clinically elevated scores. Higher family conflict and higher NLEs resulted in clinically elevated INT-EXT behaviors. Conversely, low family conflict protected children's behavioral functioning from the stressors. Family cohesion was the sole predictor of children's social competencies but did not moderate the stressors.     

Multilevel selected primary prevention of child maltreatment

Few treatment studies and even fewer primary prevention studies have demonstrated successful reduction of child maltreatment. Successful preventive interventions have often been lengthy and expensive; shorter programs have been didactic and ineffective. The present investigation relied on a 7-level model of successful parenting to mount a time-limited, "selected" prevention effort with high-risk mothers.This program included modeling, role-playing, Socratic dialogue, home practice, and home visits. The study demonstrated effective intervention at every level of the model, including improvements in (a) parenting skills, (b) developmentally appropriate interventions, (c) developmentally appropriate beliefs, (d) negative affect, (e) acceptance of a responsible parent role, (f) acceptance of a nurturing parent role, and (g) self-efficacy. Directions for future research are considered.     

Pathways from child maltreatment to internalizing problems: perceptions of control as mediators and moderators.

Using a prospective longitudinal design, we examined internalizing problems and perceptions of control in a community sample of 785 children, 59 of whom had been maltreated. Children's internalizing problems and perceptions of control were measured via self-report at annual assessments in third grade through seventh grade (modal ages 9-13 years). Children's experiences of multiple types of maltreatment were rated based on social service records, using a standard coding system. Results of longitudinal analyses examining the roles of specific types of maltreatment (neglect, harsh parenting, and sexual abuse) revealed that neglect and sexual abuse were each associated with more internalizing problems, especially among children who experienced both these maltreatment types. Neglected children reported higher levels of perceived external control than other children did. Sexual abuse was associated with higher levels of perceived external control, but only among children who had also been neglected. Results of mediation analyses showed that higher levels of perceived external control accounted substantially for associations between specific maltreatment types and children's internalizing problems. Results of moderator analyses revealed that, among maltreated children, greater perceived internal control predicted fewer internalizing problems, suggesting that perceived internal control functioned as a protective factor. Children maltreated early in life were less likely to have this protective characteristic. Results are discussed in terms of their implications for understanding the developmental consequences of specific and co-occurring types of maltreatment.     

Psychological adjustment of children with cystic fibrosis: the role of child cognitive processes and maternal adjustment.

Found 60% of children 7-12 years old with cystic fibrosis to have a parent-reported behavior problem and 62% met the criteria for a DSM-III diagnosis based on a structured clinical interview with the child. Mixed internal and external behavior problem patterns and diagnoses of anxiety and oppositional disorder were most frequent. Support was provided for the hypothesized psycho-social/mediational roles of child perception of self-worth and maternal anxiety in child adjustment. Together, the variables of the transactional stress and coping model accounted for 39 and 43% of the variance in mother-reported internalizing and externalizing behavior problems and for 68% of the variance in child-reported problems.     

The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes.

A substantial body of literature suggests that childhood maltreatment is related to negative outcomes during adolescence, including delinquency, drug use, teenage pregnancy, and school failure. There has been relatively little research examining the impact that variation in the developmental stage during which the maltreatment occurs has on these relationships, however. In this paper, we reassess the impact of maltreatment on a number of adverse outcomes when developmentally specific measures of maltreatment-maltreatment that occurs only in childhood, only in adolescence, or in both childhood and adolescence-are considered. Data are drawn from the Rochester Youth Development Study, a broad-based longitudinal study of adolescent development. The analysis examines how maltreatment affects delinquency, drug use, alcohol-related problems, depressive symptoms, teen pregnancy. school dropout, and internalizing and externalizing problems during adolescence. We also examine whether the type of maltreatment experienced at various developmental stages influences the outcomes. Overall, our results suggest that adolescent and persistent maltreatment have stronger and more consistent negative consequences during adolescence than does maltreatment experienced only in childhood.     

The timing of parent and child depression: a hopelessness theory perspective.

This study examined whether children's inferential styles moderate the association between the onset of depressive symptoms in children and their parents. To provide a powerful test of our hypotheses, we utilized a high-risk sample (parents with a history of major depressive episodes and their children) and a multiwave longitudinal design. During the initial assessment, 140 children (ages 6 to 14) completed measures assessing depressogenic inferential styles. Parents and children also completed measures assessing current level of depressive symptoms. Following the initial assessment, children and parents were contacted every 6 weeks for the next year to complete measures assessing depressive symptoms. The results of hierarchical linear modeling analyses indicated that children who exhibited depressogenic inferential styles reported greater elevations in depressive symptoms following elevations in their parent's level of depressive symptoms than did children who did not exhibit such styles. The strength of this association was greater in girls.     

Understanding children's injury-risk behaviors: the independent contributions of cognitions and emotions

OBJECTIVE: Unintentional injuries are a leading threat to the health of elementary-school children, with many injuries happening when children are left to make their own decisions about risk taking during play. The present study sought to identify determinants of children's physical taking. METHODS: An ecologically valid task that posed some threat of injury was used (i.e., highest height of a balance beam they would walk across). Ratings of cognitions (extent of danger, perceived vulnerability for personal injury, potential severity of injury) and emotional reactions (fear, excitement) were taken when on the beam, just before the children walked across. RESULTS: Regression analysis, controlling for age and sex, revealed that risk taking was predicted from ratings of danger, fear, and excitement. CONCLUSIONS: Both cognitive and emotional factors independently contribute to predict children's physical risk taking. Theoretical and practical implications of these findings are discussed.     

Attachment and psychosomatic medicine: developmental contributions to stress and disease

OBJECTIVE: The object of this study was to evaluate the evidence linking attachment insecurity to illness. Attachment theory describes lifelong patterns of response to threat that are learned in the interaction between an infant and his or her primary caregiver. Despite its biopsychosocial domain, attachment theory has only recently been applied to psychosomatic medicine. METHOD: MEDLINE and PsychInfo databases were searched from 1966 to 2000 for English language papers with key words "attachment" and "object relations." Papers and their cited references were reviewed if they were directly related to physical illness, symptoms, or physiology. A hypothetical causal model was developed. RESULTS: Direct and indirect evidence from survey studies supports an association between attachment insecurity and disease. Animal studies and human experiments suggest that attachment contributes to individual differences in physiological stress response. There is also less robust support for insecure attachment leading to symptom reporting and to more frequent health risk behaviors, especially substance use and treatment nonadherence. Evidence supports the prediction from attachment theory that the benefits of social support derive more from attachment relationships than nonattachment relationships. CONCLUSIONS: Although the available data are suggestive rather than conclusive, the data can be organized into a model that describe attachment insecurity leading to disease risk through three mechanisms. These are increased susceptibility to stress, increased use of external regulators of affect, and altered help-seeking behavior. This model warrants further prospective investigation.     

Children with physical handicaps and their mothers: the interrelation of social support, maternal adjustment, and child adjustment.

Examined the interrelation of maternal adjustment, mother-child interaction, and child adjustment in 29 families of children with spina bifida and without mental retardation and in 28 families of children without handicaps. A multivariate, ecological model proposed that adjustment of mother and child depends on the adaptiveness of maternal response to the stress of the physical handicap and on the ability of mothers to create an optimal caregiving environment through mother-child interaction. Analyses examining the relationships among maternal social support, maternal psychological adjustment, and child adjustment are reported. Social support was found to be related to higher maternal psychological adjustment and to higher child adjustment, and maternal psychological adjustment was related positively to child adjustment in both groups. No significant differences were found between groups in the examined relationships or in the levels of resources and adjustment. Results underscore strengths of families of children with spina bifida in their adaptation to the stress of the handicap.     

Training competent psychologists in the field of child maltreatment

Child maltreatment is a serious threat to children's physical and psychological well-being; therefore, it is critically important to develop high-quality educational programs to train psychologists in effectively addressing child abuse and neglect. Various health care disciplines and areas within the field of psychology have established competencies as a guide for student training curricula; however, none have been established for the area of child maltreatment. The present article presents training competencies for the field of child maltreatment that have been developed from a program designed to train psychology graduate students to practice and conduct research in child maltreatment. The competencies have been divided into eight core areas including assessment, treatment, multidisciplinary collaboration, advocacy, ethics, research, research ethics, and professional development.