The psychological maltreatment of children--technical report

Psychological maltreatment is a common consequence of physical and sexual abuse but also may occur as a distinct entity. Until recently, there has been controversy regarding the definition and consequences of psychological maltreatment. Sufficient research and consensus now exist about the incidence, definition, risk factors, and consequences of psychological maltreatment to bring this form of child maltreatment to the attention of pediatricians. This technical report provides practicing pediatricians with definitions and risk factors for psychological maltreatment and details how pediatricians can prevent, recognize, and report psychological maltreatment. Contemporary references and resources are provided for pediatricians and parents     

Facilitators and barriers to implementation of an evidence-based parenting intervention to prevent child maltreatment: the Triple P-Positive Parenting Program

The prevention of child maltreatment via parenting interventions requires implementation on a broad scale, which is facilitated by drawing on a multidisciplinary array of service workers located in multiple settings. This underscores the importance of understanding factors that impact worker implementation of evidenced-based parenting and family support interventions. This study involved structured interviews with 174 service providers from several disciplines who had been trained previously in the delivery of the Triple P-Positive Parenting Program. These follow-up interviews, conducted an average of about 2 years after professional in-service training, provided the basis for examining predictors of sustained program use. Predictors examined included facilitators and barriers to program use, as well as organizational and provider-level characteristics such as attitudes toward evidence-based interventions. Highlighting the importance of a systems-contextual perspective on implementation, several provider and organization-level characteristics significantly predicted program use including provider self-confidence after training, fit of program with ongoing duties, availability of posttraining support, and perceived benefit of intervention for children and families. Implications for prevention and implementation science are discussed in view of the challenges inherent in the field of child maltreatment.     

Child maltreatment and foster care: unpacking the effects of prenatal and postnatal parental substance use

Parental substance use is a well-documented risk for children. However, little is known about specific effects of prenatal and postnatal substance use on child maltreatment and foster care placement transitions. In this study, the authors unpacked unique effects of (a) prenatal and postnatal parental alcohol and drug use and (b) maternal and paternal substance use as predictors of child maltreatment and foster care placement transitions in a sample of 117 maltreated foster care children. Models were tested with structural equation path modeling. Results indicated that prenatal maternal alcohol use predicted child maltreatment and that combined prenatal maternal alcohol and drug use predicted foster care placement transitions. Prenatal maternal alcohol and drug use also predicted postnatal paternal alcohol and drug use, which in turn predicted foster care placement transitions. Findings highlight the potential integrative role that maternal and paternal substance use has on the risk for child maltreatment and foster care placement transitions.     

Stress and anger as contextual factors and preexisting cognitive schemas: predicting parental child maltreatment risk

Progress in the child maltreatment field depends on refinements in leading models. This study examines aspects of social information processing theory (Milner, 2000) in predicting physical maltreatment risk in a community sample. Consistent with this theory, selected preexisting schema (external locus-of-control orientation, inappropriate developmental expectations, low empathic perspective-taking ability, and low perceived attachment relationship to child) were expected to predict child abuse risk beyond contextual factors (parenting stress and anger expression). Based on 115 parents' self-report, results from this study support cognitive factors that predict abuse risk (with locus of control, perceived attachment, or empathy predicting different abuse risk measures, but not developmental expectations), although the broad contextual factors involving negative affectivity and stress were consistent predictors across abuse risk markers. Findings are discussed with regard to implications for future model evaluations, with indications the model may apply to other forms of maltreatment, such as psychological maltreatment or neglect.     

Family history and parental recognition of overweight in Croatian children

The aim of this study was to evaluate the perception of parents on the weight status of their offspring, particularly in relation to a family history of obesity and obesity-related illnesses. A cross-sectional study of 1,068 child-parent dyads sampled at school entry health examination was conducted (median age of the child 6.75 years, range 5.7-8.3 years, 50.3 % males). The parental perception of the weight status of their child was compared to the body mass index (BMI, kilogram per square meter), calculated from measured weight and height. Weight status (underweight, normal, overweight, and obese) was defined using the United States Centers for Disease Control and Prevention BMI for age reference charts. Backward multiple linear regression analysis was used to determine possible predictors of parental misclassification of overweight/obese children. Among this cohort of children, 12 % were overweight, 10.2 % obese, and 8.1 % were underweight. Only 24.8 % of obese children and 2.2 % of overweight children were considered "overweight" by their parents. A positive family history was not significantly associated with parental recognition of overweight. Parental misperception of overweight/obese children as being normal was related to the child BMI z-score (odds ratio (OR) 0.036; 0.012-0.111) and diabetes in family history (OR 3.187; 1.207-8.413). CONCLUSION: The majority of parents did not perceive their overweight/obese children as overweight. As having an obese family member or one who has suffered from an obesity-related illness does not increase the parental ability to recognize overweight in their children, strategies to increase public awareness about the importance of one's family medical history are needed.     

The role of marital discord and parenting in relations between parental problem drinking and child adjustment

BACKGROUND: Research suggests that children exposed to parental drinking problems are at risk for maladjustment. However, the potential impact of drinking problems in a community sample and the processes involved in the relationship between parental drinking and child outcomes have rarely been examined. METHOD: A community sample of 235 mothers and fathers of kindergarten children completed measures of problem drinking symptoms, family functioning and child adjustment. RESULTS: Model tests indicate that problem drinking was associated with greater marital conflict, and that marital conflict was related to ineffective parenting which was in turn related to poorer child adjustment. CONCLUSIONS: Even in a community sample, parental problem drinking behaviors are associated with reduced family functioning that relates to child outcomes.     

Health concerns of university women with a history of child physical and sexual maltreatment

Three health symptom checklists were used to measure physical health concerns among university women in relation to prior child physical maltreatment (CPM) (20%, n = 153) and child sexual abuse (CSA) (19%, n = 143). A history of CPM was related to all three general areas of health concerns as well as to many of the specific subscales comprising the measures (e.g., muscular-skeletal symptoms and gynerological problems), whereas an interaction between CSA and CPM was linked to greater premenstrual distress subscale scores (particularly emotional and behavioral symptoms). Overall, although CSA was not related to health symptoms, within the CSA subgroup, greater duration and severity of CSA was predictive of higher premenstrual distress even after controlling for CPM. This study emphasizes the need for greater awareness of the physical health-related correlates of both physical and sexual maltreatment in childhood and their associated implications for women's health care needs.     

The relation between the absolute level of parenting and differential parental treatment with adolescent siblings' adjustment

BACKGROUND: The present study extends existing studies on the role of differential parental treatment in explaining individual differences in adolescent problem behaviors above the absolute level of parenting and clarifies the function of gender of the child, birth rank and gender constellation of the sibling dyads. METHOD: The absolute level of parenting practices and differential treatment were examined in a sample of 288 Dutch families consisting of two parents and two adolescents. Parents reported on adolescent internalizing and externalizing problem behavior and adolescents reported on parental warmth and coercive control. RESULTS: Parenting dimensions were related to problem behavior for same- and mixed-gender sibling pairs, with coercive control as the strongest predictor. No direct association was found between differential parental treatment and child outcomes above the absolute levels of parenting in same-gender sibling pairs. However, differential maternal and paternal control was related to internalizing behavior of girls and differential paternal warmth was linked to externalizing behavior of the older siblings in mixed-gender sibling pairs. CONCLUSION: Differential parental treatment is uniquely associated with child problem behavior above the absolute level of parenting for girls and early-born children in mixed-gender sibling pairs. Any examination of the effects of differential treatment should not be undertaken without considering the gender and birth rank of the sibling pairs.     

Do parental smoking and history of allergy influence cord-serum IgE?

The associations between parental smoking habits during pregnancy, family history of allergy, and IgE levels in cord-serum IgE (clgE) were investigated prospectively in 1251 infants. Mean clgE levels were similar in infants with positive and negative family history of allergy (0.50 and 0.54 kU/1, respectively). In infants with a positive family history of allergy whose mothers smoked more than 10 cigarettes a day, however, the mean clgE level was significantly higher (0.78 kU/1) than that in infants of nonsmoking mothers (p = 0.011). Similarly, the mean clgE level was significantly higher in boys (0.61 kU/1) than in girls (0.51 kU/1) of nonsmoking parents (p = 0.03). However, in infants of smoking parents, there was no significant difference in the mean clgE level between boys and girls. A total of 178 (14%) mothers and 477 (38%) fathers were current smokers, and in 128 (10%) cases, both parents were active smokers. The mean clgE level tended to be slightly higher in infants of smoking mothers, especially when the mother consumed more than 10 cigarettes a day (0.63 vs 0.54 kU/1) (p > 0.05). Thus, clgE levels were higher only in genetically prone babies whose mothers consumed more than 10 cigarettes a day.     

Child and parental literacy levels within families with a history of dyslexia

Background: The present study concerns literacy and its underlying cognitive skills in Dutch children who differ in familial risk (FR) for dyslexia. Previous studies with FR‐children were inconclusive regarding the performance of FR‐children without dyslexia as compared to the controls. Moreover, van Bergen et al. (2011) recently showed that FR‐children with and without dyslexia differed in parental reading skills, suggesting that those who go on to develop dyslexia have a higher liability. The current study concerned 1) the comparison of three groups of children at the end of second grade and 2) the intergenerational transfer of reading and its underlying cognitive skills from parent to child. Method: Three groups of children were studied at the end of second grade: FR‐dyslexia (n = 42), FR‐no‐dyslexia (n = 99), and control children (n = 66). Parents and children were measured on naming, phonology, spelling, and word and pseudoword reading. Results: The FR‐dyslexia children were severely impaired across all tasks. The FR‐no‐dyslexia children performed better than the FR‐dyslexia children, but still below the level of the controls on all tasks; the only exception was rapid naming (RAN), on which they were as fast as the controls. Focusing on the FR subsample, parental reading and RAN were related to their offspring’s reading status. Conclusions: We replicated and extended van Bergen et al.’s study in showing that the FR‐children who develop dyslexia are likely to have a higher liability. Both the group comparisons and the parent–child relations highlight the importance of good RAN skills for reading acquisition.     

Health risk behaviors and attempted suicide in adolescents who report prior maltreatment

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of a high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9 to 12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. Thirteen percent of the adolescents had been maltreated: 5.2% reported prior physical abuse, 5.4% sexual abuse, and 2.7% both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were three times more likely than non-abused peers to drink alcohol and smoke cigarettes, almost twice as likely to use illicit drugs, six times more likely to self-induce vomiting, and five times more likely to attempt suicide. A student with a history of prior sexual abuse had a three and one-half times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicate that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.     

Perceptions of child maltreatment by parents from the Indian subcontinent: challenging myths about culturally based abusive parenting practices

Clinicians and researchers emphasize the importance of recognizing differential cross-cultural definitions of child maltreatment, cautioning awareness that some ethnic groups may use harsher methods to discipline their children. Using a mixed-method research approach, based on questionnaire and focus group data, 29 parents of South Asian descent provided input on their attitudes toward child discipline, maltreatment, and neglect. Study findings suggest that South Asian parents do not differ significantly from other populations in their judgment of appropriate parenting approaches; that is, persistent and excessive use of physical discipline was considered to be inappropriate, behaviors of parents that may have negative emotional consequences for children were recognized as inappropriate, and lack of proper supervision of children was seen as a concern. Notably, though, participants voiced their reluctance to contact child protective services should they encounter families struggling with abuse. Implications for practice and directions for future research are suggested.     

Child maltreatment in depressed adolescents: differences in symptomatology based on history of abuse

Research has demonstrated that youth who are sexually or physically abused are at greater risk for developing depression. Although the association between depression and child maltreatment has been well documented, much less is known about the potential differences in the clinical presentation of depressive symptomatology among these victims. The current study examines differences in symptoms of depression in adolescents based on differing histories of abuse (i.e., sexual abuse only, physical abuse only, sexual and physical abuse, and no history of sexual or physical abuse), abuse incident characteristics, and gender. Participants were drawn from a subsample (n = 548) from the National Survey of Adolescents who met criteria for major depressive episode in the past year. Results indicate significant differences in severity of depression and specific depressive symptoms based on type of abuse experienced and gender. Implications for the clinical assessment and treatment of depressed adolescents with regard to abuse history are discussed.     

Borderline personality disorder features and history of childhood maltreatment in mothers involved with child protective services

This study examines the history of childhood maltreatment and Borderline Personality Disorder (BPD) symptoms in mothers whose children were removed from the home by Child Protective Services (CPS) to identify potential targets for future intervention efforts. Forty-one mothers of children removed from the home due to abuse and/or neglect and 58 community-control mothers without CPS involvement were assessed for history of childhood maltreatment, alcohol and drug use, and BPD features. CPS-involved mothers scored significantly higher on measures of childhood maltreatment history and BPD features than did control mothers. The highest BPD scores were associated with the most severe histories of mothers' childhood maltreatment. In total, 50% of CPS-involved mothers reported elevated BPD features, compared with 15% of control mothers. Further, 19% of CPS-involved mothers had self-reported scores consistent with a BPD diagnosis, compared with 4% of control mothers. BPD features rather than maltreatment history per se predicted maternal involvement with CPS, controlling for alcohol and drug use predictors. The present data suggest that evidence-based treatments to address BPD symptoms may be indicated for some CPS-involved parents.     

School-based asthma surveillance: A comparison of student and parental report

This study addressed the comparability of data obtained from a student-based and parent-based asthma and respiratory health survey. Our goal was to ascertain whether there were meaningful and systematic differences in asthma classification based on symptom and diagnosis reports obtained separately from students and their parents. A brief, written survey, based on the International Study of Asthma and Allergy in Children questionnaire, was administered to 6th through 10th grade students in two schools in Oakland, CA, USA. Students who reported asthma-like indicators for the previous 12-month period were defined as positive and a more extensive questionnaire was mailed home to those parents. A more refined classification of asthma based on parent report of indicators was compared with student report. Forty-four percent of 1298 students were classified as positive for current asthma-like symptoms and 50% of parent surveys were returned. For the positive students with parent surveys, 59% were classified as 'probable' for asthma based on the parent survey. Overall, the agreement between parent and students' classification was 70%, and 83% for students with a parent report of physician diagnosis of asthma. Students who were discordant with parents for physician diagnosis of asthma were more likely to be male, and more likely to have a parent report of unscheduled Emergency Department visit for wheezing or trouble breathing. Findings indicated that with the exception of medication, students reported asthma indicators more frequently that parents, independent of classification. Student report of physician diagnosis with a 12-month report of an asthma symptom was determined to be a good indicator of probable current asthma. Inclusion of or reliance on a parental questionnaire is not likely to improve the reliability of a school-based asthma surveillance program in our population.