The dimensions of maltreatment: introduction

Child Behavior Problems and Maltreatment Exposure

OBJECTIVES

Establish the longitudinal cross-lagged associations between maltreatment exposure and child behavior problems to promote screening and the type and timing of interventions needed.

METHODS

The Longitudinal Studies of Child Abuse and Neglect, a multiwave prospective cohort study of maltreatment exposure, enrolled children and caregivers (N = 1354) at approximately age 4 and followed them throughout childhood and adolescence. Families completed 7 waves of data collection with each wave occurring 2 years apart. Maltreatment was confirmed using official case records obtained from Child Protective Services. Six-month frequencies of behavior problems were assessed via caregiver-report. Two random-intercept, cross-lagged panel models tested the directional relations between maltreatment exposure and externalizing and internalizing behaviors.

RESULTS

Maltreatment exposure predicted increases in externalizing behaviors at ages 8 (b = 1.06; 95% confidence interval [CI] 0.14-1.98), 12 (b = 1.09; 95% CI 0.08-2.09), and 16 (b = 1.67; 95% CI 0.30-3.05) as well as internalizing behaviors at ages 6 (b = 0.66; 95% CI 0.03-1.29), 12 (b = 1.25; 95% CI 0.33-2.17), and 14 (b = 1.92; 95% CI 0.76-2.91). Increases in externalizing behaviors predicted maltreatment exposure at age 12 (odds ratio 1.02; 95% CI 1.00-1.05).

CONCLUSIONS

Maltreatment exposure is robustly associated with subsequent child behavior problems, strengthening inferences about the directionality of these relations. Early screening of externalizing behaviors in pediatric settings can identify children likely to benefit from intervention to reduce such behaviors as well as prevent maltreatment exposure at entry to adolescence.

Contamination bias in the estimation of child maltreatment causal effects on adolescent internalizing and externalizing behavior problems

BACKGROUND

When unaddressed, contamination in child maltreatment research, in which some proportion of children recruited for a nonmaltreated comparison group are exposed to maltreatment, downwardly biases the significance and magnitude of effect size estimates. This study extends previous contamination research by investigating how a dual-measurement strategy of detecting and controlling contamination impacts causal effect size estimates of child behavior problems.

METHODS

This study included 634 children from the LONGSCAN study with 63 cases of confirmed child maltreatment after age 8 and 571 cases without confirmed child maltreatment. Confirmed child maltreatment and internalizing and externalizing behaviors were recorded every 2 years between ages 4 and 16. Contamination in the nonmaltreated comparison group was identified and controlled by either a prospective self-report assessment at ages 12, 14, and 16 or by a one-time retrospective self-report assessment at age 18. Synthetic control methods were used to establish causal effects and quantify the impact of contamination when it was not controlled, when it was controlled for by prospective self-reports, and when it was controlled for by retrospective self-reports.

RESULTS

Rates of contamination ranged from 62% to 67%. Without controlling for contamination, causal effect size estimates for internalizing behaviors were not statistically significant. Causal effects only became statistically significant after controlling contamination identified from either prospective or retrospective reports and effect sizes increased by between 17% and 54%. Controlling contamination had a smaller impact on effect size increases for externalizing behaviors but did produce a statistically significant overall effect, relative to the model ignoring contamination, when prospective methods were used.

CONCLUSIONS

The presence of contamination in a nonmaltreated comparison group can underestimate the magnitude and statistical significance of causal effect size estimates, especially when investigating internalizing behavior problems. Addressing contamination can facilitate the replication of results across studies.

Trajectories of resilience among young children involved with child protective services

Although child maltreatment is associated with short- and long-term maladaptive outcomes, some children are still able to display resilience. Currently, there is a limited understanding of how children's resilience changes over time after experiencing maltreatment, especially for young children. Therefore, the current study used a longitudinal, multidimensional approach to examine trajectories of resilience among very young children involved in child protective services and determine whether placement setting and caregiving behaviors are associated with resilience trajectories. This study used data from National Survey of Child and Adolescent Well-Being I and conducted repeated measures latent class analysis, focusing on children under 2 years old at baseline (n = 1,699). Results suggested that there were three trajectories of resilience: increasing resilience, decreasing resilience, and stable, low resilience. Caregiver cognitive stimulation was related to increasing trajectories of resilience compared to both decreasing and stable, low resilience. These findings illustrate the importance of caregiving behaviors for promoting resilience among a particularly vulnerable population.

Identifying Trajectories of Maltreatment Revictimization and Juvenile Justice Outcome: A Latent Class Analysis of Subtype, Timing, and Chronicity

Continued exposure to abuse or neglect is a strong predictor for immediate and long-term negative developmental outcomes including developmental delays, disabilities, poor school performance, criminal behavior, and mental health issues. The purpose of this study was to identify distinct subgroups of children with repeat victimization based on maltreatment timing, subtype, and chronicity and to examine how the unique subgroups are related to youth's juvenile justice outcome. Using data from Longitudinal Studies of Child Abuse and Neglect, this study included 286 children (47% males, 41% blacks) with more than one report for substantiated maltreatment from birth to age 17. Latent class analysis was employed to identify heterogeneity in the patterns of maltreatment revictimization. Four latent classes emerged: (a) Prevailing Early Neglect (52.6%); (b) Co-occurring Maltreatments in Preschool Age (20.1%); (c) Incremental Neglect with Sexual Abuse in School Age (18.7%); and (d) Co-occurring Maltreatments in School Age (8.6%). Black children were overrepresented in Incremental Neglect with Sexual Abuse in School Age compared to white and other racial groups of children. Ordinal logistic regression analysis indicated that there was no significant difference in the juvenile justice outcome across four subgroups of children with revictimization. Our person-centered investigations of maltreatment subtype, timing, and chronicity highlight the need for precise assessment and prevention strategies based on a more nuanced understanding of various patterns of childhood maltreatment revictimization.

Disentangling Poverty From Neglect: Using a Person-Centered Approach to Examine Risk Factors for Neglect Among Families in Poverty

Approximately 18% of U.S. children under 5 years old live in poverty, which is one of the strongest predictors of child neglect. However, most families in poverty do not engage in neglect and this may be due to heterogeneity in risk factors. This study examined how risk factors co-occurred among families in poverty across early childhood and whether risk profiles were differentially related to physical and supervisory neglect across time. Results suggested there were four risk profiles across early childhood (i.e., years 1 and 3). At year 1, the four profiles in order of prevalence were: Low Risk, High Risk, Depressed and Uninsured, and Stressed with Health Problems. At year 3, the profiles were: Low Risk, High Risk, Depressed with Residential Instability, and Stressed with Health Problems. Overall, the High Risk profile was associated with more physical and supervisory neglect across time compared to the Low Risk profile; however, the Stress with Health Problems profile was also associated with greater physical neglect. These findings illustrate heterogeneity in the risk factors among families in poverty and demonstrate the differential impact of risk exposure on later neglect. Results also provide evidence to practitioners and policymakers about target risk experiences to prevent neglect.

Comprehensive Health Assessment for Children in Out-of-Home Care: An Exploratory Study of Service Needs and Mental Health in a Norwegian Population

A comprehensive model for routine multi-disciplinary health assessment for children in out-of-home care was piloted in a Norwegian region. This paper reports on identified service needs and mental disorders among 196 children (0-17 years) receiving the assessment. Cross-sectional data was extracted from assessment reports. Results show needs across a range of services, with a mean of 2.8 recommended services for children aged 0-6 and 3.3 for children aged 7-17. Mental disorders were identified in 50% of younger children, and 70% of older children. For all children, overall service need was associated with mental disorders, in addition to male gender among younger children. Need for specialized mental health services was associated with mental disorders among younger children and increasing age among older children. The high frequency of service needs and mental disorders illustrate the importance of offering comprehensive health assessments routinely to this high-risk child population and necessitates coordinated service delivery.

Differential Pathways from Child Maltreatment Types to Insecure Adult Attachment Styles via Psychological and Social Resources: A Bayesian Network Analysis

Child maltreatment has been linked to insecure adult attachment. However, it is not yet clear how different child maltreatment types are associated with attachment-related anxiety and avoidance in adulthood; and whether resilience against these insecure attachment styles is dependent on risk-specific resources. Therefore, this study explored differential pathways from child maltreatment types to attachment-related anxiety and avoidance in adulthood and examined whether psychological resources (self-esteem) and social resources (perceived social support) show risk-specific effects. An online survey retrospectively assessed experiences of child maltreatment, the level of attachment-related anxiety and avoidance in adulthood, self-esteem, and perceived social support in N = 604 former members of fundamentalist Christian faith communities (mean age = 41.27 years, SD = 12.50; 65.90% female). Cross-sectional data was analyzed using Bayesian network analysis. Only emotional child maltreatment showed direct relationships to insecure adult attachment. Specifically, emotional abuse and emotional neglect were associated with anxious and avoidant adult attachment, respectively. The effects of other child abuse types on adult attachment were mediated through emotional abuse, which indicated patterns of complex traumatization. Self-esteem mediated the effect of emotional abuse on anxious attachment, while perceived social support mediated the effect of emotional neglect on avoidant attachment. Social support was also linked to self-esteem and was therefore also important for individuals with experiences of emotional abuse. This study showed that child maltreatment types and their interactions are meaningfully linked to attachment-related anxiety and avoidance in adulthood. Interventions for survivors of child maltreatment should focus on risk-specific resources to support their resilience.

Recurrence of Substantiated Maltreatment Reports between Low-Income Parents With Disabilities and Their Propensity-Score Matched Sample Without Disabilities

Using the Longitudinal Studies of Child Abuse and Neglect dataset, 127 low-income parents with disabilities and a propensity score matched sample of 254 parents without disabilities were compared for the rates of repeated substantiated child maltreatment allegations and potentially distinct risks for substantiated child maltreatment recurrence. The number of substantiated child maltreatment allegations was not significantly higher for low-income parents with disabilities (M = 1.17, SD = 1.83) than their matched sample (M = .93, SD = 1.44) (t = -1.29, p = .197). Findings from the negative binomial regression indicated that parental disability was also not a significant predictor for repeated substantiated child maltreatment allegations among low-income parents after controlling other risk factors (Exp(B) = 1.16, p < .353). In both groups, black parents were more likely to have repeated substantiated maltreatments than white parents. For parents with disabilities, being an older parent, receiving SNAP benefits, having a daughter, and having a child in continued out-of-home care significantly increased the risk for repeated substantiations while having a GED or higher education degree and living with a larger number of family decreased the risk. For parents without disabilities, family instability was the only additional risk factor for repeated maltreatment substantiations.

Child maltreatment, parent-child relationship quality, and parental monitoring in relation to adolescent behavior problems: Disaggregating between and within person effects

BACKGROUND

Parent-child relationship quality (PCRQ) and parental monitoring (PM) are associated with adolescent behavior problems following child maltreatment (CM). Whether these associations are best characterized as between (trait) or within-person (state) differences is unknown.

OBJECTIVE

Disaggregate between and within-person effects for PCRQ and PM on adolescent behavior problems and test whether these effects vary as a function of prior CM.

PARTICIPANTS AND SETTING

Participants (n = 941) are from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN).

METHODS

Multi-level modeling was employed using PCRQ, PM, and adolescent behaviors assessed at ages 12, 14, and 16 and confirmed CM prior to age 12.

RESULTS

At the between-person level, adolescents with higher average levels of PCRQ and PM had significantly lower initial levels of externalizing (b = -9.47 and -5.54, respectively, p's < 0.05; possible range 0-66) and internalizing behaviors (b = -4.45 and -6.41, respectively, p's < 0.001; possible range 0-62). At the within-person level, greater declines in externalizing and internalizing behaviors were found when individuals reported higher-than-usual levels of PCRQ (b = -4.99 and -2.59, respectively, for externalizing and internalizing, p's < 0.001) and PM (b = -3.58 and -1.69, respectively, for externalizing and internalizing, p's < 0.001). There was an interaction between PM and CM on internalizing behaviors over time (b = -1.15, p = 0.026).

CONCLUSIONS

There are between and within-person effects of PCRQ and PM on adolescent behavior problems. Adolescents with CM histories and low levels of PM may be at risk for sustained internalizing behaviors.

Psychometric properties and normative data of the childhood trauma questionnaire-short form in Chinese adolescents

Background

The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a widely utilized instrument of childhood maltreatment (CM). However, psychometric properties and normative data of the CTQ-SF for Chinese adolescents are still unknown.

Objective

To examine psychometric properties and normative data of Chinese version CTQ-SF in a nationally representative sample of Chinese adolescents, including internal consistency reliability, test-retest reliability, structural validity, and convergent validity.

Method

A total of 20,951 adolescents aged 12 to 18 years were recruited from five provinces across China. Item analysis was used for 25 clinical items of the CTQ-SF. Confirmatory factor analysis was performed to examine fit indices of the factor structure. The Adverse Childhood Experiences Scale (ACEs) was used to evaluate convergent validity. The percentile ranks for scores of the CTQ-SF and each subscales were presented.

Results

According to the results of three methods in Item analysis, Item 4 should be dropped. The remaining 24 clinical items achieved satisfactory fits in an alternative four-factor model. The alternative CTQ-SF showed acceptable internal consistency and the Cronbach's α of the four subscales was 0.824 (Neglect), 0.755 (Sexual Abuse), 0.713 (Physical Abuse), and 0.666 (Emotional Abuse), respectively. Besides, test-retest reliability and convergent validity of the alternative CTQ-SF were also acceptable.

Conclusion

The alternative four-factor model CTQ-SF exhibits good reliability and validity among Chinese adolescents. Additionally, the normative information of the CTQ-SF could provide practical support for determining severity of different subtypes of CM.

Complex early childhood experiences: Characteristics of Northern Territory children across health, education and child protection data

Early identification of vulnerable children to protect them from harm and support them in achieving their long-term potential is a community priority. This is particularly important in the Northern Territory (NT) of Australia, where Aboriginal children are about 40% of all children, and for whom the trauma and disadvantage experienced by Aboriginal Australians has ongoing intergenerational impacts. Given that shared social determinants influence child outcomes across the domains of health, education and welfare, there is growing interest in collaborative interventions that simultaneously respond to outcomes in all domains. There is increasing recognition that many children receive services from multiple NT government agencies, however there is limited understanding of the pattern and scale of overlap of these services. In this paper, NT health, education, child protection and perinatal datasets have been linked for the first time. The records of 8,267 children born in the NT in 2006-2009 were analysed using a person-centred analytic approach. Unsupervised machine learning techniques were used to discover clusters of NT children who experience different patterns of risk. Modelling revealed four or five distinct clusters including a cluster of children who are predominantly ill and experience some neglect, a cluster who predominantly experience abuse and a cluster who predominantly experience neglect. These three, high risk clusters all have low school attendance and together comprise 10-15% of the population. There is a large group of thriving children, with low health needs, high school attendance and low CPS contact. Finally, an unexpected cluster is a modestly sized group of non-attendees, mostly Aboriginal children, who have low school attendance but are otherwise thriving. The high risk groups experience vulnerability in all three domains of health, education and child protection, supporting the need for a flexible, rather than strictly differentiated response. Interagency cooperation would be valuable to provide a suitably collective and coordinated response for the most vulnerable children.

Relationship between Child Abuse and Delinquent Behavior in Male Adolescents Deprived of Liberty

The objective is to identify the prevalence of child abuse and criminal behavior among young male prisoners in Ecuador.

METHOD

A total of 425 young people between 12 and 18 years of age, deprived of liberty from different centers for adolescent offenders in Ecuador, were used. The level of abuse to which they had been subjected in childhood was evaluated, as well as the risk factors present in their history. The relationship between abuse, risk factors, and criminal behavior was analyzed.

RESULTS

A high prevalence of the different types of abuse was found in the mean age of 15.03 years standard deviation (SD = 1.34).

CONCLUSION

In addition, a relationship was discovered between the abuse suffered during childhood and the risk factors present in criminal behavior during adolescence, which was demonstrated in this article. The practical implications of these results are discussed, taking into consideration their relevance for prevention.

Neglect in Childhood, Problem Behavior in Adulthood

Few studies have reported problem behaviors in adulthood related to the timing of child neglect. The objective was to examine the relationship between classes of child neglect and later behavior. The sample included 473 participants from the prospective Longitudinal Studies of Child Abuse and Neglect (LONGSCAN); their mean age was 23.8 years. They completed an online survey regarding behaviors and experiences in early adulthood. Neglect was assessed via Child Protective Services (CPS) and self-reports of neglect. Latent class analysis (LCA) identified three classes: Late Neglect, Chronic Neglect, and Limited Neglect. There were significant differences between Limited and Late Neglect regarding later intimate partner aggression and violence (IPAV) and psychological distress, and among all classes for criminal behavior. High-risk youth experiencing neglect beginning in mid-adolescence appear especially vulnerable to later criminal behavior, psychological distress, and IPAV. Those working with such youth can help ensure that their needs are adequately met, to prevent or mitigate problems in adulthood.

Can early childhood education be compensatory? Examining the benefits of child care among children who experience neglect

Children that experience neglect are at risk for maladaptive outcomes. One potential resource for these children is early childhood education (ECE), but there is currently limited evidence which is compounded by data limitations. This study used data from the National Study of Child and Adolescent Well-being II (N = 1,385) to compare children's cognitive and social-emotional outcomes among children involved in child protective services that experienced either no care, informal care, or formal care, as well as moderation by type of neglect. Results suggest that ECE was related to increased cognitive and social skills and decreased behavior problems, depending on whether the child attended informal or formal care, with some associations being stronger for children that experienced neglect. These findings have implications for practitioners and policymakers in the intersection of ECE and child protective services.

Controlling contamination in child maltreatment research: Impact on effect size estimates for child behavior problems measured throughout childhood and adolescence

Contamination, when members of a comparison or control condition are exposed to the event or intervention under scientific investigation, is a methodological phenomenon that downwardly biases the magnitude of effect size estimates. This study tested a novel approach for controlling contamination in observational child maltreatment research. Data from The Longitudinal Studies of Child Abuse and Neglect (LONGSCAN; N = 1354) were obtained to estimate the risk of confirmed child maltreatment on trajectories of internalizing and externalizing behaviors before and after controlling contamination. Baseline models, where contamination was uncontrolled, demonstrated a risk for greater internalizing (b = .29, p < .001, d = .40) and externalizing (b = .14, p = .040, d = .19) behavior trajectories. Final models, where contamination was controlled by separating the comparison condition into subgroups that did or did not self-report maltreatment, also demonstrated risks for greater internalizing (b = .37, p < .001, d = .51) and externalizing (b = .22, p = .028, d = .29) behavior trajectories. However, effect size estimates in final models were 27.5%-52.6% larger compared to baseline models. Controlling contamination in child maltreatment research can strengthen effect size estimates for child behavior problems, aiding future child maltreatment research design and analysis.

What about trauma? Accounting for trauma exposure and symptoms in the risk of suicide among adolescents who have been adopted

BACKGROUND

Research suggests that individuals who have been adopted are at increased risk for suicidal behaviors, but this research does not account for the role of trauma.

OBJECTIVES

The study provided rates of trauma exposure among individuals who were adopted with child welfare involvement. The study also examined risk of suicidal ideation (SI) and behaviors (SB) based on adoption status, first as bivariate associations and then in context of trauma exposure and symptoms.

PARTICIPANTS AND SETTING

Participants in the LONGSCAN study were recruited at multiple US sites based on various risk factors for maltreatment. The current study included only those individuals with adequate information at key timepoints (n = 894), 106 (11.9%) of whom were adopted.

METHODS

Measures were collected at multiple timepoints, including caregiver-report, self-report, and review of child welfare records. Data were analyzed through logistic regression and descriptive statistics.

RESULTS

High rates of potentially traumatic experiences were found among individuals who were adopted (over 93%). The bivariate logistic regression replicated previous findings that adolescents who were adopted had increased likelihood of endorsing SI (OR 2.14, 95% CI 1.27-3.60, p = .004) and SB (OR 2.40, 95% CI 1.24-4.63, p = .009) compared to non-adopted peers. However, when polytrauma and traumatic stress symptoms were added to the model, adoption was no longer a significant predictor for SI (OR 1.35, 95% CI 0.70-2.60, p = .369) or SB (OR 1.46, 95% CI 0.68-3.13, p = .332).

CONCLUSIONS

Although much remains to be explored about the association between adoption and risk for suicidal thoughts and behaviors, the current study indicates that traumatic stress plays a critical role.

Child Maltreatment and Substance Use in Emerging Adulthood: Internalizing and Externalizing Behaviors at the Transition to Adolescence as Indirect Pathways

One well-established outcome of child maltreatment is an increased likelihood of substance use in emerging adulthood. However, research identifying the indirect pathways that explain this relation is lacking, thereby limiting substance use prevention efforts for the child maltreatment population. The present study helped address this gap by accessing data from The Longitudinal Studies on Child Abuse and Neglect (LONGSCAN; n = 1,136), a prospective cohort study of child maltreatment from birth through age eighteen. Internalizing and externalizing problems at age twelve were examined as indirect effects of the relation between child maltreatment prior to age four and substance use at age eighteen. A multiple mediator model tested the total and specific indirect effects of internalizing and externalizing concerns while controlling for demographic risk factors. Results demonstrated that the total indirect effect for internalizing and externalizing behaviors was statistically significant, Standardized Point Estimate = 0.01, 95% CI: 0.00-0.02. Examination of the specific indirect effects revealed that only externalizing behaviors constituted an indirect pathway, Standardized Point Estimate = 0.01, 95% CI: 0.00-0.03. These results suggest that externalizing behaviors at the transition to adolescence are important intervention targets for reducing the risk for substance use in emerging adulthood in the child maltreatment population.

Racial differences in early adolescent substance use: Child abuse types and family/peer substance use as predictors

This study examined the associations among child abuse types, family/peer substance use, and adolescent substance use, as well as testing whether these associations vary by race. The sample was derived from the Longitudinal Studies of Child Abuse and Neglect (N = 562). Child sexual abuse, family substance use, and peer substance use were associated with a higher likelihood of adolescent substance use. Sexual abuse was more strongly associated with substance use in Black youth than in White youth. Conversely, greater peer substance use had a stronger association with substance use in White youth than in Black youth.

Measuring early life adversity: A dimensional approach

Exposure to adversity in childhood is associated with elevations in numerous physical and mental health outcomes across the life course. The biological embedding of early experience during periods of developmental plasticity is one pathway that contributes to these associations. Dimensional models specify mechanistic pathways linking different dimensions of adversity to health and well-being outcomes later in life. While findings from existing studies testing these dimensions have provided promising preliminary support for these models, less agreement exists about how to measure the experiences that comprise each dimension. Here, we review existing approaches to measuring two dimensions of adversity: threat and deprivation. We recommend specific measures for measuring these constructs and, when possible, document when the same measure can be used by different reporters and across the lifespan to maximize the utility with which these recommendations can be applied. Through this approach, we hope to stimulate progress in understanding how particular dimensions of early environmental experience contribute to lifelong health.

Protective factors against child neglect among families in poverty

BACKGROUND

Despite neglect being the most common form of maltreatment, it is still understudied relative to other maltreatment types. Further, there is limited evidence on mechanisms through which to prevent child neglect and on mechanisms that might buffer the risk of poverty.

OBJECTIVE

The current study estimated how different protective factors decreased subtypes of neglect, both physical and supervisory, across early childhood and in relation to poverty.

PARTICIPANTS AND SETTING

The final sample included 2980 mothers from the Fragile Families and Child Wellbeing Study.

METHODS

The current study used linear regressions in a structural equation modeling framework to estimate how protective factors at years 1 and 3 were related to neglectful parenting at years 3 and 5, as well as whether protective factors buffered the association between poverty and neglect.

RESULTS

Mothers' perceived instrumental social support, part-time employment, and full-time employment were associated with less physical neglect at both time points (β range from -0.15 to -0.05; all p < 0.05). Perceived instrumental social support was also related to less supervisory neglect at both times (β = -0.05, p < 0.05 for both times). Perceived instrumental social support significantly moderated the association between poverty at year 1 and physical neglect at year 3 (β = 0.06, p < 0.01).

CONCLUSIONS

These findings provide important information to practitioners and policymakers on potential mechanisms to reduce neglect, as well as reducing neglect among economically disadvantaged families.

Physiological Stress Response Reactivity Mediates the Link Between Emotional Abuse and Youth Internalizing Problems

Youth who are raised in emotionally abusive families are more likely to have poor mental health outcomes such as depression and anxiety. However, the mechanisms of this association are unclear. The present study utilized a longitudinal sample of low-SES youth (N = 101, M_ageT1 = 10.24) to examine stress response reactivity (i.e. vagal withdrawal, sympathetic activation, and hypothalamic-pituitary-adrenal [HPA] axis activation) as mediators between emotional abuse and prospective youth internalizing symptoms. Results indicated that blunted HPA reactivity to a laboratory social stress task mediated the association between emotional abuse and youth internalizing symptoms. Emotional abuse was also associated with blunted parasympathetic nervous system activity (i.e. less vagal withdrawal than average). In sum, emotional abuse is a potent risk factor for youth internalizing symptoms, and this link may be mediated via dysregulation in physiological stress response systems. Primary prevention of childhood emotional abuse and secondary prevention programs that target self-regulation skills may reduce rates of youth internalizing symptoms and disorders.

Threat-specific maltreatment exposure: Comparison of measurement models and associations with internalizing, externalizing, and PTSD symptoms

BACKGROUND

Child maltreatment is associated with short- and long-term mental health sequelae. Extant research has demonstrated that exposure characteristics (i.e., severity, frequency, duration, onset) are important in the measurement of maltreatment experiences. Emerging research has highlighted the contributions of these characteristics on symptom outcomes.

OBJECTIVE

The current study used multiple exposure characteristics of threat-specific types of maltreatment (i.e., physical abuse, sexual abuse, witnessing domestic violence) to examine three distinct measurement models of maltreatment and their relation to symptoms.

PARTICIPANTS AND SETTING

A racially and ethnically diverse sample of treatment-seeking youth (74 % female) ages 4-17 (N = 348) participated in the study. The majority of the youth (61 %) endorsed experiencing more than one type of threat-specific maltreatment.

METHOD

Using Structural Equation Modeling, we tested one-factor, three-factor, and bifactor models of maltreatment characteristics, and hypothesized that the bifactor model would yield the best fitting model based on prior studies supporting family violence as an underlying factor for child physical abuse and domestic violence.

RESULTS

The bifactor measurement model fit the data better than the three- and one-factor models. In the bifactor structural model that included symptom outcomes, physical abuse was significantly and positively associated with child internalizing and externalizing symptoms, whereas sexual abuse and witnessing domestic violence were associated with externalizing symptoms and PTSD.

CONCLUSION

Our findings support the inclusion of multiple exposure characteristics in the measurement of maltreatment and suggest that specific types of threat-specific maltreatment may have distinct associations with mental health sequelae.

The roles of child maltreatment types and peer relationships on behavior problems in early adolescence

BACKGROUND

Although previous research has established that child maltreatment (CM) and peer relationships (i.e., deviant peer affiliation, being ignored by peers) are strong predictors of adolescent internalizing (INT) and externalizing (EXT) behavior problems, no study has examined the above effects concurrently. Nor have researchers investigated the potential peer relationship differences in the effects of CM types on adolescent behavior problems. Thus, this study aims to examine the independent and combined effects of different types of CM and peer relationships on behavior problems.

METHODS

The Generalized Estimating Equations approach was conducted using the Longitudinal Studies of Child Abuse and Neglect. Child-Protective-Services reports and youth self-reports were used for each type of CM. Deviant peer affiliation (DP) has been assessed using a modified version of the Youth-Risk-Behavior-and-Monitoring-the-Future Survey, while being ignored by peers was assessed using a single question. Adolescent INT and EXT were measured using the Youth-Self-Report.

RESULTS

Emotional abuse was associated with both INT and EXT, whereas physical abuse was associated with EXT. Higher DP and higher incidence of being ignored by peers were both associated with higher levels of INT and EXT. Emotionally abused youth with higher levels of DP had less INT, compared to emotionally abused youth with lower levels of DP.

CONCLUSION

The Findings indicate the need for interventions that 1) take into account the different effects of CM types, specifically for emotionally abused youth; 2) help youth to build positive relationships with peers; and 3) work to reduce the possibility of affiliation with deviant peers.

Longitudinal association between deviant peer affiliation and externalizing behavior problems by types of child maltreatment

BACKGROUND

Previous research has documented that deviant peer affiliation (DP) and externalizing behavior problems (EXT) are highly related and often co-occur. However, the directionality of the association between DP and EXT remains debatable. In addition, few studies have examined the longitudinal effects of child maltreatment types on co-development of DP and EXT overtime. Therefore, this study examined the role of child maltreatment in predicting the co-development of DP and EXT.

METHODS

DP and EXT were assessed at ages 12, 14, and 16. DP was measured using 13 items from the modified version of the Youth Risk Behavior and Monitoring the Future Survey. EXT was measured using the Child Behavior Checklist. Each type of child maltreatment (birth to age 12) was assessed using the CPS substantiated cases.

RESULTS

The results indicated that, on average, DP increased over time, whereas EXT decreased over time. In addition, the initial levels of EXT were associated with the slope of DP. Conditional parallel-process latent growth curve modeling identified that physically abused adolescents had higher initial levels of DP and showed a slower increase in DP, while those who had been emotionally abused were associated with a steeper decrease in EXT.

CONCLUSION

The findings offer several meaningful implications for practice. First, early assessment of and treatment for EXT may be helpful in preventing DP over time. In addition, practitioners could assess each type of maltreatment to tailor preventive interventions for early onset and ongoing development of DP and EXT.

Development and validation of a retrospective self-report measure of childhood neglect

BACKGROUND

Several measures are available to assess childhood physical and sexual abuse, but few measures focus specifically on neglect and little psychometric research on measures exists. This paper aims to fill a gap in the field by describing a new instrument to measure childhood neglect retrospectively and providing information about construct, predictive, and discriminant validity using adults with documented histories of childhood neglect.

METHODS

Data are from a large prospective, longitudinal study of abused and neglected children and matched controls followed up and assessed in adulthood. The current sample (N =717) includes 370 individuals with histories of childhood neglect and 347 demographically matched controls without those histories. Self-reports of childhood neglect were collected in in-person interviews at approximate age 40. Participants responded to a pool of items representing neglect. Missing responses were treated as substantive information in analyses. An optimal set of items was selected using Support Vector Machine (SVM) - a machine leaning algorithm. Neglect severity, diversity and SVM-based propensity scores were tested for predictive, construct and discriminant validity.

RESULTS

The optimal item subset included 10 items. The propensity scale measured with this optimal subset passed all validity tests, showing high predictive validity for neglect, discrimination between documented cases of neglect and abuse, and significant correlation with violence in adulthood (construct validity). The simple severity and diversity scores failed in at least one of the validity tests.

CONCLUSIONS

This new instrument shows promise in detecting experiences of childhood neglect retrospectively. Missing responses were found informative in recollections of childhood neglect.

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.

Child Maltreatment, Fathers, and Adolescent Alcohol and Marijuana Use Trajectories

Background: Little is known about heterogeneity in developmental trajectories of alcohol and marijuana use among at-risk youth. Objective: This study aims to examine how child maltreatment and father structural factors at different stages in the life course are associated with different patterns of alcohol and marijuana use trajectories. Methods: A sample of youth (N = 903) were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Latent class growth analysis was employed to assess heterogeneity in patterns of adolescent alcohol and marijuana use. In addition, binary logistic regression analysis was performed to examine child maltreatment and father structural factors across different developmental stages as predictors of membership in the identified alcohol and marijuana use trajectory classes. Results: For both alcohol and marijuana use, two distinct latent classes were identified: stable no/low alcohol use (74%) vs. increasing alcohol use (26%); stable no/low marijuana use (85%) vs. increasing marijuana use (15%). Emotional abuse during early childhood and physical abuse during adolescence predicted membership in the increasing alcohol use and the increasing marijuana use classes. The presence of father in the home during early childhood was associated with lower likelihood of being in the increasing alcohol use class. Conclusions: Our findings highlight the importance of understanding the etiology of adolescent substance use through a developmental lens. Screening of exposure to child maltreatment across different developmental stages and interventions promoting father engagement during early childhood might help mitigate the risk of adolescent alcohol and marijuana use.

The Type and Timing of Child Maltreatment as Predictors of Adolescent Cigarette Smoking Trajectories

Background: There is limited research examining the association between child maltreatment and cigarette smoking as a specific type of adolescent substance use, and research examining high-risk samples and variations based on maltreatment type and timing remain sparse. Objectives: The primary aim of the study was to examine the relationship between child maltreatment and cigarette smoking trajectories. Methods: Latent class growth analysis and multinomial logistic regression were performed on 903 youth drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Results: Three distinct classes of cigarette smoking trajectories were identified: (1) Stable no/low cigarette use (61%); (2) Gradually increasing cigarette use (30%); and (3) Sharply increasing cigarette use (9%). Physical abuse during early childhood and adolescence predicted membership in the sharply increasing cigarette use class. Neglect during early childhood predicted membership in the gradually increasing cigarette use class. Conclusions: Findings suggest that interventions for adolescent cigarette smoking should integrate trauma-informed approaches. Further, the results highlight early childhood and adolescence as particularly vulnerable periods with respect to the influence of physical abuse and neglect on cigarette smoking, pointing to the need for additional maltreatment prevention efforts during these developmental stages.

Child Maltreatment Severity Questionnaire (MSQ) for Professionals: Development, Validity, and Reliability Evidence

This article presents the development and validation of the child Maltreatment Severity Questionnaire (MSQ), aiming to contribute to increase the quality and efficiency of evaluation processes in the Child Protection System (CPS). To obtain a valid and reliable instrument, a set of studies was developed: Study 1—Based on two previous studies, the questionnaire was developed and the severity level of the items within maltreatment subtypes was assigned by 93 professionals from the welfare and CPS system. Consensus about the severity levels was assessed and described in terms of within-item reliability rankings; Study 2—The MSQ was filled out for 253 children and adolescents referred to the CPS. To ensure that the items within different subtypes of maltreatment were homogenous and had internal consistency, a reliability analysis was performed; Study 3—The MSQ was filled out for 1,000 children and adolescents referred to the CPS. This study involved testing validity evidence through an exploratory and a confirmatory factor analysis. We also analyzed the internal consistency, sensibility (i.e., sex and age differences) and concurrent validity of the MSQ. Findings support the adequacy and reliability of the MSQ to be used by CPS professionals in evaluating child maltreatment.

Timing and chronicity of child neglect and substance use in early adulthood

BACKGROUND

Neglect is the most common form of child maltreatment with consequences that appear to be as serious as for abuse. Despite this, the problem has received less than its due attention.

OBJECTIVE

To examine the relationship between the timing and chronicity of neglect during childhood and substance use in early adulthood.

PARTICIPANTS AND SETTING

The sample consisted of a subset of 475 participants from the prospective Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) consortium from five geographic areas around the U.S.

METHOD

Neglect was assessed using abstracted information from CPS reports (birth-18) and self-reports of neglect (12-18). Participants completed a follow-up online survey (mean age of 24 years) that probed their use of substances.

RESULTS

The prevalence of substance use during the past year was comparable in this high-risk sample to the general population. Latent class analysis supported the presence of three groups related to the presence and timing of neglect: Chronic Neglect, Late Neglect and Limited Neglect. Late Neglect was the pattern most strongly linked to substance use in early adulthood.

CONCLUSIONS

High-risk youth experiencing neglect beginning in mid- adolescence are especially vulnerable to later substance use. Those working with such youth and their families can play a valuable role helping ensure their basic needs are adequately met, and recognizing early signs of substance use and abuse.

Timing of the first report and highest level of child protection response in association with early developmental vulnerabilities in an Australian population cohort

BACKGROUND

Childhood maltreatment is associated with early childhood developmental vulnerabilities. However, the extent to which higher levels of child protection responses confer benefit to developmental competencies, and the impact of earlier timing of first reports in relation to early childhood vulnerability remains unclear.

OBJECTIVE

We examined associations between early developmental vulnerabilities and (1) the highest level of child protection response (where OOHC was deemed the highest response among other types of reports/responses), and (2) the developmental timing of the first child protection report.

PARTICIPANTS AND SETTING

Participants included 67,027 children from the New South Wales Child Development Study, of whom 10,944 were reported to child protection services up to age 5 years.

METHODS

A series of Multinomial Logistic Regressions were conducted to examine focal associations.

RESULTS

Children with substantiated maltreatment reports showed the strongest odds of vulnerability on three or more developmental domains (adjusted OR = 4.90; 95% CI = 4.13-5.80); children placed in OOHC showed slightly better physical, cognitive and communication competencies (adjusted ORs from 1.83 to 2.65) than those with substantiated reports that did not result in OOHC placements (adjusted OR from 2.77 to 3.67), when each group was compared to children with no child protection reports. Children with first maltreatment reports occurring in the first 18 months of life showed the strongest likelihood of developmental vulnerabilities on three or more developmental domains (adjusted OR = 3.56; 95% CI = 3.15-4.01) relative to children with no child protection reports.

CONCLUSION

Earlier reports of maltreatment may signal the need for targeted remediation of early developmental competencies to mitigate early developmental difficulties.

Comparing cumulative index and factor analytic approaches to measuring maltreatment in the National Longitudinal Study of Adolescent to Adult Health

Child maltreatment is a complex and multifaceted construct in need of advanced statistical techniques to improve its measurement. The current study compared the predictive utility of a cumulative index to a factor analytic approach for constructing a measure of maltreatment. Data were from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (Wave III: n = 14,800; Wave IV: n = 12,288). As adults, participants retrospectively reported on their childhood experiences of physical abuse, sexual abuse, emotional abuse, physical neglect, supervisory neglect, and social services investigations. Both the cumulative index and a two-factor solution showed evidence of convergent validity, predicting lifetime incidence of homelessness, being paid for sex, and various measures of running away or living apart from biological parents, and prospectively predicting depression, substance use, and criminal behavior. The latent variables, derived from a factor analytic approach, had greater explanatory power for many outcomes compared to the cumulative index, even when controlling for sociodemographic variables. Results suggest that factor analysis is a better methodology than a cumulative index for measuring maltreatment in large datasets when explanatory power for external outcomes is of greatest concern.

The Role of Emotional Abuse in Youth Smoking

INTRODUCTION

The purpose of this prospective study is to examine the role of emotional abuse in predicting youth smoking.

METHODS

Data were drawn from the Longitudinal Studies of Child Abuse and Neglect. The sample was restricted to those who had an interview at age 12 years and at least one interview at ages 14, 16, or 18 years (n=775). Self-reported smoking at ages 14, 16, and 18 years was the time-varying dependent variable. Peer and household smoking were modeled as time-varying predictors. Type of abuse, youth sex, race/ethnicity, history of child neglect, and study site were modeled as time-invariant predictors. Dates of data collection from age 4 years to age 18 years range from July 1991 to January 2012. Analyses were conducted in 2017.

RESULTS

After controlling for a history of neglect, sex, race/ethnicity, study site, household and peer smoking, those with physical and/or sexual abuse only, or emotional abuse only, were at no greater risk of smoking compared with the no abuse group. However, those classified as having a combination of physical and/or sexual abuse and emotional abuse were at significantly greater risk for youth smoking compared with those with no reported physical/sexual or emotional abuse (β=0.51, z=2.43, p=0.015).

CONCLUSIONS

Emotional abuse, in combination with physical and/or sexual abuse, predicted youth smoking, whereas the other types of abuse (physical and/or sexual abuse), or emotional abuse alone, did not. Considering the important health implications of early smoking initiation, it is important to document critical influential factors to better inform intervention efforts.

Vulnerability or resilience to early substance use among adolescents at risk: The roles of maltreatment and father involvement

Although research has indicated that maltreated children are at higher risk of adolescent substance use, it remains unclear whether the type and timing of maltreatment affect the likelihood of adolescent substance use. Research has also found father involvement to be a potential protective factor against adolescent substance use, but the role of quality vs. quantity of father involvement as well as gender differences in the effects of father involvement on substance use among at-risk adolescents have not been studied. The current study adds value to the existing literature by filling these gaps in knowledge. We conducted a secondary data analysis with a sample of 685 at-risk adolescents drawn from the Longitudinal Studies of Child Abuse and Neglect. The study found a connection between early childhood (birth to 5) physical abuse and adolescent substance use, but not for later childhood physical abuse or other forms of child maltreatment. The quality of father involvement was found to be a protective factor, regardless of child gender; quantity of father involvement was not significant. Based on these findings, development of intervention strategies focusing on prevention of early childhood physical abuse and promoting positive father-child relationships are important prevention strategies for adolescent substance use. Additionally, professionals working with at-risk adolescents need to be cognizant of the implications of early childhood physical abuse and act accordingly to mitigate the increased potential for adolescent substance use.

Dimensions of maltreatment and academic outcomes for youth in foster care

Childhood maltreatment is often associated with youth's ability to successfully function in school. Youth with a history of maltreatment often receive lower grades and scores on tests of academic achievement, as well as demonstrate more negative behaviors in school, as compared to non-maltreated youth. However, there are many inconsistencies in previous studies examining the association between maltreatment and academic outcomes in youth. One potential reason for mixed findings within the literature could be a result of how maltreatment is measured and operationalized. The current study examined if the methods used to define and describe maltreatment contribute to the association between maltreatment and academic functioning in youth. Youth in foster care (N = 490, M_age = 13.13[3.09]) were recruited and information on their maltreatment history and academic functioning was obtained from official agencies, school records, and self-reported measures. Using a SEM framework when examining each dimension separately in the same model, results suggested that frequency maltreatment was more predictive of academic behavior, as compared to type and severity. No dimensions were associated with grades and significant findings were only observed for models using self-report data. However, when examined using a measurement model approach, maltreatment as a whole was associated with school behavior, which was found for both self-report and case file measurement models. The findings suggest a need for research on academic functioning to take a comprehensive approach when measuring and defining maltreatment as this may be a more robust and accurate predictor of academic functioning.

Gender differences in pathways from child physical and sexual abuse to adolescent risky sexual behavior among high-risk youth

This study investigated gender differences in the roles of internalizing and externalizing symptoms and substance use as pathways linking child physical and sexual abuse to risky sexual behavior among youth at risk of maltreatment. Path analysis was performed with 862 adolescents drawn from Longitudinal Studies of Child Abuse and Neglect. Four waves of data collected in the United States were used: childhood physical and sexual abuse experiences (from ages 0-12) were assessed by Child Protective Services reports, internalizing and externalizing symptoms were measured at age 14, substance use was measured at age 16, and risky sexual behavior was measured at age 18. Physical abuse was directly associated with risky sexual behavior in boys but not girls. For girls, physical abuse had a significant indirect effect on risky sexual behavior via externalizing symptoms. Gender-focused preventive intervention strategies may be effective in reducing risky sexual behavior among at-risk adolescents.

Does adult attachment style mediate the relationship between childhood maltreatment and mental and physical health outcomes?

Attachment theory has been proposed as one explanation for the relationship between childhood maltreatment and problematic mental and physical health outcomes in adulthood. This study seeks to determine whether: (1) childhood physical abuse and neglect lead to different attachment styles in adulthood, (2) adult attachment styles predict subsequent mental and physical health outcomes, and (3) adult attachment styles mediate the relationship between childhood physical abuse and neglect and mental and physical health outcomes. Children with documented cases of physical abuse and neglect (ages 0-11) were matched with children without these histories and followed up in adulthood. Adult attachment style was assessed at mean age 39.5 and outcomes at 41.1. Separate path models examined mental and physical health outcomes. Individuals with histories of childhood neglect and physical abuse had higher levels of anxious attachment style in adulthood, whereas neglect predicted avoidant attachment as well. Both adult attachment styles (anxious and avoidant) predicted mental health outcomes (higher levels of anxiety and depression and lower levels of self-esteem), whereas only anxious adult attachment style predicted higher levels of allostatic load. Path analyses revealed that anxious attachment style in adulthood in part explained the relationship between childhood neglect and physical abuse to depression, anxiety, and self-esteem, but not the relationship to allostatic load. Childhood neglect and physical abuse have lasting effects on adult attachment styles and anxious and avoidant adult attachment styles contribute to understanding the negative mental health consequences of childhood neglect and physical abuse 30 years later in adulthood.

Childhood Maltreatment and Early Developmental Vulnerabilities at Age 5 Years

This study examined associations between maltreatment and early developmental vulnerabilities in a population sample of 68,459 children (M_age  = 5.62 years, SD = .37) drawn from the Australian state of New South Wales, using linked administrative data for the children and their parents (collected 2001-2009). Associations were estimated between (a) any maltreatment, (b) the number of maltreatment types, and (c) the timing of first reported maltreatment and vulnerability and risk status on multiple developmental domains (i.e., physical, social, emotional, cognitive, and communication). Pervasive associations were revealed between maltreatment and all developmental domains; children exposed to two or more maltreatment types, and with first maltreatment reported after 3 years of age, showed greater likelihood of vulnerability on multiple domains, relative to nonmaltreated children.

Child Maltreatment and Risky Sexual Behavior

Risky sexual behavior is a serious public health problem. Child sexual abuse is an established risk factor, but other forms of maltreatment appear to elevate risky behavior. The mechanisms by which child maltreatment influence risk are not well understood. This study used data from 859 high-risk youth, followed through age 18. Official reports of each form of maltreatment were coded. At age 16, potential mediators (trauma symptoms and substance use) were assessed. At age 18, risky sexual behavior (more than four partners, unprotected sex, unassertiveness in sexual refusal) was assessed. Neglect significantly predicted unprotected sex. Substance use predicted unprotected sex and four or more partners but did not mediate the effects of maltreatment. Trauma symptoms predicted unprotected sex and mediated effects of emotional maltreatment on unprotected sex and on assertiveness in sexual refusal and the effects of sexual abuse on unprotected sex. Both neglect and emotional maltreatment emerged as important factors in risky sexual behavior. Trauma symptoms appear to be an important pathway by which maltreatment confers risk for risky sexual behavior. Interventions to reduce risky sexual behavior should include assessment and treatment for trauma symptoms and for history of child maltreatment in all its forms.

Predictive Risk Modelling to Prevent Child Maltreatment and Other Adverse Outcomes for Service Users: Inside the 'Black Box' of Machine Learning

Recent developments in digital technology have facilitated the recording and retrieval of administrative data from multiple sources about children and their families. Combined with new ways to mine such data using algorithms which can 'learn', it has been claimed that it is possible to develop tools that can predict which individual children within a population are most likely to be maltreated. The proposed benefit is that interventions can then be targeted to the most vulnerable children and their families to prevent maltreatment from occurring. As expertise in predictive modelling increases, the approach may also be applied in other areas of social work to predict and prevent adverse outcomes for vulnerable service users. In this article, a glimpse inside the 'black box' of predictive tools is provided to demonstrate how their development for use in social work may not be straightforward, given the nature of the data recorded about service users and service activity. The development of predictive risk modelling (PRM) in New Zealand is focused on as an example as it may be the first such tool to be applied as part of ongoing reforms to child protection services.

Childhood Maltreatment and Perception of Child Maltreatment among Respondents in Nigeria

This study examined childhood maltreatment and perception of maltreatment among respondents in Nigeria. A sample of 304 respondents completed online questionnaire on childhood experience and perception of abusive behaviours. Descriptive analysis was used to examine the responses. Of the 71 abusive behaviours examined, a high level of consensus (95–100 per cent agreement) was reached on five sexually abusive behaviours: having sexual intercourse with a child, asking a child to perform oral sex on adults, having sex in the presence of a child, fondling the breasts of a child for sexual pleasure and forcing a child to masturbate adults or other children. Abusive behaviour least perceived as abusive was experienced by most respondents during childhood: using corporal punishment as the only form of discipline. Finally, those who experienced the following abusive behaviours during childhood were significantly less likely to perceive of them as abusive: witnessing a parent/guardian being drunk all the time and forcing a child younger than 11 years old to take care of parents/guardians or siblings almost daily. Findings highlight the potential risks of childhood experience of abusive behaviours on perception of abusive behaviours and indicate the relevance of abusive behaviours to child protection policy and practice in the region.

Characteristics of Child Maltreatment and Adolescent Marijuana Use: A Prospective Study

There has been increasing acceptance of marijuana use in the United States in recent years, and rates among adolescents have risen. At the same time, marijuana use during adolescence has been linked to an array of health and social problems. Maltreated children are at risk for marijuana use, but the relationships among characteristics of maltreatment and marijuana use are unclear. In this article, we examine how the type and the extent of maltreatment are related to the level of adolescent marijuana use. Data analyses were conducted on a subsample of maltreated adolescents (n = 702) from the Longitudinal Studies of Child Abuse and Neglect project. Approximately half the sample had used marijuana, and maltreatment was associated with its use. Multivariate regression models showed that being male, extensive maltreatment, and peer marijuana use were associated with heavy use of marijuana. These findings suggest the importance of comprehensively assessing children's maltreatment experiences and their peers' drug use to help prevent or address possible marijuana use in these high-risk adolescents.

Adverse childhood experiences and sexual victimization in adulthood

Understanding the link between adverse childhood experiences (ACEs) and sexual victimization (SV) in adulthood may provide important information about the level of risk for adult SV and sexual re-victimization among childhood sexual abuse (CSA) survivors. In the present paper, we explore the relationship between ACEs, including CSA, and SV in adulthood. Data from the CDC-Kaiser ACE Study were used to examine the effect of experiences of early adversity on adult SV. Adult HMO members (n=7,272) undergoing a routine health exam provided detailed information about ACEs that occurred at age 18 or younger and their experiences of SV in adulthood. Analyses revealed that as ACE score increased, so did risk of experiencing SV in adulthood. Each of the ACE variables was significantly associated with adult SV, with CSA being the strongest predictor of adult SV. In addition, for those who reported CSA, there was a cumulative increase in adult SV risk with each additional ACE experienced. As such, early adversity is a risk factor for adult SV. In particular, CSA is a significant risk factor for sexual re-victimization in adulthood, and additional early adversities experienced by CSA survivors may heighten adult SV risk above and beyond the risk associated with CSA alone. Given the interconnectedness among various experiences of early adversity, adult SV prevention actions must consider how other violence-related and non-violence-related traumatic experiences may exacerbate the risk conferred by CSA on subsequent victimization.

Predicting risk of entry into foster care from early childhood experiences: A survival analysis using LONGSCAN data

This study examined whether a multi-domain model of maltreatment informed by an ecological framework-including factors related to the child, caregiver, family, neighborhood, and dimensions of maltreatment experience-predicted entry into foster care between the ages of 4 and 18 among children with no prior foster care experience. To determine which factors predict entry into foster care, secondary data analyses were conducted utilizing a sub-sample from LONGSCAN (Longitudinal Studies of Child Abuse and Neglect) of 942 children and their primary caregivers. Results demonstrate that there are important predictors for entry into out-of-home placement across multiple ecological domains. Characteristics related to child, caregiver, and family characteristics, and neighborhood context, as well as dimensions of maltreatment (particularly emotional maltreatment), predicted risk of placement in out-of-home care. Implications for child welfare practice are discussed. This examination of the effects of multiple ecological domains adds to our understanding of children's risk of removal and entry into out-of-home placement.

Beating the brain about abuse: Empirical and meta-analytic studies of the association between maltreatment and hippocampal volume across childhood and adolescence

We present new empirical data and meta-analytic evidence for the association of childhood maltreatment with reduced hippocampal volume. In Study 1, we examined the effects of maltreatment experiences reported during the Adult Attachment Interview on hippocampal volume in female twin pairs. We found that reduced hippocampal volume was related to childhood maltreatment. In addition, individuals who reported having experienced maltreatment at older ages had larger reductions in hippocampal volume compared to individuals who reported maltreatment in early childhood. In Study 2, we present the results of a meta-analysis of 49 studies (including 2,720 participants) examining hippocampal volume in relation to experiences of child maltreatment, and test the moderating role of the timing of the maltreatment, the severity of maltreatment, and the time after exposure to maltreatment. The results of the meta-analysis confirmed that experiences of childhood maltreatment are associated with a reduction in hippocampal volume and that the effects of maltreatment are more pronounced when the maltreatment occurs in middle childhood compared to early childhood or adolescence.

Trajectories of Adverse Childhood Experiences and Self-Reported Health at Age 18

OBJECTIVE

Despite growing evidence of links between adverse childhood experiences (ACEs) and long-term health outcomes, there has been limited longitudinal investigation of such links in youth. The purpose of these analyses was to describe the patterns of exposure to ACEs over time and their links to youth health.

METHODS

The current analyses used data from LONGSCAN, a prospective study of children at risk for or exposed to child maltreatment, who were followed from age 4 to age 18. The analyses focused on 802 youth with complete data. Cumulative exposure to ACEs between 4 and 16 was used to place participants in 3 trajectory-defined groups: chronic ACEs, early ACEs only, and limited ACEs. Links to self-reported health at age 18 were examined using linear mixed models after controlling for earlier health status and demographics.

RESULTS

The chronic ACEs group had increased self-reported health concerns and use of medical care at 18 but not poorer self-rated health status. The early ACEs only group did not significantly differ from limited ACEs on outcomes.

CONCLUSIONS

In addition to other negative outcomes, chronic ACEs appear to affect physical health in emerging adulthood. Interventions aimed at reducing exposure to ACEs and early mitigation of their effects may have lasting and widespread health benefits.

Early childhood maltreatment and trajectories of behavioral problems: exploring gender and racial differences

The current study aimed to examine the trajectory of child behavior problems over time as a function of early maltreatment. We anticipated that early alleged maltreatment would have a substantial impact on both internalizing and externalizing behaviors. The impact of gender and racial differences in the trajectories were also examined. Using the LONGSCAN archived data, a total of 484 children were selected for the study from varying sites. Two groups were formed: children with early allegations of maltreatment from birth to age 4 and children without any report. Children included did not have further allegations of maltreatment from ages 4 to 12. Additionally, they must have completed a behavioral assessment using the Child Behavior Checklist at the age 4 baseline interview. Multilevel modeling using the SAS PROC MIXED procedure was used to examine the effects of early allegations of maltreatment on the trajectories of both internalizing and externalizing problems. Although race was not significant, gender was found to differ in trajectory of behavioral problems among children with early allegations of maltreatment. For boys, the impact of early maltreatment was strongest at the most proximal assessment of behavioral outcomes and then decreased gradually over the course of subsequent periods. For girls, although no significant impact was observed at each measurement point, the impact of early maltreatment increased and became pronounced over time. Findings support the importance of early intervention/prevention to decrease the likelihood of presenting behavioral problems in later childhood years with consideration to gender.