Glimpsing the Iceberg: Parent-Child Physical Aggression and Abuse

Despite evidence that parents' physical aggression abuse has long-lasting negative consequences, information about the true population prevalence of aggression and physical abuse is limited. We have even less information about how parental aggression and abuse vary by child age, parent gender, and how that aggression and abuse might be clustered within families. To address these gaps, an anonymous, computer-based assessment was administered to nearly 40,000 parents of more than 60,000 children in the United States Air Force, which included a detailed assessment on up to four minor children of aggression and its impact. The survey was the largest of its type ever conducted in the United States, allowing for stable, crossvalidated estimation of rates of both corporal punishment and physical abuse. Approximately 39% of children experienced corporal punishment, peaking at three years of age, and 7% experienced physical abuse, peaking at age six. About 45% of parents reported perpetrating corporal punishment and 8% abuse; these rates were higher in multi-child families and most often involved more than one child. Parent gender was not associated with physical aggression or abuse.

Predictors of Crosscutting Patterns of Psychological Health and Family Maltreatment

INTRODUCTION

Psychological problems and family maltreatment are significant public health problems. Although research focuses almost exclusively on either individual psychological problems or family maltreatment, there is substantial co-occurrence of these problems. Similarly, intervention services are often "siloed": individuals with mental health needs are referred for mental health services, individuals with family conflict are referred for family-based treatment, etc. These treatment "silos" may miss the larger picture of the co-occurrence of risk, promotion, and the problems themselves. In a previous paper, we used latent class analysis to identify subgroups of individuals with crosscutting patterns (i.e., classes) of psychological and family maltreatment problems. In this study, we explored the predictors of these latent classes.

MATERIALS AND METHODS

Participants consisted of two large population samples of U.S. Air Force active duty members (ns = 27,895 and 30,841) who were married or cohabiting and had one or more children living in their household. Participants completed an anonymous community assessment survey, which included questionnaire items tapping personal, family, and community problems and well-being. Assessments were conducted in 2008 and 2011. All study procedures were approved by the authors' Institutional Review Board. We used exploratory factor analysis and latent class analysis to (1) identify higher-order factors of risk and promotive variables and (2) examine them as predictors of our previously identified latent classes.

RESULTS

Findings indicated that individuals who reported better physical well-being as well as personal and family coping, relationship satisfaction, and support were more likely to be in the lowest-risk subgroup. Notably, individuals in the subgroup most at risk for serious violence and suicide, evidencing disinhibitory psychopathology, endorsed lower risk and higher promotive factors than those individuals in other high-risk subgroups who fell along the internalizing/externalizing continuum.

CONCLUSIONS

These findings reinforce the need for integrated prevention and treatment of psychological and family maltreatment problems. Not only do these problems often co-occur, but their risk and promotive factors also tend to be intertwined. The unique (i.e., not on the continuum of the other five classes) problem profile of participants evidencing disinhibitory psychopathology is matched by a unique risk/promotive factor profile, and they will thus likely require a unique intervention approach.

Leadership perspectives on facilitators and barriers to sustaining evidence-based prevention interventions in the United States Military

The U.S. Department of Defense (DoD) aims to prevent suicide, harassment, sexual assault, and partner and child maltreatment by implementing evidence-based behavioral health interventions (EBIs). However, sustaining EBI implementation over time and with fidelity to result in meaningful impacts is a tremendous challenge. We interviewed 35 military leaders in positions to observe, and possibly hinder, the erosions of EBI implementations to learn what distinguishes EBIs that sustain in the military from those that fade away. Thematic analysis identified barriers and supports to EBI sustainment consistent with the Consolidated Framework for Implementation Research, reflecting the domains: outer setting, inner setting, individuals, and innovation. Participants described how factors at different levels of the social ecology interact with each other and emphasized how aspects of military culture (e.g., hierarchical structure, frequent moves, mission focus) can both support and challenge implementing and sustaining behavioral-health EBIs. EBI implementation in the military differs from most civilian settings in that service member participation in certain preventative programs is mandated. The results indicate how policy and practice can strengthen sustained EBI implementation to reduce harm and support service members.

Do Brief Lab-Based Interventions Decrease Coercive Conflict Within Couples and Parent-Child Dyads?

Coercive conflicts between parents and children and between couples are implicated in the pathogenesis of a variety of psychological and physical health problems. Despite its seeming importance to population health, there are no widely available, easy-to-use methods with demonstrated efficacy to engage coercive conflict and reduce it. Identifying and testing potentially efficacious and disseminable micro-interventions (i.e., interventions that can be delivered in under 15 minutes via computer or paraprofessional) for targets with cross-cutting health implications, such as coercive conflict, is the focus of the National Institutes of Health Science of Behavior Change initiative. We experimentally tested four micro-interventions targeting coercive conflict in couple and parent-child dyads in a within-between design. There were mixed but supportive findings for the efficacy of most of the micro-interventions. Attributional reframing, implementation intentions, and evaluative conditioning all reduced coercive conflict as assessed by some but not all measures of observed coercion. No findings indicated any iatrogenic effects. Interpretation bias modification treatment improved at least one measure of coercive conflict for couples, but not for parents and children; additionally, it increased self-reported coercive conflict. Overall, these results are encouraging and suggest that very brief and highly disseminable micro-interventions for coercive conflict are a fruitful direction for inquiry. Optimizing micro-interventions and deploying them across the health care infrastructure could tremendously enhance family functioning and, in turn, health behaviors and health (ClinicalTrials.gov IDs: NCT03163082, NCT03162822).

Patient aggression toward dentists

BACKGROUND

Workplace violence toward health care professionals is both widespread and widely overlooked. Only 4 studies of aggression toward dentists have been published-none in the United States-with the prevalence of aggression ranging from 29% through 80%. The purpose of this study was to provide an initial estimate of rates of patient aggression in dental practices in the United States.

METHODS

The authors surveyed 98 dentists recruited from the faculty and alumni network of a college of dentistry. Participants completed a confidential online survey assessing whether they had experienced any of 21 specific types of aggressive behaviors from their patients.

RESULTS

Past-year aggression prevalence was 22.2%, 55.0%, and 44.4% for physical, verbal, and reputational aggression, respectively. Career prevalence was 45.5%, 74.0%, and 68.7% for physical, verbal, and reputational aggression, respectively. Rates did not differ by sex, race, ethnicity, specialty, age, years practicing, or average number of patients treated per day.

CONCLUSIONS

Participants reported levels of physical, verbal, and reputational aggression at rates comparable with those of other health care professionals in the United States and abroad. Additional research with larger representative samples of dentists in the United States is necessary to confirm these prevalence estimates. Future research should also investigate predictors and outcomes of patient aggression and prevention and intervention strategies.

PRACTICAL IMPLICATIONS

Substantial rates of patient aggression highlight the need to address this problem in dental practices. The authors discuss implications for the dental profession, including proactive steps that could be taken to reduce patient aggression in dental offices.

Predicting the transition from juvenile delinquency to adult criminality: Gender-specific influences in two high-risk samples

BACKGROUND

Most juvenile offenders desist from offending as they become adults, but many continue and ultimately enter the adult corrections system. There has been little prospective examination of which variables may predict the latter transition, particularly for women.

AIMS

Our aim was to find out, for men and women separately, what variables identifiable in adolescent offenders predict their continuation of offending into adult life.

METHODS

Participants were 61 male and 81 female youths who had been referred from the juvenile justice system for chronic delinquency and recruited into randomised controlled trials comparing Multidimensional Treatment Foster Care with group care ('treatment as usual'). All participants had attained adulthood by the time of our study. We first examined gender differences in childhood risk factors and then used Cox proportional-hazards models to estimate the relationship of potential risk factors to first adult arrest.

RESULTS

Results indicated that, for men, juvenile justice referrals alone predicted risk of any first adult arrest as well as arrest for felony arrest specifically. Each additional juvenile referral increased the risk of any adult arrest by 9% and of adult felony arrest by 8%. For women, family violence, parental divorce and cumulative childhood risk factors, but not juvenile justice referrals, were significant predictors of adult arrest. Each additional childhood risk factor increased the risk of adult arrest by 21%. Women who experienced parental divorce were nearly three times more likely to be arrested as an adult, and those who experienced family violence 2.5 times more so than those without such experiences.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

We found preliminary evidence of gender differences in childhood risk factors for adult offending, and, thus potentially, for the development and use of interventions tailored differently for girls and boys and young men and young women to reduce their risk of becoming adult recidivists. Copyright © 2015 John Wiley & Sons, Ltd.

Drug Use Trajectories After a Randomized Controlled Trial of MTFC: Associations with Partner Drug Use

Trajectories of drug use were examined in a sample of women with prior juvenile-justice system involvement. One hundred fifty-three young women who participated in a randomized controlled trial of Multidimensional Treatment Foster Care (MTFC) in adolescence were assessed on five occasions over a 24-month period in young adulthood (mean age = 22.29 years at T1). Participants assigned to the MTFC condition during adolescence reported greater decreases in drug use than girls assigned to the treatment as usual (TAU) condition. Partner drug use was significantly associated with women's concurrent drug use, although participants in the MTFC condition were more resilient to partner drug use than in the TAU condition. Implications for drug use prevention and intervention programs during adolescence are discussed.

Maternal depression and co-occurring antisocial behaviour: testing maternal hostility and warmth as mediators of risk for offspring psychopathology

BACKGROUND

Disruption in the parent-child relationship is a commonly hypothesized risk factor through which maternal depression may increase risk for offspring psychopathology. However, maternal depression is commonly accompanied by other psychopathology, including antisocial behaviour. Few studies have examined the role of co-occurring psychopathology in depressed mothers. Using a longitudinal study of offspring of mothers with recurrent depression, we aimed to test whether maternal warmth/hostility mediated links between maternal depression severity and child outcomes, and how far direct and indirect pathways were robust to controls for co-occurring maternal antisocial behaviour.

METHODS

Mothers with a history of recurrent major depressive disorder and their adolescent offspring (9-17 years at baseline) were assessed three times between 2007 and 2010. Mothers completed questionnaires assessing their own depression severity and antisocial behaviour at Time 1 (T1). The parent-child relationship was assessed using parent-rated questionnaire and interviewer-rated 5-min speech sample at Time 2 (T2). Offspring symptoms of depression and disruptive behaviours were assessed using the Child and Adolescent Psychiatric Assessment at Time 3 (T3).

RESULTS

Maternal hostility and warmth, respectively, mediated the association between maternal depression severity and risk for offspring psychopathology. However, the effects were attenuated when maternal antisocial behaviour was included in the analysis. In tests of the full theoretical model, maternal antisocial behaviour predicted both maternal hostility and low warmth, maternal hostility predicted offspring disruptive behaviour disorder symptoms, but not depression, and maternal warmth was not associated with either child outcome.

CONCLUSIONS

Parenting interventions aimed at reducing hostility may be beneficial for preventing or reducing adolescent disruptive behaviours in offspring of depressed mothers, especially when depressed mothers report co-occurring antisocial behaviour.

MTFC for High Risk Adolescent Girls: A Comparison of Outcomes in England and the United States

The current study examined 12-month outcomes for girls enrolled in an implementation trial of Multidimensional Treatment Foster Care (MTFC) in England. In addition to examining changes from pre-treatment to post-treatment, we also compared results for girls enrolled in the England implementation trial to girls enrolled in two randomized controlled trials (RCTs) of MTFC in the United States (US). The England MTFC sample included 58 girls in foster care between the ages of 12 and 16 years. The US MTFC intervention samples included 81 girls between the ages of 13 and 17 years who were referred to out-of-home care due to chronic delinquency. Results indicated improvement in offending, violent behavior, risky sexual behavior, self-harm, and school activities for girls enrolled in the England implementation trial. The effect sizes of these results were similar to those obtained in the US RCTs, with the exception of substance use which showed significant decreases for girls enrolled in the US RCTs, but not for girls enrolled in the England implementation trial. These results, in combination with other cross-cultural findings, support the notion that MTFC might be relevant across US and European cultures.

Depressive symptom trajectories among girls in the juvenile justice system: 24-month outcomes of an RCT of Multidimensional Treatment Foster Care

Youth depression is a significant and growing international public health problem. Youth who engage in high levels of delinquency are at particularly high risk for developing problems with depression. The present study examined the impact of a behavioral intervention designed to reduce delinquency (Multidimensional Treatment Foster Care; MTFC) compared to a group care intervention (GC; i.e., services as usual) on trajectories of depressive symptoms among adolescent girls in the juvenile justice system. MTFC has documented effects on preventing girls' recidivism, but its effects on preventing the normative rise in girls' depressive symptoms across adolescence have not been examined. This indicated prevention sample included 166 girls (13-17 years at T1) who had at least one criminal referral in the past 12 months and who were mandated to out-of-home care; girls were randomized to MTFC or GC. Intent-to-treat analyses examined the main effects of MTFC on depression symptoms and clinical cut-offs, and whether benefits were greatest for girls most at risk. Depressive symptom trajectories were specified in hierarchical linear growth models over a 2 year period using five waves of data at 6 month intervals. Depression clinical cut-off scores were specified as nonlinear probability growth models. Results showed significantly greater rates of deceleration for girls in MTFC versus GC for depressive symptoms and for clinical cut-off scores. The MTFC intervention also showed greater benefits for girls with higher levels of initial depressive symptoms. Possible mechanisms of effect are discussed, given MTFC's effectiveness on targeted and nontargeted outcomes.

Marital hostility and child sleep problems: direct and indirect associations via hostile parenting

The current study examined two family process predictors of parent-reported child sleep problems at 4.5 years in an adoption sample: marital hostility and hostile parenting. Participants were 361 linked triads of birth parents, adoptive parents, and adopted children. We examined direct and indirect pathways from marital hostility to child sleep problems via hostile parenting. Mothers' marital hostility at 9 months was associated with child sleep problems at 4.5 years. Fathers' marital hostility at 9 months evidenced an indirect effect on child sleep problems at 4.5 years via fathers' hostile parenting at 27 months. Findings were significant even after controlling for genetic influences on child sleep (i.e., birth parent internalizing disorders). The findings suggest targets for prevention and intervention programs that are potentially modifiable (e.g., hostile parenting, marital hostility), and inform theory by demonstrating that relations among marital hostility, hostile parenting, and child sleep problems are significant after accounting for genetic influences.

Longitudinal pathways from marital hostility to child anger during toddlerhood: genetic susceptibility and indirect effects via harsh parenting

We examined direct and indirect pathways from marital hostility to toddler anger/frustration via harsh parenting and parental depressive symptoms, with an additional focus on the moderating role of genetic influences as inferred from birth parent anger/frustration. Participants were 361 linked triads of birth mothers, adoptive parents, and adopted children who were 9 (T1) and 18 (T2) months old across the study period. Results indicated an indirect effect from T1 marital hostility to T2 toddler anger/frustration via T2 parental harsh discipline. Results also indicated that the association between marital hostility and toddler anger was moderated by birth mother anger/frustration. For children whose birth mothers reported high levels of anger/frustration, adoptive parents' marital hostility at T1 predicted toddler anger/frustration at T2. This relation did not hold for children whose birth mothers reported low levels of anger/frustration. The results suggest that children whose birth mothers report elevated frustration might inherit an emotional lability that makes them more sensitive to the effects of marital hostility.

Factor Structure and Validity of the Parenting Scale

Confirmatory factor analyses based on the scoring derived from 5 prior studies of the Parenting Scale were conducted using a representatively recruited sample of 453 couples parenting 3-to 7-year-old children. Comparative analyses favored the Reitman et al. (2001) 2-factor scoring system as well as a 3-factor solution, including Lax, Overreactive, and Hostile discipline. This 3-factor solution demonstrated good fit across parent gender and child age and gender. Mothers rated themselves as more overreactive than fathers. The factor scores correlated significantly with several validity measures, including child behavior problems. The Hostile factor contributed significantly to the prediction of child behavior problems after controlling for Lax and Overreactive discipline. Both parents reported using more dysfunctional discipline than they thought they should.

Bidirectional Influences in Mother-Toddler Dyads: An Examination of the Relative Influence of Mothers' and Children's Behaviors

This study examined bidirectional relations between mothers' lax and overreactive discipline and children's misbehavior and negative affect. We examined the moment-to-moment stability of mothers' and children's behaviors (actor effects) and mothers' and children's influence on their partners' subsequent behaviors (partner effects). Participants were 71 mothers and their 24-48-month-old children observed during a thirty-minute interaction. Both children and mothers exhibited stability in their own behaviors and influenced the subsequent behaviors of their partners. Additionally, a comparison of partner effects indicated that overreactive discipline more strongly predicted child negative affect than child negative affect predicted overreactive discipline. In contrast, although a child's negative affect predicted lax discipline, lax discipline did not predict subsequent child negative affect.

Children's responses to interparental conflict: a meta-analysis of their associations with child adjustment

A meta-analysis examined the relations between children's adjustment and children's cognitive, affective, behavioral, and physiological responses to interparental conflict. Studies included children between 5 and 19 years of age. Moderate effect sizes were found for the associations between cognitions and internalizing and externalizing behavior problems and self-esteem problems, negative affect and behavioral responses and internalizing behavior problems, and behavioral responses and self-esteem problems. Small to moderate effect sizes were found for the associations between cognitions and relational problems, negative affect and behavioral responses and externalizing behavior problems, and physiological reactions and internalizing and externalizing behavior problems. Effect sizes were, with 1 exception, larger for internalizing than for externalizing behavior problems. Age significantly moderated the majority of effect sizes.