‎Risk Factors for Child Maltreatment

What is child maltreatment?  Any act or series of acts of commission

or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.

◦ Acts of Commission (Child Abuse)  Physical abuse  Sexual abuse  Psychological abuse

◦ Acts of Omission (Neglect)

Types of Maltreatment

 Physical abuse – nonaccidental injury inflicted by a caregiver

 Sexual abuse – the use of a child for the sexual gratification of an adult

 Emotional/psychological abuse  Neglect – act of omission ◦ Physical neglect ◦ Medical neglect ◦ Educational neglect

Child Maltreatment: Etiological Theories

 Many etiological theories have been proposed over the years to explain the development of child maltreatment: – Attachment theory – Ecological models – Research on specific risk factors

 Each framework attempted to explain the specific conditions leading to abusive dynamics within families. These conditions may be associated with the child, the parents, and the broader environment; each theory emphasizes different factors

Attachment Theory

 Attachment: any form of behavior that results in a person attaining or maintaining proximity to another preferred individual perceived as stronger or wiser

 The attachment system is biological in nature, and is activated by stress (environmental or relational). Its evolutionary role is protection

 The attachment figure serves as a “secure base” from which the child can explore the social and physical world

 Children build “internal working models” of their own worthiness from experiences of caregiver ‘s availability and sensitivity. These models also guide expectations for future relationships

Attachment  John Bowlby: was a British psychiatrist who defined attachment as “lasting

psychological connectedness between human beings” (Bowlby, 1969, p. 194). Bowlby shared the psychoanalytic view that early experiences in childhood have an important influence on development and behavior later in life. Our early attachment styles are established in childhood through the infant/caregiver relationship.

 Bowlby believed that there are four distinguishing characteristics of attachment:

◦ Proximity Maintenance – The desire to be near the people we are attached to.

◦ Safe Haven – Returning to the attachment figure for comfort and safety in the face of a fear or threat.

◦ Secure Base – The attachment figure acts as a base of security from which the child can explore the surrounding environment.

◦ Separation Distress – Anxiety that occurs in the absence of the attachment figure

◦ http://www.youtube.com/watch?v=VAAmSqv2GV8

Secure Attachment Caregivers are sufficiently sensitive, responsive, and consistent. Children develop trust, and are able to experience and regulate negative emotions; develop working models of self as lovable and psychologically coherent

 Children are able to separate from parents, seek comfort from parents when frightened, return of parents is met with positive emotions, prefers parents to strangers.

 Adults have trusting, lasting relationships; tend to have good self-esteem; are comfortable sharing feelings with friends and partners; seek out social support.

Ambivalent Attachment  Caregivers are distant, and emotionally unavailable when

the child is vulnerable. Children adapt by “downplaying” and inhibiting their feelings of need, exhibit apparent independence and self-sufficiency

 Children may be wary of strangers; may become greatly distressed when the parent leaves and does not appear to be comforted by the return of the parent.

 Adults may be reluctant to become close to others; may worry that their partner does not love them and may become very distraught when a relationship ends.

Ambivalent Attachment  Children who are ambivalently attached tend to

be extremely suspicious of strangers. These children display considerable distress when separated from a parent or caregiver, but do not seem reassured or comforted by the return of the parent. In some cases, the child might passively reject the parent by refusing comfort, or may openly display direct aggression toward the parent.

Avoidant Attachment

 Children may avoid parents; may not seek much comfort or contact from parents and shows little or no preference between a parent and a stranger.

 Adults may have problems with intimacy; may invest little emotion in social and romantic relationships and may be unwilling or unable to share thoughts and feelings with others.

Disorganized Attachment

 No consistent strategy, common in abusive families where children are afraid of their caregivers

 Children show a mixture of avoidant and resistant behaviors; may seem dazed, confused or apprehensive.

 At age 6 or so, children may take on a parental role and act as a caregiver toward the parent (Main & Cassidy, 1988)

Attachment Theory

 How do we know the baby’s attachment style? – An experimental procedure called “The Strange

Situation”, and associated experimental procedures http://www.youtube.com/watch?v=DH1m_ZMO7GU

 Attachment styles during childhood affect attachment patterns to significant individuals in adulthood: – Secure———-Secure-autonomous – Avoidant——–Dismissing – Ambivalent—–Preoccupied – Disorganized—Disorganized

Attachment Theory

 Attachment theory sheds light on the development of child maltreatment through intergenerational transmission of attachment patterns

 The basic premise is that parents who experienced insensitive caregiving in their original families are more likely to be insensitive (and often maltreating) towards their own children

 A number of studies support this premise: – Children who have been abused or neglected tend to exhibit insecure attachment patterns – Maltreating parents are more likely to report insensitive parenting, abuse, or rejection in their original families

Monkey Mothers Matter

Harlow’s Experiment  In Harlow’s classic experiment, two groups of

baby rhesus monkeys were removed from their mothers. In the first group, a terrycloth mother provided no food, while a wire mother did, in the form of an attached baby bottle containing milk.

 In the second group, a terrycloth mother provided food; the wire mother did not. It was found that the young monkeys clung to the terrycloth mother whether or not it provided them with food, and that the young monkeys chose the wire surrogate only when it provided food.

Harlow’s Experiment – The study found that monkeys who were

raised with either a wire mother or a cloth mother gained weight at the same rate. However, the monkeys that had only a wire mother had trouble digesting the milk and suffered from diarrhea more frequently.

– Harlow’s interpretation of this behavior, which is still widely accepted, was that a lack of contact comfort is psychologically stressful to the monkeys.

Attachment Theory

 Critics of attachment theory: – Focuses on psychological factors only; does not include

environmental factors associated with child maltreatment (e.g. marital and financial problems may cause stress, which may lead to child maltreatment – even among parents who were securely attached themselves) – Excessive focus on mothers when attachment theory was first

developed (change has occurred in recent years) – Does not account for child’s temperament

 Nonetheless, attachment theory contributed significantly to better understanding of intergenerational transmission of maltreatment

Types of Factors

 Potentiating: increase risk for maltreatment

 Compensatory: buffers, decreases risk ——————————————————  Transient – temporary  Enduring – ongoing; chronic —————————————————— Applied to each level of analysis

A look at the Ecological Model: Levels of Analysis of Each Instance of Maltreatment

 Microsystems ◦ a person’s immediate

surroundings  Mesosystem ◦ Interconnections between

microsystems  Exosystems ◦ local institutions, such as

schools and churches  Macrosystems ◦ larger social setting, including

cultural values, economic policies, and political processes

Ontogenic: factors within the individual

Ecological Models

 The main advantage of the ecological models over the attachment theory is multidimensionality: factors contributing to the development of maltreatment may be environmental, rather than psychological only

 Today, most child protection professionals relay on ecological models in their assessments: evaluate individual level characteristics, family environment, broader community environment, and cultural values and beliefs

 The ecological model is particularly useful for organizing various risk factors into different levels, and considering multiple influences that may affect maltreatment

Specific Risk Factors  Scholars often integrate research on specific risk factors into the

ecological model: – Child/parent personality characteristics can be viewed as part of the individual level – Characteristics of the family environment (e.g. marital discord) can be viewed as part of the microsystem – Community characteristics (e.g. unsafe neighborhoods) can be viewed as part of the exosystem -Values and beliefs about children’s rights and appropriate discipline strategies can be viewed as part of the macrosystem

 Important: a risk factor may be associated with higher likelihood of maltreatment, without directly causing it

Macrosystemic Issues  Acceptability of violence ◦ Levels of violent crime, presence of weapons ◦ Levels of violence in media ◦ Acceptance of corporal punishment

 Sexualization of children  Individualism ◦ Focus on nuclear family both fully responsible for and

controlling of children ◦ Geographical isolation of families with children

 Values/definitions of work

Exosystemic Issue: Poverty

 Poverty as a stressor: inadequate resources, feelings of disempowerment (becomes a microsystemic issue)

 Poverty places individuals in less safe environments, requiring more parental effort to protect

 Poverty places individuals in resource scarce environments

 Increasingly poor urban areas are places to which people are not committed – less sense of community

Microsystemic Issues  History of abuse in parents  Mental illness in parents  Substance abuse in parents  Domestic violence  Problematic parenting practices  Lack of social support

History of Child Abuse in Parents

 Child abuse in parents may result in mental health issues (depression, PTSD)

 Attachment impairment  Lack of modeling of appropriate parenting

behaviors

Mental Health Issues in Parents

 Depression most common mental illness  Mental illness impacts childrearing  Mental health issues increase risk of

substance abuse, especially in women

Substance Abuse

 Direct physical effects on fetus ◦ Critical issue: should prenatal maternal

substance abuse be considered maltreatment and subject to intervention prenatally?

 Effects in terms of prenatal care  Effects in terms of caregiving capacity

Prenatal Alcohol Use  Fetal Alcohol Syndrome ◦ physical and cognitive abnormalities in children caused

by a pregnant woman’s heavy drinking ◦ FAS is defined by 4 criteria  Maternal drinking during pregnancy  Characteristic pattern of facial abnormalities  Growth retardation  Brain damage, often manifested by intellectual

difficulties or behavioral problems

Addictive Drugs  Heroin, crack cocaine can lead to babies born

exhibiting withdrawal symptoms  Babies must go through withdrawal  Research is conflicting, but overall effects seem

to be “subtle but significant”  Not clear regarding long-term neurological

problems; early studies did not differentiate prenatal from postnatal effects (raised in a home with drugs; poverty, etc)

 Often the problems are associated with low birth weight and/or poor prenatal care

Postnatal Effects

 Breast feeding—some drugs passed this way

 Most important: ineffective caretaker ◦ dulled, sleepy, not responsive: impairment in

attachment ◦ Expose babies to others who are high: not

protective

Family Costs of Drug Use  It is estimated that 1 in 10 U.S. children live with

at least one parent in need of treatment for drug or alcohol dependency.

 Children of alcoholics are four times more likely to have alcohol or drug problems than children of nonalcoholics.

 Nearly 5 million adults who abuse alcohol have children younger than age 18 living with them.

Family Costs of Drug Use

 Children have higher probability of ◦ Abuse and neglect ◦ behavioral difficulties ◦ Absenteeism from school ◦ Decreased self-esteem ◦ Learning difficulties

Substance Abuse

 Some national estimates indicate that between 50 – 60% of child abuse cases are linked to adult substance abuse behavior

 CAPTA mandates notification of child protection staff if substance-exposed newborns are identified as being affected by illegal substance abuse  However, states’ responses differ

 Case in 12/95 involved 3 child deaths in a meth lab explosion in their home. Increased attention for the needs of children living in drug homes

Domestic Violence

 Chronic v isolated; uni- v bi-directional  Women get hurt more  “Coercive control” is chronic and may be more

significant: ◦ Threats of physical violence ◦ Demeaning comments ◦ Isolation and control (jealousy, accountability of

whereabouts, financial dependency, restricting social contacts) ◦ Abuse of pets

 Critical issue: Should victims of coercive control be held responsible for not protecting children?

“Witnessing” Domestic Violence

 Seeing  Hearing  Hearing about it or seeing aftereffects  Living in household with coercive control

dynamics

DV Raises Risk of Direct Child Abuse  Children get caught in middle by accident or try

to intervene  Physical abuse of child is more likely to occur by

both parents  Sexual abuse of child is more likely to occur by

father  Child is neglected as disempowered mother is

unable to attend to child or comfort child  Witnessing domestic violence is viewed as a

type of psychological abuse of children (terrorizing)

Social Support

 Lack of social support has been associated with risk of CA/N, re-referral, and recurrence of CA/N

 Emotional support  Concrete support  Single parents

Childrearing Practices

 Developmentally appropriate child development information

 Empathy/attunement to child’s emotional needs

 Views on discipline ◦ Alternatives to corporal punishment

 Parent-child role reversal  Views on child autonomy/independence

Ontogenetic Issues

 Gender, age  Temperament  Disabilities, health issues  Challenges of different ages  Behavioral problems (can be caused by

past experiences, including abuse or neglect)

Specific Risk Factors

 Research studies identified many factors associated with the occurrence of maltreatment: – Perpetrators` socioeconomic status: low SES (including educational attainment) was found to be associated with higher likelihood of maltreatment – Perpetrators` psychological factors: some studies revealed that abusers tended to report higher stress, marital problems, loneliness, and unhappiness – Community factors: unsafe and impoverished neighborhoods are associated with higher likelihood of maltreatment, as are factors such as high unemployment – Victims` characteristics: some studies reported that children with behavioral problems and certain medical conditions (e.g. learning disabilities, mental retardation) are at higher risk for maltreatment