Ecological influences on the sequelae of child maltreatment: a review of the literature

Social contexts of isolation, vulnerability, and resilience among minors with experiences of commercial sexual exploitation in the Netherlands

BACKGROUND

Despite extensive research on vulnerabilities to commercial sexual exploitation (CSE) of minors, knowledge gaps remain in understanding the broader contextual conditions that put young people at risk for CSE. Individual risk factors alone are insufficient to capture the broader context of risk; 'contextual vulnerability' to CSE requires further exploration.

OBJECTIVE

This study provides an empirically-driven theoretical framework that unpacks vulnerability and resilience to CSE, focusing on the socioecological context of minors, including family, friends, schools, neighborhoods, institutions, and others.

PARTICIPANTS AND SETTING

Data were obtained from an online platform in the Netherlands, where young people anonymously shared experiences of CSE by engaging in conversations with online care providers. The sample included conversations from 240 minors with CSE experiences between 2019 and 2022.

METHODS

A constructivist grounded theory method was used, combining inductive coding to identify patterns and themes in the data with deductive reasoning to link themes to theoretical concepts, generating new theoretical insights into the socioecological aspects of vulnerability.

RESULTS

Three key themes emerged from the findings: (1) minors often faced social isolation within unsafe or unstable family environments, with limited external support; (2) relationships beyond the family, when unsafe or unstable, contributed to minors' social vulnerability due to withdrawal, heightened exposure to harm, and distrust in formal institutions; and (3) positive experiences and supportive relationships across socioecological levels fostered social resilience and mitigated harm.

CONCLUSIONS

A socioecological approach is needed to unpack contextual vulnerability to CSE and should guide prevention and intervention strategies.

Personal, Family, and Environmental Factors Associated with Somatic Complaints in School-Aged Child Victims of Sexual Abuse

Little is known about somatic complaints in school-aged child victims of sexual abuse and the associated risk factors. Given that somatic symptoms can lead to functional impairment and decreased health-related quality of life, identifying associated factors in the child's environment is essential. This study aimed to identify personal, family, and environmental factors associated with somatic complaints among child victims of sexual abuse. The sample included 654 children (68.8% girls; M = 8.96 years, SD = 1.88) seeking services after disclosure of child sexual abuse. Hierarchical linear regression models were used to investigate the associations between personal, family, and environmental factors, and somatic symptoms. Sex differences in the associations between risk factors and the level of somatic symptoms were systematically tested. Most children (58%) had at least one somatic symptom (M girls = 1.37, SD = 1.44 and M boys = 1.04, SD = 1.38). After controlling for sex and age, stress related to sexual abuse disclosure (β = 0.16, 95% CI [0.08, 0.23]), parental distress (β = 0.18, 95% CI [0.10, 0.26]), the number of stressful life events experienced (β = 0.12, 95% CI [0.05, 0.20]) and neighborhood social deprivation (β = 0.21, 95% CI [0.01, 0.42]) were independently associated with greater level of somatic complaints. Stress related to sexual abuse disclosure, parental distress, the number of stressful life events, and neighborhood social deprivation were associated with higher levels of somatic complaints in this population.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-024-00665-y.

Do the norms of tolerance for child physical abuse modify the intergenerational transmission of physical abuse?

BACKGROUND

Intergenerational transmission of physical abuse is well-known; however, the potential for contextual effect modification remains unknown.

OBJECTIVE

We investigated whether the norms of tolerance for child physical abuse modify the intergenerational transmission of physical abuse.

PARTICIPANTS AND SETTING

Data from the Child Living Standard Survey (grades five and eight) conducted between 2016 and 2018 in three prefectures in Japan was analyzed.

METHODS

The norms of tolerance for child physical abuse were calculated based on the proportion of caregivers who physically abuse their offspring in each of the 33 districts (n = 43,534). The caregivers' childhood physical abuse victimization and perpetration of child physical abuse were assessed via questionnaire. A multilevel analysis was performed to evaluate the cross-level interaction of the norms of tolerance for child physical abuse at the neighborhood level on the association between the caregiver's childhood physical abuse victimization and perpetration of child physical abuse, stratified by fathers (n = 4334) and mothers (n = 38,290).

RESULTS

By district, the average percentage of caregivers who physically abuse their offspring was 14.4 %. Intergenerational transmission was confirmed for both fathers and mothers. Fathers who are living with highly tolerant norms for child physical abuse showed higher odds of intergenerational transmission of physical abuse, while mothers showed no effect modification.

CONCLUSION

The norms of tolerance for child physical abuse showed a more prominent intergenerational transmission of physical abuse for fathers but not for mothers. To modify the cycle of physical abuse, interventions to reduce norms of tolerance for child physical abuse may be useful.

A qualitative study of coping strategies and resilience in the aftermath of childhood adversity in first-episode psychosis

AIM

Exposure to adversity during childhood is associated with elevated risk for commonly occurring forms of psychopathology, especially psychotic disorders. Despite the noteworthy consequences associated with adverse childhood experiences, an inconsistent and unpredictable number of at-risk populations present with remarkably good physical and mental health outcomes that can be attributed to resilience. This study aimed to qualitatively explore the experience of childhood adverse events and coping strategies employed by individuals that promote resilience and better mental health outcomes.

METHODS

Fourteen individuals with a history of childhood adversity were recruited to participate using a case-study approach. A semi-structured interview guide was developed based on empirical evidence and theoretical background, and the interviews were analysed using a reflexive thematic approach.

RESULTS

Our findings showed that the type of adversity impacted the experience of trauma, for example, the death of a caregiver versus emotional abuse or witnessing violence at home. Five coping strategies were identified (social support, religious coping, problem or emotion-focused coping, and meaning-making), with healthy controls found to identify and use these resources more than the psychosis group to promote individual well-being and better mental health outcomes.

CONCLUSIONS

Our findings provide insights into experiences in the aftermath of childhood adversity, emphasising the need to assess the history of trauma systematically. They further underscore the importance of mental health prevention programmes bolstering individual-level coping strategies and the resources available within our environments to help them manage adversity, improve overall outcomes, and promote resilience.

Assessment of Gender Diverse Children: Incorporating the Standard of Care 8th Edition

This article provides an overview of the World Professional Association of Transgender Health (WPATH) Standard of Care 8th edition (SOC8) chapter on transgender and gender diverse (TGD) prepubescent children (see Scott Leibowitz's article, "Assessment of Transgender and Gender Diverse Adolescents: Incorporating the Standard of Care 8th Edition," in this issue). This is the first WPATH SOC chapter in history, specifically devoted to children, acknowledging that the developmental needs and experiences of these youth can be distinguished from those of TGD adolescents. The child standards are based on the consensus of a range of expert authors and a broader consensus derived from a Delphi process involving the entire international interdisciplinary SOC8 authorship. The child SOC draw upon general developmental literature and employ an ecological framework to establish practice recommendations, including an assessment framework which engages family members and community outreach as warranted. The primary authors of the Child chapter of the SOC 8 include the following: Amy Tishelman, Ph.D. (lead author); Dianne Berg, Ph.D., Laura Edwards-Leeper, Ph.D., Diane Ehrensaft, Ph.D.; Susie Green, Aron Janssen, M.D., Jiska Ristori, Psy.D., Thomas Steensma, Ph.D., and John Strang, Psy.

Emerging Adults' Adverse Life Events and Psychological Functioning: A Comparison Based on Intergenerational Trajectories of Child Maltreatment

Intergenerational continuity of child maltreatment (CM) is a well-documented phenomenon of concern; however, its effects on the child's level of exposure to CM, as well as subsequent trauma exposure and adult functioning remain undocumented. The present study aimed to further explore the intergenerational effects of CM by comparing emerging adults (EA; ages 18-25) on their exposure to CM, adult victimization, and psychological functioning according to their mother's CM histories. One hundred and eighty-five mothers and their EA completed independently an online survey measuring sociodemographics, material deprivation, CM, adult victimization, and psychological functioning. The participating dyads (primarily White and female-identifying) were recruited online through social media, universities, and advertisements in non-profit organizations throughout Canada. Findings revealed that maternal histories of CM were associated with increased neglectful and physically abusive acts endured in childhood for maltreated EA. Maternal histories of CM, regardless of the EA' victimization status, were associated with a higher EA' number of adulthood interpersonal-but not non-interpersonal-traumas experienced. While a maternal history of CM was a risk factor for intimate partner violence (IPV) in maltreated EA, it was protective for non-maltreated EA. Maltreated EA with maltreated versus non-maltreated mothers presented more psychological difficulties, but only if they also reported material deprivation. Practitioners working with children at-risk or exposed to CM should document parents' histories of CM and take that into account in their assessments and intervention practices. This study also provides further evidence to support social policies targeting the family system as a whole.

Methodological inconsistencies confound understanding of language measurement in the child maltreatment population: A systematic review

BACKGROUND

While researchers have found a link between childhood maltreatment and language difficulties, the underlying mechanisms remain unclear and replication across the literature is inconsistent.

OBJECTIVE

To conduct a systematic review examining the methodological inconsistencies related to studies' samples construction, maltreatment measurement, and language outcomes using a language acquisition theory-based approach.

METHODS

Using the PRISMA framework, a literature search was conducted across five databases to identify studies that have investigated the effects of maltreatment on the language dimensions of vocabulary and grammar. Data were extracted for participant and maltreatment characteristics.

RESULTS

Fifty articles were reviewed. The results revealed: 1) maltreated children performed consistently below peers on grammar but not vocabulary assessments, 2) disproportionate use of vocabulary assessments, 3) considerable variability on participant characteristics and limited multidimensional measurement of maltreatment exposure, and 4) only nine studies analyzed the relationship between a maltreatment dimension (e.g., type, severity) and language.

CONCLUSIONS

Based on the results of this review, we propose three calls to action: 1) more language acquisition research in the child maltreatment field, 2) specificity when constructing samples with maltreated children, and 3) comprehensive and multidimensional maltreatment measurement. Implications for education were examined.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Adult mental health and child maltreatment: An ecological study across rural-urban and economic continua with implications for post-pandemic human services

This ecological, county-level, cross-sectional study examines relationships between the mental health of adults (IV) and child maltreatment report rates (DV), as they vary by socioeconomic distress and rurality (n = 3015 counties), using the most recent available data from several linked sources. In a two-way model, maltreatment reports increased 20.1% for each additional half day of poor mental health in metro counties, 11.7% in nonmetro counties, and 13% in rural counties. Our zero-inflated negative binomial model, moderated by rurality and economic distress, showed a significant relationship between the number of poor mental health days and increased child maltreatment report rates in counties (χ²  = 145.52, p < 0.0001). Investment in prevention and treatment of adult mental health concerns is imperative, especially in light of the increase in mental health problems caused by the coronavirus disease 2019 pandemic and increased tension within national political debate. Our results indicate successful support of adult mental health will prevent child maltreatment and reduce the cyclical financial burden of child maltreatment and mental health concerns.

The Protective Effect of Neighbourhood Collective Efficacy On Family Violence and Youth Antisocial Behaviour in Two South Korean Prospective Longitudinal Cohorts

Neighbourhood collective efficacy has been proposed as a protective factor against family violence and youth antisocial behaviour. However, little is known about its impact on parent and child behaviour in non-Western countries. Using data from two population-based prospective cohorts from South Korea, including primary school students aged 10-12 years (N = 2844) and secondary school students aged 15-17 years (N = 3449), we examined the interplay between collective efficacy, family violence, and youth antisocial behaviour, and whether effects vary by SES. In a first series of models, in both samples, higher levels of collective efficacy were associated with lower levels of family violence, whereas higher levels of family violence were associated with higher levels of youth antisocial behaviour. There was no direct effect of collective efficacy on youth antisocial behaviour; however, there was an indirect effect via family violence. Although these effects were more pronounced in low SES children, there was no evidence of moderation by SES. In a second series of models, in primary school students, collective efficacy was not associated with youth antisocial behaviour. However, there was a direct effect of collective efficacy on family violence, even after adjusting for youth antisocial behaviour. Again, there was no evidence of moderation by SES. In secondary school students, the pattern of results was less consistent, however, again, suggesting more pronounced effects of collective efficacy in low SES children. The findings suggest that collective efficacy may influence family violence more directly, whereas youth antisocial behaviour may be affected more indirectly through the family environment.

The relationship between child neglect and adolescent interpersonal functioning: A systematic review

BACKGROUND

Neglect is a highly prevalent, yet historically understudied form of maltreatment. Recent research has revealed the far reaching and unique effects that neglect has on subsequent cognitive, behavioural and socio-emotional development, and on long-term physical and mental health outcomes. Adolescent interpersonal functioning is important to explore given the significant relational transitions that occur during this stage of development, and the known impact that these social changes can have on future life outcomes.

OBJECTIVE

This systematic review synthesises the literature exploring the relationship between neglect and adolescent interpersonal functioning in peer relationships.

METHODS

Seven databases and three grey literature sites were systematically searched, and identified records screened against inclusion criteria.

RESULTS

Twenty-one articles were included in the final sample, exploring five different indicators of adolescent interpersonal functioning. Around half of the papers investigating quality of peer relationships found that neglect, particularly emotional neglect, is associated with reduced relationship quality, and there is consistent evidence that neglect increases the risk of gang involvement and deviant peer affiliation.

CONCLUSIONS

These findings may be used to strengthen a trauma-informed approach to work with adolescents. Research on neglect and adolescent romantic relationships is sparse. Overall, the literature is varied and further research using longitudinal data and consistent measures of neglect would be of value.

Exploring protective and risk factors in the home environment in high-risk families - results from the Danish High Risk and Resilience Study-VIA 7

BACKGROUND

Exposure to inadequate home environment may put the healthy development of familial high-risk children at risk. This study aimed to investigate associations between risk factors and an adequate home environment of children having a parent diagnosed with schizophrenia or bipolar disorder.

METHODS

From a cohort of 522 children, data from 463 7-year-old children was included. Of these 172 children had familial risk for schizophrenia, 109 children had familial risk for bipolar disorder, and 190 were population-based controls. As part of a comprehensive battery, all participants were assessed with the Middle Childhood-Home Observation for Measurement of the Environment Inventory (MC-HOME Inventory) measuring the quality of the home environment.

RESULTS

When analyzing all families together, we found that having a parent diagnosed with schizophrenia would have a negative impact on the home environment (ß = -1.08; 95% CI (-2.16;-0.01); p = 0.05), while familial risk for bipolar disorder did not show significant predictive value. Being a single caregiver and child having experienced severe life events from ages 4 to 7 showed significant negative impact, while child having a mental illness diagnosis did not. Being a female caregiver, good social functioning of the caregiver, high child IQ and not being a single caregiver were found to predict positive values for the home environment. We found similar results when analyzing caregivers with and without a diagnosis separately.

CONCLUSIONS

Knowledge of what predicts good home environment should be used to inform development of early interventions for families at risk.

Enduring effect of abuse: Childhood maltreatment links to altered theory of mind network among adults

Childhood maltreatment (CM) confers a great risk of maladaptive development outcomes later in life, however, the neurobiological mechanism underlying this vulnerability is still unclear. The present study aimed to investigate the long-term consequences of CM on neural connectivity while controlling for psychiatric conditions, medication, and, substance abuse. A sample including adults with (n = 40) and without CM (n = 50) completed Childhood Trauma Questionnaire (CTQ), personality questionnaires, and resting-state functional magnetic resonance imaging scan were recruited for the current study. The whole-brain functional connectivity (FC) was evaluated using an unbiased, data-driven, multivariate pattern analysis method. Relative to controls, adults with CM suffered a higher level of temperament and impulsivity and showed decreased FC between the insula and superior temporal gyrus (STG) and between inferior parietal lobule (IPL) and middle frontal gyrus, STG, and dorsal anterior cingulate cortex (dACC), while increased FC between IPL and cuneus and superior frontal gyrus (SFG) regions. The FCs of IPL with dACC and SFG were correlated with the anxious and cyclothymic temperament and attentional impulsivity. Moreover, these FCs partially mediated the relationship between CM and attentional impulsivity. Our results suggest that CM has a significant effect on the modulation of FC within theory of mind (ToM) network even decades later in adulthood, and inform a new framework to account for how CM results in the development of impulsivity. The novel findings reveal the neurobiological consequences of CM and provide new clues to the prevention and intervention strategy to reduce the risk of the development of psychopathology.

Rural Child Maltreatment: A Scoping Literature Review

TOPIC OF REVIEW

The current study sought to review the state of existing knowledge on rural maltreatment.

METHOD OF REVIEW

We conducted a scoping literature review to answer two research questions: (1) Is maltreatment higher in rural areas compared to urban areas? and 2) Are there unique correlates of maltreatment in rural areas?

NUMBER OF RESEARCH STUDIES MEETING THE CRITERIA FOR REVIEW

This review included studies that compared child maltreatment in rural and urban areas in the United States (9) and predictors of maltreatment in rural areas (7).

CRITERIA FOR INCLUSION

Studies that compared child maltreatment in rural and urban areas in the United States were included. For our second research question, related to understanding maltreatment in rural areas, we included those studies that exclusively examined rural areas, when maltreatment was the outcome variable.

HOW RESEARCH STUDIES WERE IDENTIFIED

Studies were reviewed from relevant databases (Annual Reviews, PsychINFO, PubMed, Web of Science) between 1975 and 2019.

MAJOR FINDINGS

Findings were mixed on whether rates of maltreatment were higher or lower in rural areas. While five studies reported higher rates of maltreatment in rural areas, four reported higher rates in urban areas. Overall, child maltreatment rates tended to be higher in urban areas among people of color and higher in rural areas among White people. One study found that community economic factors were not related to maltreatment in a rural area, in stark contrast to robust findings from urban areas.

Child Maltreatment, School Bonds, and Adult Violence: A Serial Mediation Model

Physically abused youth are vulnerable to experiencing difficulties across multiple domains of school functioning. Most of the literature examining the relationship between child physical abuse (CPA) and adult violence has focused narrowly on academic outcomes rather than taking a broader view that explores the processes undergirding school engagement and connections. The present study adopted Connell's model of school engagement, connectedness and outcomes within a social bond framework to examine (a) the link between CPA and school social bonds, (b) the link between CPA and adult violence persistence, and (c) the mediational (parallel, serial) effects of school bonds (engagement, connection, and achievement) on violence perpetration in adulthood. Consistent with previous research, results indicated that children who experience physical abuse have poorer academic performance, which, in turn, is related to future violent trajectories. We further found that the relationship between CPA and violence persistence is mediated by a process of bonding to school that begins with being actively engaged in school activities and ends with higher levels of academic achievement. In particular, some of the "school achievement" effect found in previous research operates through behavioral and emotional manifestations and may be partly explained through physically abused children's lessened ability to be engaged with and connected to school activities. We conclude with a discussion of the policy implications stemming from our findings.

Risk for substance use among adolescents at-risk for childhood victimization: The moderating role of ADHD

BACKGROUND

Youth who are victimized by violence are at heightened risk for substance use (SU) during adolescence, a period characterized by elevated impulsivity and risk-taking behavior. This risk may be magnified by attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE

To examine risk/protective factors for adolescent SU among adolescents at-risk for victimization and whether ADHD moderates these associations.

PARTICIPANTS AND SETTING

Participants were 1058 caregiver-adolescent dyads in the U.S. who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN).

METHOD

Binary logistic regression analyses were conducted for each SU type. First-order effects of all variables were tested first and for each SU outcome, followed by tests of two-way interactions between ADHD group and each predictor, after controlling for first-order effects.

RESULTS

More externalizing behavior (odds ratio [OR] = 1.38; 95 % confidence interval [CI]:1.12, 1.71) and less parental knowledge (OR = .75; 95 %CI: .60, .95) were associated with greater risk for subsequent tobacco use. Less positive peer affiliation was associated with greater risk for subsequent illicit SU (OR = .59; 95 %CI: .36, .96). More deviant peer affiliation were associated with greater risk for all forms of SU. ADHD moderated the association between deviant peer affiliation and marijuana use [b = .9, p < .05, 95 %CI: .03, 1.77), such that deviant peer affiliation was a significantly stronger predictor of marijuana use among adolescents with ADHD than those without.

CONCLUSIONS

Findings suggest risk and protective factors for SU are largely consistent for adolescents at-risk for victimization with and without ADHD, but at-risk adolescents with ADHD may be more susceptible to deviant peer influences.

Does Educational Success Mitigate the Effect of Child Maltreatment on Later Offending Patterns?

Analyses examined offending patterns during adolescence and adulthood and their relation to child maltreatment subtypes and education factors measured during adolescence and adulthood. A total of 356 participants were followed from preschool to adulthood in a prospective longitudinal study. Child maltreatment subtypes include physical-emotional abuse, sexual abuse, and neglect. Offending patterns were analyzed as latent classes of (a) chronic offending, (b) desistence, and (c) stable low-level or non-offending. Physical-emotional and sexual abuse were associated with a higher likelihood of chronic offending relative to stable low-level offending. Education variables, including high educational engagement and good academic performance, predicted a higher likelihood of low-level offending relative to desistence, but not desistence relative to chronic offending. Only educational attainment predicted desistence relative to chronic offending. There was no moderating effect of education variables on the association between child maltreatment subtypes and later offending patterns. Implications for research, practice, and policy are discussed.

Prevalence of childhood maltreatment among people with opioid use disorder: A systematic review and meta-analysis

BACKGROUND

Experience of childhood maltreatment (CM) is a risk factor for opioid use disorder (OUD). CM is also associated with comorbid mental disorders and poor treatment outcomes among people with OUD. To our knowledge, this is the first systematic review and meta-analysis to estimate the prevalence of CM among people with OUD.

METHODS

We searched MEDLINE, EMBASE, and PsycINFO to identify observational studies that evaluated CM among people with OUD from January 1990 to June 2020. Prevalence of each CM type, sample characteristics, and methodological factors were extracted from each eligible study. Random-effects meta-analyses were used to pool prevalence estimates. Stratified meta-analyses were used to assess heterogeneity.

RESULTS

Of the 6,438 publications identified, 113 studies reported quantitative CM data among people with OUD and 62 studies (k = 62; N = 21,871) were included in primary analyses. Among people with OUD, the estimated prevalence of sexual abuse was 41% (95% CI 36-47%; k = 38) among women and 16% (95% CI 12-20%; k = 25) among men. Among all people with OUD, prevalence estimates were 38% (95% CI 33-44%; k = 48) for physical abuse, 43% (95% CI 38-49%; k = 31) for emotional abuse, 38% (95% CI 30-46%; k = 17) for physical neglect, and 42% (95% CI 32-51%; k = 17) for emotional neglect. Sex, history of injecting drug use, recruitment methods, and method of assessing CM were associated with substantial heterogeneity.

CONCLUSIONS

People with OUD frequently report the experience of CM, supporting the need for trauma-informed interventions among this population. Future research should consider the impact of CM on OUD presentations and when assessment is appropriate, use of validated instruments.

An overview of child maltreatment (neglect and abuse) associations with developmental trajectories and long-term outcomes in the 1958 British birth cohort

Childhood maltreatment types (neglect and psychological, physical, or sexual abuse) are associated with many poor outcomes in adulthood. Yet, research mainly focuses on the cumulative adversity burden rather than specificities and commonalities of associations with adult outcomes and intervening pathways. To build understanding of life-course pathways to a range of outcomes, this overview summarises evidence from several original research studies using the 1958 British Birth Cohort on specific maltreatment types, child development trajectories, adult intermediaries and outcomes. About one-in-five participants were identified as neglected or abused in childhood (~10% were identified for neglect, 10% for psychological abuse, 6% for physical abuse and 1.4% for sexual abuse). Neglect was associated with key dimensions of development, for example, slower height growth, delayed maturation, faster BMI gain, and poorer emotional and cognitive development. Associated adulthood outcomes included harmful behaviours (notably smoking), poorer physical health (e.g. shorter height, excess BMI, poorer blood lipids and glucose, poor-rated health and physical functioning), worse mental health, lower socioeconomic circumstances (e.g. poorer living conditions) and elevated mortality in mid-adulthood. Childhood abuse associations were less widespread and were often only for specific types: most types were unrelated to childhood height and cognitive abilities, but all types were associated with poorer child emotional development, adult mental health, smoking, blood lipids and self-rated health. Additionally, physical abuse was associated with faster BMI gain, higher adult BMI, blood glucose, inflammation and mortality in mid-adulthood; sexual abuse with faster BMI gain, higher adult BMI, poor physical functioning at 50y and higher mortality in mid-adulthood. Adult health measures associated with neglect and abuse are key predictors of serious disease, disability and death. Therefore, neglect and abuse associations with these measures represent an important burden for individuals and society.

Perceptions of danger, tolerance of delinquency, and economic disadvantage: Examining neighborhood influences on child physical abuse

BACKGROUND

Social disorganization theory posits that both structural and social features of a particular geographic unit are associated with criminal behavior. Despite many tests of social disorganization theory, few studies have assessed its relevance to child abuse.

OBJECTIVE

This study seeks to explain neighborhood variation in child maltreatment. The goal of the current study is to fill this gap by investigating whether or not child physical abuse is related to neighborhood economic disadvantage, perceptions of the dangerousness of the neighborhood, and norms regarding delinquency.

PARTICIPANTS AND SETTING

Data were drawn from the Project on Human Development in Chicago Neighborhoods (PHDCN) and included 2364 respondents from 79 neighborhoods. The dependent variable, the variety or number of acts of severe child physical abuse, was reported by caregivers, while neighborhood characteristics were based on information from the U.S. Census Data and adult respondents living in Chicago neighborhoods.

METHODS

A multilevel, over-dispersed, Poisson regression models were utilized to predict the variety of acts of severe physical abuse that a child living within a given neighborhood would experience.

RESULTS

Neighborhood economic disadvantage was not significantly associated with greater variety of physical abuse. However, neighborhoods perceived as dangerous had greater variety of physical abuse (b = .25, p < .05), while those with a greater tolerance for deviance had somewhat lower variety of physical abuse (b= -.69, p ≤ .10).

CONCLUSIONS

These results suggest that some contextual factors may help explain child maltreatment and should be subject to additional research.

Sexual Abuse Prevention Education for Preschool-Aged Children: Parents' Attitudes, Knowledge and Practices in Beijing, China

The purpose of this study was to investigate Chinese parents' attitudes, knowledge, and practices with their preschool-aged children on sexual abuse prevention education, and to explore the associated factors of parental educative practices on child sexual abuse (CSA) prevention. Four hundred and forty parents of young children from 16 classes in 3 preschools in Beijing completed the questionnaire anonymously and voluntarily (response rate = 80%). Less than one third of parents believed that children most often were sexually abused by familiar persons, and less than 30% of parents believed that if a child has been sexually abused, there will usually be no obvious physical evidence. Parents were reluctant to discuss CSA protective skills with their young children. Less than half of the parents had told their children that if sexual abuse happens, parents or other trusted adults should be told. The multivariate linear regression equation showed that both parents' knowledge (B = 0.11, SE B = 0.05, p = 0 .03) and attitudes (B = 0.27, SE B = 0.10, p = .01) were significant factors for parents' communication about CSA prevention with their children. Findings from this study suggest that it is urgent to implement the sexual abuse prevention education with Chinese parents of preschoolers. Applications and limitations of these findings are discussed.

Child protection cases, one size fits all? Cluster analyses of risk and protective factors

BACKGROUND

To provide effective tailor made case management in Child Protection Services (CPS) a insight is needed into the specific characteristics of the target group. Using the ecological perspective of maltreatment, this study explored poorly known characteristics of the CPS population.

OBJECTIVE

To distinguish CPS subgroups based on risk and protective factors enables tailor made case management that fits the specific needs of these subgroups.

PARTICIPANTS AND SETTING

We studied 250 Dutch CPS cases of family supervision by court order that had completed the LIRIK and Action Plan checklists in August 2014-March 2015.

METHODS

This quantitative study analyzed risk and protective factors for children and parents reported in client files. Subgroups were identified by two-step cluster analyses. Chi-square analyses identified relations between parental risk subgroups and other groups.

RESULTS

Building on the interplay between risk and protective factors on the levels of child, parent and environment, we found five distinct subgroups in the CPS population. The most vulnerable is parents with multiple problems (31%) or socio-economic problems (13%). Parts of both subgroup have limited protective factors. Parents with major life events (16%) or poor parenting (13%) are characterized by single-level problems. One subgroup (28%), the unaccepted, has no parental risk factors registered.

CONCLUSIONS

Studying client files can lead to a better understanding of the healthcare needs of the CPS population. To develop and implement more effective case management requires constant dialogue between science, policy, and the experiences of both clients and professional.

Spirituality and its Relation to Mental Health Outcomes: An Examination of Youth in Foster Care

The effects of spirituality and youth relationships with others on internalizing, externalizing, and adaptive outcomes were examined in a sample of 159 youth between the ages of 8 and 21 in foster or residential care. Indirect effects of direct coping and perceived social support on the relations between these factors and youth outcomes were examined. Preliminary analyses indicated a significant relation between youth spirituality and adaptive outcomes, with a significant indirect effect of perceived social support on these relations. However, these relations were nonsignificant when accounting for youth relationships with others. Final results indicated that youth relationships with others significantly affected youth adaptive functioning through both coping and perceived social support. Youth relationships also significantly affected youth internalizing symptoms, albeit only through youths' perceived levels of social support. These findings suggest that, while spiritual beliefs are potentially an important factor in affecting outcomes for foster youth, the strongest effects likely occur through youths' relationships with others, social support, and coping in relation to adaptive outcomes for these youth.

Drug overdose and child maltreatment across the United States' rural-urban continuum

This national study of US counties (n = 2963) investigated whether county-level drug overdose mortality is associated with maltreatment report rates, and whether the relationship between overdose mortality and maltreatment reports is moderated by a county's rural, non-metro or metro status. Data included county-level 2015 maltreatment reports from the National Child Abuse and Neglect Data System, modeled drug-overdose mortality from the Centers for Disease Control, United States Department of Agriculture Rural-Urban Continuum Codes, US Census demographic data and crime reports from the Federal Bureau of Investigation. All data were linked across counties. Zero-inflated negative binomial (ZINB) regression was used for county-level analysis. As hypothesized, results from the ZINB model showed a significant and positive relationship between drug overdose mortality and child maltreatment report rates (χ = 101.26, p < .0001). This relationship was moderated by position on the rural-urban continuum (χ=8.76, p = .01). For metro counties, there was a 1.9% increase in maltreatment report rate for each additional increment of overdose deaths (IRR=1.019, CI=[1.010, 1.028]). For non-metro counties, the rate of increase was 1.8% higher than for metro counties (IRR=1.018, CI=[1.006, 1.030]); for rural counties, the rate of increase was 1.2% higher than for metro counties (IRR=1.012, CI=[0.999, 1.026]). Additional research is needed to determine why the relationship between drug overdose mortality and maltreatment reports is stronger in non-metro and rural communities. One potential driver requiring additional inquiry is that access to mental and physical health care and substance use treatment may be more limited outside of metropolitan counties.

Caregiver depression and trajectories of behavioral health among child welfare involved youth

Child welfare involvement has been linked to child behavioral health issues, including increased likelihood of internalizing mental health problems such as depression and anxiety, and externalizing behavioral problems such as oppositional behaviors and substance use problems. One predictor of child behavioral health is caregiver mental health. Although, there remains a specific gap associated with identification of factors among caregivers that are associated with longitudinal child behavioral health trajectories. Using LONGSCAN, we explore the effects of caregiver depression on the behavioral health of children over time. Multilevel mixed-effects linear regression models showed that children with a caregiver who reported depression showed significantly higher internalizing behavioral problems over time, and significantly larger decreases in externalizing behavioral problems over time, compared to children with a caregiver who reported no depression. These findings emphasize that early interventions geared towards jointly assessing and treating parent and child mental health issues in the child welfare system may be successful at improving future behavioral health outcomes.

Developmental effects of childhood household adversity, transitions, and relationship quality on adult outcomes of socioeconomic status: Effects of substantiated child maltreatment

The degree to which child maltreatment interacts with other household adversities to exacerbate risk for poor adult socioeconomic outcomes is uncertain. Moreover, the effects of residential, school, and caregiver transitions during childhood on adult outcomes are not well understood. This study examined the relation between household adversity and transitions in childhood with adult income problems, education, and unemployment in individuals with or without a childhood maltreatment history. The potential protective role of positive relationship quality in buffering these risk relationships was also tested. Data were from the Lehigh Longitudinal Study (n = 457), where subjects were assessed at preschool, elementary, adolescent, and adult ages. Multiple group path analysis tested the relationships between childhood household adversity; residential, school, and caregiver transitions; and adult socioeconomic outcomes for each group. Caregiver relationship quality was included as a moderator, and gender as a covariate. Household adversity was negatively associated with education level and positively associated with income problems for non-maltreated children only. For both groups, residential transitions was negatively associated with education level and caregiver transitions was positively associated with unemployment problems. Relationship quality was positively associated with education level only for non-maltreated children. For children who did not experience maltreatment, reducing exposure to household adversity is an important goal for prevention. Reducing exposure to child maltreatment for all children remains an important public health priority. Results underscore the need for programs and policies that promote stable relationships and environments.

Differential impacts of participation in organized activities and maltreatment types on adolescent academic and socioemotional development

Participation in organized activities has been largely regarded as beneficial for academic and socioemotional development for adolescents, but the impacts of various types of organized activities for adolescents at risk for maltreatment have been rarely tested. In this study, we investigated the differential impacts of five types of maltreatment exposure (physical maltreatment, sexual maltreatment, neglect, other type, and multiple types) on the associations between four types of organized activities (mentored groups, art and music clubs, sport clubs, and academic clubs) and academic and socioemotional development (school engagement, delinquency, depressive symptoms, and trauma symptoms) of adolescents who were investigated by Child Protective Services (CPS) for maltreatment exposure. Data came from a national, longitudinal sample of 790 adolescents in contact with CPS in the U.S. After controlling for demographic characteristics of participants and prior levels of each outcome, multiple linear regression models were fitted to the data with interactions between the organized activities and the maltreatment types. The main findings of this study included: 1) adolescents who participated in mentored groups, sport clubs, and academic clubs reported higher levels of school engagement; 2) adolescents who participated in academic clubs reported fewer depressive symptoms; 3) adolescents who participated in art and music clubs reported more trauma symptoms compared to non-participants; and 4) the effects of participation in mentored groups on delinquency and trauma symptoms differed by maltreatment type. These results indicate both possible benefits and risks of organized activity participation for adolescents with certain maltreatment exposures.

Positive and Negative Affect and Adolescent Adjustment: Moderation Effects of Prefrontal Functioning

We examined whether cognitive control moderates the effects of emotion on adolescent internalizing and externalizing symptomatology in a longitudinal study of 138 adolescents. Self-reported positive affect (PA) and negative affect and behavioral and neural indicators of cognitive control, indexed by performance and prefrontal hemodynamic response during a cognitive interference task, were collected at Time 1. Self-reported internalizing and externalizing symptomatology were collected at Time 1 and Time 2 (1 year later). Results indicated that higher PA predicted decreases in externalizing symptomatology, but only for adolescents with poor neural cognitive control. No moderation effects were found for behavioral cognitive control. Findings imply the beneficial effects of PA on the development of externalizing problems among adolescents with poor prefrontal functioning.

School readiness of maltreated children: Associations of timing, type, and chronicity of maltreatment

Children who have been maltreated during early childhood may experience a difficult transition into fulltime schooling, due to maladaptive development of the skills and abilities that are important for positive school adaptation. An understanding of how different dimensions of maltreatment relate to children's school readiness is important for informing appropriate supports for maltreated children. In this study, the Australian Early Development Census scores of 19,203 children were linked to information on child maltreatment allegations (substantiated and unsubstantiated), including the type of alleged maltreatment, the timing of the allegation (infancy-toddlerhood or preschool), and the total number of allegations (chronicity). Children with a maltreatment allegation had increased odds of poor school readiness in cognitive and non-cognitive domains. Substantiated maltreatment was associated with poor social and emotional development in children, regardless of maltreatment type, timing, or chronicity. For children with unsubstantiated maltreatment allegations, developmental outcomes according to the type of alleged maltreatment were more heterogeneous; however, these children were also at risk of poor school readiness irrespective of the timing and/or chronicity of the alleged maltreatment. The findings suggest that all children with maltreatment allegations are at risk for poor school readiness; hence, these children may need additional support to increase the chance of a successful school transition. Interventions should commence prior to the start of school to mitigate early developmental difficulties that children with a history of maltreatment allegations may be experiencing, with the aim of reducing the incidence of continuing difficulties in the first year of school and beyond.

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.

A Randomized Controlled Trial Examination of a Remote Parenting Intervention: Engagement and Effects on Parenting Behavior and Child Abuse Potential

Technology advances increasingly allow for access to remotely delivered interventions designed to promote early parenting practices that protect against child maltreatment. Among low-income families, at somewhat elevated risk for child maltreatment, there is some evidence that parents do engage in and benefit from remote-coaching interventions. However, little is known about the effectiveness of such programs to engage and benefit families at high risk for child maltreatment due to multiple stressors associated with poverty. To address this limitation, we examined engagement and outcomes among mothers at heightened risk for child abuse, who were enrolled in a randomized controlled, intent-to-treat trial of an Internet adaptation of an evidence-based infant parenting intervention. We found that engagement patterns were similar between higher and lower risk groups. Moreover, an intervention dose by condition effect was found for increased positive parent behavior and reduced child abuse potential.

Childhood maltreatment and high dietary fat intake behaviors in adulthood: A birth cohort study

Childhood maltreatment has been associated with a wide range of chronic medical conditions including obesity, other metabolic events and eating disorders. However, little is known about the association between childhood maltreatment and high dietary fat intake. This study addresses the extent to which co-occurring and specific forms of substantiated childhood maltreatment are associated with self-reported high dietary fat intake in adulthood and whether there is a gender-childhood maltreatment interaction in predicting this association. The study also examines the association between age at substantiation of maltreatment, number of childhood maltreatment substantiations and high dietary fat intake-related behaviors. The data were from a prospective Australian pre-birth mother-child dyads study, the Mater-University of Queensland Study of Pregnancy. The study followed 7223 mother-child dyads following the birth of a live, singleton baby at the Mater hospital. Recruitment was early in pregnancy, and then follow-ups at 3-5days postpartum and again when the child was 6 months, 5, 14 and 21 years of age. The data were linked to agency-substantiated cases of childhood maltreatment 0-14 years. This study extended the data linkage to 3766 (47.4% female) participants who had complete data on dietary fat intake behaviors at the 21-year follow-up. Consecutive logistic regressions were used to estimate odds ratios with respective 95% confidence intervals for high dietary fat intake for multiple and specific forms of childhood maltreatment, as well as age at and number of childhood maltreatment substantiations. Finally, a gender-childhood maltreatment interaction term was used to predict the outcome. In both unadjusted and adjusted analyses, substantiated childhood maltreatment including physical abuse were associated with high dietary fat intake-related behaviors. Similarly, substantiation of childhood maltreatment between the ages of 5 and 14 years was significantly associated with high dietary fat intake-related behaviors as were two or more substantiations of maltreatment. Inclusion of gender-childhood maltreatment interaction only had a minor impact on the size and direction of the association. Chronic and severe forms of childhood maltreatment including physical abuse are associated with a higher rate of dietary fat intake in young adulthood. Further research to replicate this association might focus on possible neuro-hormonal mechanisms that might explain this behavior.

Gendered Pathways From Child Abuse to Adult Crime Through Internalizing and Externalizing Behaviors in Childhood and Adolescence

Gender differences in externalizing and internalizing pathways from child abuse to adult crime were examined across four waves of an extended longitudinal study ( N = 186 males and 170 females) using multiple-group structural equation modeling. Results show that child abuse was associated with both internalizing and externalizing behaviors in the elementary school years for both males and females. However, gender differences were found such that internalizing behaviors increased the risk of adult crime for females only, and externalizing behaviors increased the risk of adult crime for males only. Internalizing behaviors among males actually lessened the risk of adult crime, and externalizing behaviors were unrelated to adult crime among females. Findings confirm distinct pathways leading from child abuse to later crime for males and females, which is important for prevention and intervention strategies.

Environmental and individual attributes associated with child maltreatment resulting in hospitalization or death

Maltreatment continues to be a leading cause of death for young children. Researchers are beginning to uncover which neighborhood attributes may be associated with maltreatment outcomes. However, few studies have been able to explore these influences while controlling for individual family attributes, and none have been able to parse out the most severe outcomes-injuries resulting in hospitalization or death. This study utilizes a retrospective, case-control design on a dataset containing both individual and environmental level attributes of children who have been hospitalized or died due to maltreatment to explore the relative influence of attributes inside and outside the household walls. Binary conditional logistic regression was used to model the outcome as a function of the individual and environmental level predictors. Separate analyses also separated the outcome by manner of maltreatment: abuse or neglect. Finally, a sub-analysis included protective predictors representing access to supportive resources. Findings indicate that neighborhood attributes were similar for both cases and controls, except in the neglect only model, wherein impoverishment was associated with higher odds of serious maltreatment. Dense housing increased risk in all models except the neglect only model. In a sub-analysis, distance to Family Resource Centers was inversely related to serious maltreatment. In all models, variables representing more extreme intervention and/or removal of the victim and/or perpetrator from the home (foster care or criminal court involvement) were negatively associated with the risk of becoming a case. Medi-Cal insurance eligibility of a child was also negatively associated with becoming a case. Government interventions may be playing a critical role in child protection. More research is needed to ascertain how these interventions assert their influence.

The Protective Effect of Kinship Involvement on the Adjustment of Youth in Foster Care

Child maltreatment and family dysfunction (e.g., conflict) can have a long-term deleterious impact on youth well-being. Using a child welfare sample, this study examined whether dysfunction in the nuclear family of origin was associated with adjustment problems, including internalizing and externalizing behavior problems, beyond the effect of child maltreatment, and whether extended family (kinship) involvement protected against youth's adjustment problems. Participants included 171 children and adolescents (mean age = 10.15; 50.3% female) who entered foster care due to child maltreatment. Results indicated that greater dysfunction in the nuclear family of origin and child maltreatment were independently associated with greater internalizing and externalizing behavior problems. Results also showed that kinship involvement was protective against externalizing behavior problems. Moreover, kinship involvement buffered the association between dysfunction in family of origin and internalizing behaviors only at low levels of family dysfunction. These results support policies that encourage the involvement of extended and noncustodial family members in the lives of maltreated youth following their entry into foster care.

Effects of Exposure to Domestic Physical Violence on Children's Behavior: A Chinese Community-based Sample

Domestic physical violence (DPV) is common in China due to its long history of slavery and feudalism. This study aimed to examine the effects of exposure to DPV on children's behavior in a Chinese community. Ninety-three 12- to 16-year-old adolescents exposed to DPV were compared to 54 adolescents with no exposure to DPV. We found that DPV exposure was associated with adverse behaviors in children, especially among boys. Children witnessing DPV alone had similar behavioral scores as the abused children. We recommend that both abused and DPV witness-only adolescents in Chinese communities need treatment to mitigate the effects on maladjusted behaviors. The intervention programs for children who witness domestic violence are also important.

The Levels of Cortisol, Oxidative Stress, and DNA Damage in the Victims of Childhood Sexual Abuse: A Preliminary Study

In this study we aimed to investigate serum cortisol, oxidative stress, and DNA damage in children who are sexual abuse victims. The study included 38 children who sustained child sexual abuse and 38 age- and gender-matched children who did not have a history of trauma. Cortisol levels reflecting the status of the hypothalamic-pituitary-adrenal axis, anti-oxidant enzymes glutathione peroxidase, superoxide dismutase, natural anti-oxidant coenzyme Q, and 8-hydroxy-2-deoxyguanosine as the indicator of DNA damage were analyzed in serum samples using the enzyme linked immunosorbent assay method. Cortisol levels were significantly higher in the child sexual abuse group compared to the control group. There were no significant differences between the groups in terms of oxidative stress and DNA damage. Cortisol and 8-hydroxy-2-deoxyguanosine levels decreased as the time elapsed since the sexual abuse increased. Coenzyme Q level was lower in victims who sustained multiple assaults than in the victims of a single assault. Cortisol and superoxide dismutase levels were lower in the victims of familial sexual abuse. Decreases in cortisol and 8-hydroxy-2-deoxyguanosine levels as time elapsed may be an adaptation to the toxic effects of high cortisol levels over a prolonged period of time. Child sexual abuse did not result in oxidative stress and DNA damage; however, some features of sexual abuse raised the level of oxidative stress.

Understanding the Interplay Between Neighborhood Structural Factors, Social Processes, and Alcohol Outlets on Child Physical Abuse

This article seeks to understand the relative influence of neighborhood structural characteristics (e.g., disadvantage) and social processes (e.g., interactions between residents) on child physical abuse. Using multilevel modeling in a sample of 3,023 parents in 194 zip codes, structural characteristics of factor scores representing residential stability and foreign-born Latino males were negatively related to child physical abuse. High proportions of naturalized and Asian/Pacific Islander families were positively related to the frequency of physical abuse. Higher levels of neighborhood social disorder were related to more frequent physical abuse, while higher levels of collective efficacy were related to less frequent physical abuse. Programs designed to alleviate disorder and increase neighborly interactions may be effective at reducing physical abuse. By understanding the relative importance of the demographic characteristics of neighborhoods and the actions and interactions of residents within the neighborhoods, policy and practice can be tailored more effectively to prevent maltreatment.

Childhood Maltreatment and Educational Outcomes

Children (0-18 years) with maltreatment histories are vulnerable to experiencing difficulties across multiple domains of functioning, including educational outcomes that encompass not only academic achievement but also mental well-being. The current literature review adopted Slade and Wissow's model to examine (1) the link between childhood maltreatment and academic achievement, (2) the link between childhood maltreatment and mental health outcomes (i.e., emotional and behavioral difficulties), and (3) the bidirectional relationship between childhood academic achievement and mental health. In addition, we reviewed variables that might influence or help explain the link between childhood maltreatment and educational outcomes, drawing on developmental perspectives and Bronfenbrenner's ecological model. Finally, whenever possible, we presented findings specific to maltreated children in out-of-home care to highlight the unique challenges experienced by this population. Results indicated that children with maltreatment histories often experience impairments in both their academic performance (e.g., special education, grade retention, lower grades) and mental well-being (e.g., anxiety, low mood, aggression, social skills deficits, poor interpersonal relationships). These impairments appeared to be particularly pronounced among maltreated children in out-of-home care. Findings, albeit sparse, also indicated that mental health difficulties are negatively associated with children's academic achievement and, similarly, that academic achievement deficits are linked with mental health problems. The link between childhood maltreatment and educational outcomes may be partly explained through the disruption of key developmental processes in children, such as attachment, emotion regulation, and sense of agency. As well, maltreatment characteristics and the functioning of various systems in which children are embedded (e.g., family, school, child welfare) can serve to positively or negatively influence the educational outcomes of maltreated children. The theoretical, research, and applied implications stemming from the findings are considered.

Geographic variation in racial disparities in child maltreatment: The influence of county poverty and population density

There are documented disparities in the rates at which black children come into contact with the child welfare system in the United States compared to white children. A great deal of research has proliferated aimed at understanding whether systematic biases or differential rates of risk among different groups drive these disparities (Drake et al., 2011). In the current study, county rates of maltreatment disparity are compared across the United States and examined in relation to rates of poverty disparity as well as population density. Specifically, using hierarchical linear modeling with a spatially lagged dependent variable, the current study examined data from the National Child Abuse and Neglect Data System (NCANDS) and found that poverty disparities were associated with rates of maltreatment disparities, and densely populated metropolitan counties tended to have the greatest levels of maltreatment disparity for both black and Hispanic children. A significant curvilinear relationship was also observed between these variables, such that in addition to the most densely populated counties, the most sparsely populated counties also tended to have higher rates of maltreatment disparity for black and Hispanic children.

Designing mental health interventions informed by child development and human biology theory: a social ecology intervention for child soldiers in Nepal

The anthropological study of human biology, health, and child development provides a model with potential to address the gap in population-wide mental health interventions. Four key concepts from human biology can inform public mental health interventions: life history theory and tradeoffs, redundancy and plurality of pathways, cascades and multiplier effects in biological systems, and proximate feedback systems. A public mental health intervention for former child soldiers in Nepal is used to illustrate the role of these concepts in intervention design and evaluation. Future directions and recommendations for applying human biology theory in pursuit of public mental health interventions are discussed.

Double disadvantage: the influence of childhood maltreatment and community violence exposure on adolescent mental health

BACKGROUND

Childhood maltreatment is a key risk factor for maladjustment and psychopathology. Although maltreated youth are more likely to experience community violence, both forms of adversity are generally examined separately. Consequently, little is known about the unique and interactive effects that characterize maltreatment and community violence exposure (CVE) on mental health.

METHODS

Latent Profile Analysis (LPA) was applied to data from a community sample of high-risk adolescents and young adults (n = 204, M = 18.85) to categorize groups of participants with similar patterns of childhood (i.e. past) maltreatment exposure. Associations between childhood maltreatment, CVE and mental health outcomes were then explored using multivariate regression and moderation analyses.

RESULTS

Latent Profile Analysis identified three groups of individuals with low, moderate and severe levels of childhood maltreatment. Maltreatment was associated with more internalizing, externalizing, and trauma-related symptoms. By contrast, CVE showed independent associations with only externalizing and trauma-related symptoms. Typically, childhood maltreatment and CVE exerted additive effects; however, these forms of adversity interacted to predict levels of anger.

CONCLUSIONS

Exposure to maltreatment and community violence is associated with increased levels of clinical symptoms. However, while maltreatment is associated with increased symptoms across a broad range of mental health domains, the impact of community violence is more constrained, suggesting that these environmental risk factors differentially impact mental health functioning.

Multilevel correlates of behavioral resilience among children in child welfare

Resilience, defined as positive adaptation and functioning following exposure to significant adversity, is an important topic of investigation in child welfare. The current study used data from the Ontario Looking After Children (OnLAC) project to estimate the prevalence of behavioral resilience (i.e., lower frequency of conduct and emotional problems, higher frequency of prosocial behavior) in 531 5-9 year olds living in out-of-home care, and to determine how behaviorally-resilient children are functioning in other domains (i.e., peer relationships and academic performance). Furthermore, hierarchical linear modeling was used to examine the contribution of four levels of analysis (i.e., child, family, child welfare worker, and child welfare agency) on behaviors and to identify the contribution of predictor variables within each of these levels. Findings indicated that 50-70% of children exhibited resilience on one behavioral outcome while approximately 30% showed resilience on at least two of the outcomes. Also, 8.4-9.6% exhibited resilience on one of the behavioral outcomes in addition to peer relationships and academic performance. The child level accounted for the highest proportion of total explained variance in behavioral outcomes, followed by the family-, child welfare worker-, and child welfare agency-levels. A number of child and foster family variables predicted behavioral functioning. Findings indicate that it is important to inquire about children's functioning across multiple domains to obtain a comprehensive developmental assessment. Also, child and foster family characteristics appear to play considerable roles in the promotion of behavioral resilience.

Young children's knowledge and skills related to sexual abuse prevention: a pilot study in Beijing, China

To examine the level of knowledge and skills related to prevention of child sexual abuse (CSA) in a sample of Chinese preschoolers in Beijing and to explore the associations between children's scores on the knowledge and skills and their parents' reports on the knowledge and communication with children about CSA prevention. One hundred and thirty-six preschoolers were interviewed by researchers using the Chinese versions of Personal Safety Questionnaire and the "What If" Situation Test, and one parent of each child was invited to complete an anonymous questionnaire regarding parental knowledge and parent-child communication about CSA prevention. Less than half children knew that strangers were not the only perpetrators and only 16% thought that children should report secret touching. In 3 inappropriate touching requests, less than 30% of the children were aware of using verbal response to definitely refuse the inappropriate touching and less than 20% of the children were aware of definitely removing themselves from the abusive situations. Parent-child communication about CSA and parental educational level were the significant factors for children's self-protection skills. Preschool children lack CSA prevention knowledge and related self-protection skills. Culturally relevant primary CSA prevention programs in China need to be developed and parental education should be a part of CSA prevention. Parents need to be informed about CSA knowledge concepts and need to be encouraged to communicate with their children about sexual abuse prevention.

Understanding Children and Adolescents' Victimizations at Multiple Levels: An Ecological Review of the Literature

This article examines children and adolescent exposure to violence in various contexts. A systematic review of the literature was conducted to identify the definitions and types of violence reported in studies on victimization using the ecological systems framework. Sources included research studies and/or reports from scholarly journals (n = 140), books (n = 9), conference/workshops (n = 5), and web sources, such as Uniform Crime Reports (n = 23). The findings indicated that research differed in terminologies, conceptual and operational definitions, sample sizes and age group classification for children and adolescents. Further, studies lacked focus on the co-occurrence and inter-relatedness of victimization, and how these factors might affect the outcomes. Many studies employed a cross-sectional design, which limits strong conclusions about the temporal order of victimization experiences and outcomes. Future research efforts need more consistency among researchers in conceptual and operational definitions and the use of more rigorous designs. Increased holistic assessments are critical for effective prevention and intervention strategies for at-risk children and adolescents.