Definition and measurement of neglectful behavior: some principles and guidelines

Childhood neglect, the neglected trauma. A systematic review and meta-analysis of its prevalence in psychiatric disorders

Traumatic events increase risk of mental illnesses, but childhood neglect prevalence in psychiatric disorders is understudied. This systematic review and meta-analysis assessed neglect prevalence, including emotional neglect (EN) and physical neglect (PN), among adults with psychiatric disorders. We conducted a systematic search and meta-analysis in 122 studies assessing different psychiatric disorders. Prevalence was 46.6% (95%CI[34.5-59.0]) for unspecified neglect (Ne), 43.1% (95%CI[39.0-47.4]) for EN, and 34.8% (95%CI[30.6-39.2]) for PN. Although a moderating effect of the psychiatric diagnostic category was not confirmed, some clinical diagnoses had significantly lower prevalence rates than others. Patients with bipolar disorder and major depressive disorder showed lower prevalence rates of EN and PN, whereas lower prevalence was found in psychotic disorders and eating disorders for PN only. Neglect assessment was a significant moderator for Ne and PN. No moderating effect of age and sex on neglect prevalence was found. Heterogeneity levels within and between psychiatric diagnostic categories remained high. This is the first meta-analysis examining diverse types of neglect prevalence considering different psychiatric diagnoses. Our results explore the prevalence of childhood neglect and its subtypes among adults with psychiatric disorders, contributing to understanding the nuanced interplay between neglect and specific psychiatric conditions, and guiding interventions for affected individuals.

Does reward processing moderate or mediate the link between childhood adversity and psychopathology: A longitudinal study

Childhood adversity is common and associated with elevated risk for transdiagnostic psychopathology. Reward processing has been implicated in the link between adversity and psychopathology, but whether it serves as a mediator or moderator is unclear. This study examined whether alterations in behavioral and neural reward processing function as a mechanism or moderator of psychopathology outcomes following adversity experiences, including threat (i.e., trauma) and deprivation. A longitudinal community sample of 10-15-year-old youths was assessed across two waves (Wave 1: n = 228; Wave 2: n = 206). Wave 1 assessed adverse experiences, psychopathology symptoms, reward processing on a monetary incentive delay task, and resting-state fMRI. At Wave 2, psychopathology symptoms were reassessed. Greater threat experiences were associated with blunted behavioral reward sensitivity, which, in turn, predicted increases in depression symptoms over time and mediated the prospective association between threat and depression symptoms. In contrast, reward sensitivity moderated the association between deprivation experiences and prospective externalizing symptoms such that the positive association of deprivation with increasing externalizing symptoms was absent for children with high levels of reward sensitivity.

"Care About us First": Israeli Youths' Perspectives on Child Neglect

Child neglect is considered the most common form of child maltreatment with severe implications for children's development. Nonetheless, there is a dearth of scholarly literature examining child neglect, possibly stemming from a lack of consistent definition. The current qualitative study addresses this gap by aiming to understand the phenomena of child neglect from the direct perspective of youth from the general population, a perspective that has so far barely been considered. Data were collected by 10 focus groups conducted among multicultural youth aged 12 to 15 years in the north of Israel. The qualitative-thematic analysis generated three main themes, each including several subthemes: (a) experience of neglectful behavior (lack of parental care, lack of parental priority, dynamics of blaming the child, rejection, and relinquishment of the child); (b) instrumental characteristics of neglect (lack of material and financial investment in the child, expressions of neglect in providing food and nutrition, poor appearance and hygiene of the child and home); (c) lack of parental involvement (lack of parental guidance, lack of communication and availability, lack of presence in the child's life). The perspectives of the Israeli youth resembled existing conceptualizations of child neglect. The youth also added a new dimension to the conceptualizations in their focus on the emotional context involved in the range of neglectful behaviors they described. This new conceptualization of child neglect is discussed together with some suggestions for how it can inform better professional practice.

Development and Initial Validation of the Neglectful Experiences and Deprivation Scale

Socioemotional deprivation, or the absence of developmentally expected social experiences, has been linked to long-lasting health and psychological outcomes. To date, current measures of socioemotional deprivation fail to capture the cumulative impact of neglectful experiences across multiple social relationships and developmental periods. The current study developed and validated the Neglectful Experiences and Deprivation Scale (NEADS) on a sample of 547 stress-exposed adults (M/SD_age=27.77/6.54 years old; 56.5% male). Exploratory and confirmatory factor analyses in independent samples revealed a three-factor solution as the best fitting model: Caregiver Deprivation (four items; e.g., abandonment), Peer Deprivation (four items; e.g., physical isolation), Romantic Partner Deprivation (four items; e.g., emotionally unavailable). Indicators of construct validity and internal consistency support the selected three-factor model. Results provide strong preliminary evidence of the validity of the NEADS for assaying the severity, developmental timing, and psychological impact of socioemotional deprivation across the lifespan.

Latent classes of child neglect types and associated characteristics

BACKGROUND

Children who experience neglect typically endure multiple types of neglect and abuse during a single maltreatment incident. However, research on the phenomenology and predictors of neglect types has primarily examined neglect types in isolation.

OBJECTIVE

To advance understanding of neglect incidents that more accurately reflect the experiences of children who have been neglected, we examined latent classes of neglect defined by co-occurring neglect types and multiple forms of abuse. To inform efforts to identify families at-risk for particular classes of neglect, associations between child, parent, and family characteristics and latent classes were examined.

PARTICIPANTS AND SETTING

390 child neglect incidents substantiated at U.S. Army installations.

METHODS

Neglect types and incident severity were coded using the Modified Maltreatment Classification System. Child, parent, and family characteristics were coded using information drawn from case records.

RESULTS

Latent class analysis yielded 5 classes: exposure to violence, failure to provide, supervisory lapses, substance-related endangerment, and non-specific. The exposure to violence and substance-related endangerment classes were characterized as highly severe. High and low severity classes were associated with distinct child, parent, and family characteristics. The latent classes were also differentiated by distal outcomes, including probability of law enforcement investigation, child removal from home, and offender removal from home.

CONCLUSIONS

By identifying the types of neglect and abuse that are likely to occur concomitantly as well as the child, parent, and family characteristics associated with increased risk of latent classes of neglect, results advance knowledge regarding the phenomenology of neglect types and inform prevention efforts.

[Responding to children's emotional and cognitive needs: Applying the cumulative model to the general population]

OBJECTIVES

Several risk factors are associated with neglectful behaviors. Yet their cumulative effect, which refers to the accumulation of risk regardless of the presence or absence of specific factors, remains unknown. This study aims to determine whether risk accumulation predicts caregivers' responses to children's emotional and cognitive needs in the general population and to examine the presence of clinical thresholds.

METHOD

A total of 1102 maternal figures of children aged 5 to 9 years old living in Quebec were questioned through a telephone survey. The response to children's emotional and cognitive needs was measured using a validated version of the Parent-Report Multidimensional Neglectful Behavior Scale. Ten individual, family and socioeconomic risk factors were combined to compute a cumulative risk index.

RESULTS

Results indicate that the cumulative index predicts the response to children's emotional and cognitive needs in the general population. This effect is observed for families exposed to at least two risk factors and it increases considerably when risk exposure reaches 5 factors.

CONCLUSIONS

This study supports the cumulative risk hypothesis, which until now had mainly been examined in vulnerable or clinical samples. It fosters a better statistical understanding of contexts compromising an optimal response to school age children's emotional and cognitive needs in the general population. This breakthrough is particularity important considering the challenges of identifying children at risk of having their needs neglected.

Do macroeconomic shocks in the local labor market lead to child maltreatment and death?: Empirical evidence from Japan

BACKGROUND

Japan is facing a rapid increase in the number of reported child maltreatment cases. Child maltreatment has long-term consequences for the victims, and unemployment rate is considered a strong predictor of it. However, only few studies have analyzed the causal relation between child maltreatment and the unemployment rate-particularly the effects of the latter on the former-in Japan.

METHODS

Using prefecture-level longitudinal data from 2005 to 2016, we employed a fixed effects instrumental variable estimation. The estimation included a weighted average of the national unemployment rate across industries by industrial structures in 2005 as an instrument to identify the causal effects.

RESULTS

The average local unemployment rate changed by approximately 50% from the peak to the bottom in the sample period. A 50% increase in local unemployment rates increased the number of reported child neglect cases and child deaths by 80% and 70% (statistically significant at the 5% level), respectively. Further, it increased cases of death due to external causes, unintentional injuries, and unintentional drowning by 146%, 217%, and 315% (statistically significant at the 5% level), respectively.

CONCLUSION

The local unemployment rate is a risk factor for child maltreatment, resulting in children's death, especially as a result of unintentional drowning-the common cause of death due to child neglect. When the local unemployment rates rise, governments should allocate more financial and human resources for preventive measures to combat child deaths caused by neglect.

Developing and Validating a New Scale to Assess Signs of Neglect of Infants and Caregivers

This study aimed to develop a scale assessing the early signs of infant neglect and to test its reliability and validity. Neglect is a frequent type of child maltreatment and a serious problem worldwide, but it has received limited research attention. Previous studies of neglect assessment have mainly been targeted toward assessing the risk of apparent neglectful caregivers and neglected children. Early needs assessment scale focused on neglect evaluated by public health professionals in infants is necessary for the urgency of preventing neglect from infancy. Participants were community/public health nurses across Japan with experience working with neglectful caregivers of infants. The initial Signs of Neglect in Infants Assessment Scale (SIGN) was developed and refined based on previous studies, community/public health nurse consultation, and expert review. In 2017, 474 community/public health nurses completed a questionnaire regarding one infant neglect case. Item analysis, exploratory factor analysis, confirmatory factor analysis, and comparisons with a preexisting scale and case reporting status were used to narrow the scale and assess its psychometric properties. Item and exploratory factor analyses reduced the scale to 14 items on three factors: lack of basic supervisory care, child underdevelopment, and lack of emotional behavior. A confirmatory factor analysis indicated a good model fit (adjusted goodness-of-fit index = 0.921). Cronbach's alpha was >.80 for total SIGN and all three factors. SIGN score was positively correlated with the preexisting scale (r = .335, p < .001) and with child protection services reporting status (M = 12.8 for reported cases vs. 9.2 for unreported cases, p < .001). The SIGN is an innovative scale with good psychometric properties for assessing signs of infant neglect. It has the potential to contribute to preventing infant neglect by providing early support to infants and their caregivers.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Early life adversity, pubertal timing, and epigenetic age acceleration in adulthood

BACKGROUND

Given associations linking early life adversity, pubertal timing, and biological aging, we examined the direct and indirect effects of early life trauma on adult biological aging (via age of menarche).

METHODS

Participants were premenopausal women (N = 183). Path models evaluated whether early life trauma predicted early pubertal timing and thereby, adult epigenetic age acceleration (indexed via four epigenetic clocks: Horvath DNAm Age, Hannum DNAm Age, DNAm PhenoAge, and DNAm GrimAge). Secondary analyses explored the effects of type of trauma (abuse and neglect) and adult chronic stress status (caregiver of child with autism and non-caregiver).

RESULTS

Early life trauma and earlier age at menarche independently predicted accelerated aging based on one of the four epigenetic clocks, DNAm GrimAge, though early life trauma was not associated with age of menarche. Childhood abuse, but not neglect, predicted faster epigenetic aging; results did not differ by chronic stress status.

CONCLUSIONS

Early trauma and early menarche appear to exert independent effects on DNAm GrimAge, which has been shown to be the strongest epigenetic predictor of mortality risk. This study identifies a potential correlate or determinant of accelerated epigenetic aging-menarcheal age. Future research should address the limitations of this study by using racially diverse samples.

Reward processing modulates the association between trauma exposure and externalizing psychopathology

Childhood adversity is common and strongly associated with risk for psychopathology. Identifying factors that buffer children from experiencing psychopathology following adversity is critical for developing more effective intervention approaches. The present study examined several behavioral metrics of reward processing reflecting global approach motivation for reward and the degree to which reward responses scaled with reward value (i.e., behavioral sensitivity to reward value) as potential moderators of the association of multiple dimensions of adversity-including trauma, caregiver neglect, and food insecurity-with depression and externalizing psychopathology in a sample of youth aged 8-16 years (n = 132). Trauma exposure and externalizing problems were positively associated at low and moderate levels of reward reactivity, but this association became non-significant at high levels of reward reactivity. Our findings extend prior work, suggesting that high behavioral sensitivity to reward value may buffer against externalizing problems following exposure to trauma.

Social-cognitive mechanisms in the cycle of violence: Cognitive and affective theory of mind, and externalizing psychopathology in children and adolescents

Children who are victims of interpersonal violence have a markedly elevated risk of engaging in aggressive behavior and perpetrating violence in adolescence and adulthood. Although alterations in social information processing have long been understood as a core mechanism underlying the link between violence exposure and externalizing behavior, scant research has examined more basic social cognition abilities that might underlie this association. To that end, this study examined the associations of interpersonal violence exposure with cognitive and affective theory of mind (ToM), core social-cognitive processes that underlie many aspects of social information processing. In addition, we evaluated whether difficulties with ToM were associated with externalizing psychopathology. Data were collected in a community-based sample of 246 children and adolescents aged 8-16 who had a high concentration of exposure to interpersonal violence. Violence exposure was associated with lower accuracy during cognitive and affective ToM, and the associations persisted after adjusting for co-occurring forms of adversity characterized by deprivation, including poverty and emotional neglect. Poor ToM performance, in turn, was associated with externalizing behaviors. These findings shed light on novel pathways that increase risk for aggression in children who have experienced violence.

Childhood Trauma Questionnaire-Short Form (CTQ-SF): Dimensionality, validity, reliability and gender invariance among Nigerian adolescents

BACKGROUND

Childhood abuse and neglect have been associated with long term psychological consequences. There is no valid, reliable and gender invariant scale available for the evaluation of childhood abuse and neglect among Nigerian adolescents.

OBJECTIVE

To evaluate the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in terms of its factor structure, validity, reliability, and gender measurement invariance among Nigerian adolescents.

METHOD

Senior high school adolescents (n = 1337, aged 13-18 years) completed the CTQ-SF in addition to the Hospital Anxiety and Depression Scale (HADS), the 12-items General Health Questionnaire (GHQ-12), the Rosenberg Self-Esteem Scale (RSES) and the Positive and Negative Suicide Ideation Inventory (PANSI). Confirmatory factor analysis (CFA) was used to test the original (Bernstein et al., 2003) and alternative (Gerdner & Allgulander, 2009) CTQ-SF models. The fit indices of these two models tested applying CFA were compared. Concurrent validity of the CTQ-SF was examined with correlational analyses with other study measures. The internal consistencies of the CTQ-SF and its subscales were examined with the MacDonald's omega (ω_h) coefficients. Gender measurement invariance was evaluated with multiple-group CFA (MGCFA).

RESULTS

The alternative CTQ-SF model compared to the original model exhibited a better fit (CFI = 0.928, RMSEA = 0.046 [90 %CI: 0.043-0.050], SRMR = 0.044). The internal consistency and concurrent validity of this model were satisfactory. MGCFA provided evidence that supported the configural, metric and scalar gender measurement invariance.

CONCLUSION

The alternative CTQ-SF exhibited satisfactory validity, reliability, and gender measurement invariance and, therefore, could be used for the evaluation and gender comparison of abuse and neglect among Nigerian adolescents.

A Study on the Mother Education Program for the Prevention of Child Neglect

In the present research, the aim was to develop, implement, and examine the effectiveness of an education program for mothers for the prevention of child neglect. In the study, the “Mother Education Program to Prevent Child Neglect” was initially designed for implementation and a quasi-experimental design involving pretest/posttest, and one-month follow-up test was implemented to examine the effectiveness of the trial procedure. The study group of the research consisted of 24 mothers (12 mothers in the intervention group and 12 mothers in the comparison group) who agreed to participate in the study. In order to collect the sociodemographic information about the children and their mothers, an “Individual Information Form” was administered. In order to assess the neglectful behaviors of the mothers, the Parent Form of the Multidimensional Neglectful Behavior Scale-Parents Form was used. As a result of the study, a significant difference was found between the pretest and posttest scores of the mothers in the intervention group ( p<.05). The cognitive neglect and the total neglect scores of the mothers in the intervention group were found to significantly decrease after the completion of the education program. The results of the follow-up test also revealed that the effect of the education program for mothers was sustained after one month. Resultantly, suggestions related to the prevention of child neglect have been made for parents, professionals, institutions, and researchers working on the subject.

Child Neglect and the Broader Context of Child Victimization

Using a pooled data set of two waves of the National Surveys of Children's Exposure to Violence, this study investigates links between indicators of socioeconomic resources and lifetime exposure to two different forms of child neglect (physical and supervisory), examines how neglect is associated with the risk of other types of victimization, and estimates the impact of neglect on trauma symptoms. Findings suggest that physical neglect is directly linked to economic stressors, while low parental education is consequential for both physical and supervisory neglect. Both types of neglect also were strongly associated with risk of other maltreatment and most other forms of victimization. Physical neglect was particularly strongly related to sexual abuse and witnessing sibling abuse, while supervisory neglect was most strongly related to risk for sexual victimization by a nonfamily adult. Although neglect is significantly associated with trauma symptoms, poly-victims had, by far, the highest levels of trauma symptoms.

Concordance Between Parents in Perpetration of Child Mistreatment: How Often Is It by Father-Only, Mother-Only, or by Both and What Difference Does It Make?

Research on child mistreatment tends to focus on the mother or the father as the abusing parent, even though there is wide agreement that both theory and practice should deal with child maltreatment as a family system problem. Most children have the benefit or the risk of more than one caretaker for substantial periods of their lives, most often two parents or stepparents. This article is intended to illustrate the value of research which uses concordance analysis (CA) to identify children who experienced three dyadic concordance types (DCTs) of mistreatment: father-only, mother-only, or both parents, including single-parent combinations of caretakers. A concordance approach that identifies possible abusers in addition to the presenting parent using the three DCTs is a practical first step toward a family system perspective to enhance child abuse theory, research, and practice.

Associations Between Family Risk Factors and Child Neglect Types in U.S. Army Communities

Recent theory and empirical research suggest that child neglect is a heterogeneous phenomenon characterized by various types. This study examined family risk factors associated with five neglect types including failure to provide physical needs, lack of supervision, emotional neglect, moral-legal neglect, and educational neglect in 390 substantiated cases of neglect in four U.S. Army communities. Family factors associated with elevated risk of each neglect type relative to other types were identified using multivariate regression. Relatively distinct sets of family risk factors were differentially associated with the neglect types. Family mental health problems and larger family size were associated with risk of failure to provide physical needs, childcare problems and larger family size were associated with risk of supervisory neglect, and family disagreements were associated with risk of emotional neglect. None of the family factors were associated with elevated risk of moral-legal or educational neglect. Results can inform the development of indicated and relapse prevention strategies for families affected by different neglect types.

Is gender important? Victimisation and perpetration of intimate partner violence in mainland China

Establishing the prevalence of intimate partner violence (IPV) has been recommended by International Conventions and Declarations for some time beginning with the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW Articles 12 and 19) in 1979. One important recommendation of such international protocols is the implementation of national population prevalence surveys to establishing IPV as a serious social issue globally, which is intended to provide data for planning effective responses within signatory countries. However, not all countries have undertaken national prevalence surveys meaning that there are gaps in our understanding of who are the perpetrators and victims of IPV in different cultural contexts. This article presents the results of a scoping review of literature examining gender differences in prevalence rates of victimisation and perpetration of IPV in mainland China (hereon China). There has been little written about the prevalence of IPV in China generally, and this scoping process located only nine peer-reviewed articles written in both English- and Chinese-language journals focusing on both gender and IPV published between 1997 and 2016. Results of this scoping review demonstrate that while both women and men perpetrate IPV in China, the prevalence rates of different types of IPV reflect gender differences in both perpetration and victimisation, suggesting that IPV is not a unitary phenomenon. The paper concludes by discussing the implications of the findings including the importance of increasing awareness of IPV in China more generally and developing gender-specific interventions to directly address different types of IPV. Directions for future research are also canvassed.

Associations between childhood experiences of parental corporal punishment and neglectful parenting and undergraduate students' endorsement of corporal punishment as an acceptable parenting strategy

This study evaluated the effects of childhood experiences of parental corporal punishment (CP) and neglectful parenting (NP) on Japanese university students’ endorsement of parental CP (EPP) to discipline children, in relation to subjective happiness (SH). A total of 536 undergraduate students who showed no physical symptoms completed anonymous paper-based questionnaires addressing demographic characteristics, undergraduate classes, and recent health conditions on SF-8 (PCS, MCS). It was found that the proportions of participants who experienced pervasive CP and NP were larger in men than in women (36.5% vs. 19.4% for CP; 22.1% vs. 9.7% for NP). Multiple regression analyses (n = 346) revealed that the CP score was associated with positive EPP (β = 0.310, p < 0.001). Further, students whose major was nursery education reported significantly lower level of EPP; however, neither SH nor good recent health conditions significantly reduced EPP. The NP score was inversely associated with the SH score (β = -0.253, p < 0.001) (n = 346). In conclusion, childhood experiences of parental CP may affect adolescents’ views related to their own parenting. Further investigation using internationally comparable methodologies, especially in prospective cohort studies, is warranted, not only in Japan but also in other Asian countries.

Does parental substance use always engender risk for children? Comparing incidence rate ratios of abusive and neglectful behaviors across substance use behavior patterns

Parental substance use disorder (SUD) is associated with an added risk for child abuse and neglect, but less is understood about how a range of parental use behaviors is associated with differential maltreatment frequencies. This study used the National Survey of Child and Adolescent Well-Being (NSCAW I) to create categories for parental substance use behaviors that are conceptually associated with varying levels of substance-related impairments. The study sample was composed of 2100 parents of children ages 2-17 years from Wave 4 data collection. Weighted negative binomial regression models assessed the relationship between substance use behavior patterns and maltreatment frequencies by type. Behavior patterns defined by some form of past year substance use were associated with a higher frequency of physical or emotional abuse compared to non-users. In contrast, only past year SUD was associated with a higher frequency of neglect compared to other categories. In sum, the relationship between substance use and maltreatment frequencies differed for abuse and neglect, suggesting different pathways may be underlying these observed relationships.

Differential Associations of Distinct Forms of Childhood Adversity With Neurobehavioral Measures of Reward Processing: A Developmental Pathway to Depression

Childhood adversity is associated with altered reward processing, but little is known about whether this varies across distinct types of adversity. In a sample of 94 children (6-19 years), we investigated whether experiences of material deprivation, emotional deprivation, and trauma have differential associations with reward-related behavior and white matter microstructure in tracts involved in reward processing. Material deprivation (food insecurity), but not emotional deprivation or trauma, was associated with poor reward performance. Adversity-related influences on the integrity of white matter microstructure in frontostriatal tracts varied across childhood adversity types, and reductions in frontostriatal white matter integrity mediated the association of food insecurity with depressive symptoms. These findings document distinct behavioral and neurodevelopmental consequences of specific forms of adversity that have implications for psychopathology risk.

Neglect as a Violation of Species-Expectant Experience: Neurodevelopmental Consequences

The human brain requires a wide variety of experiences and environmental inputs in order to develop normally. Children who are neglected by caregivers or raised in institutional environments are deprived of numerous types of species-expectant environmental experiences. In this review, we articulate a model of how the absence of cognitive stimulation and sensory, motor, linguistic, and social experiences common among children raised in deprived early environments constrains early forms of learning, producing long-term deficits in complex cognitive function and associative learning. Building on evidence from animal models, we propose that deprivation accelerates the neurodevelopmental process of synaptic pruning and limits myelination, resulting in age-specific reductions in cortical thickness and white matter integrity among children raised in deprived early environments. We review evidence linking early experiences of psychosocial deprivation to reductions in cognitive ability, associative and implicit learning, language skills, and executive functions as well as atypical patterns of cortical and white matter development-domains that should be profoundly influenced by deprivation through the learning and neural mechanisms we propose. These patterns of atypical development are difficult to explain with existing models that emphasize stress pathways and accelerated limbic system development. A learning account of how deprived early environments influence cognitive and neural development provides a complementary perspective to stress models and highlights novel pathways through which deprivation might confer risk for internalizing and externalizing psychopathology. We end by reviewing evidence for plasticity in cognitive and neural development among children raised in deprived environments following interventions that improve caregiving quality.

[Validation of the French Version of Parental Multidimensional Neglectful Behavior Scale]

OBJECTIVE:

Measuring parental neglect is challenging on many levels and few tools exist that are able to document it with parents. This study aims to document the psychometric properties in the French version of the population-based Multidimensional Neglectful Behavior Scale, short version.

METHOD:

This study uses data from a telephone survey conducted with a representative sample of 3584 mothers and 1202 fathers of children aged between 6 months and 4 years old, 5 and 9 years old, and 10 and 15 years old. Associations are made between neglect and several other factors known to be linked to this issue, including violent parental behaviors, stress associated with the child perceived difficult temper and work-family balance, alcohol and drug use, depression symptoms, poverty, and social support.

RESULTS:

Exploratory factor analysis show the presence of different neglect dimensions relating to the children affective/cognitive, physical (basic care) and supervision needs. Although these dimensions are closely associated with the children and families’ psychosocial vulnerability factors, internal consistency coefficients are low, ranging from 0.20 to 0.64.

CONCLUSION:

Recommendations are made to improve measure in general population, including the parental supervision dimension which is particularly challenging.

A Multisource Approach to Assessing Child Maltreatment From Records, Caregivers, and Children

Practitioners and researchers alike face the challenge that different sources report inconsistent information regarding child maltreatment. The present study capitalizes on concordance and discordance between different sources and probes applicability of a multisource approach to data from three perspectives on maltreatment-Child Protection Services (CPS) records, caregivers, and children. The sample comprised 686 participants in early childhood (3- to 8-year-olds; n = 275) or late childhood/adolescence (9- to 16-year-olds; n = 411), 161 from two CPS sites and 525 from the community oversampled for psychosocial risk. We established three components within a factor-analytic approach: the shared variance between sources on presence of maltreatment (convergence), nonshared variance resulting from the child's own perspective, and the caregiver versus CPS perspective. The shared variance between sources was the strongest predictor of caregiver- and self-reported child symptoms. Child perspective and caregiver versus CPS perspective mainly added predictive strength of symptoms in late childhood/adolescence over and above convergence in the case of emotional maltreatment, lack of supervision, and physical abuse. By contrast, convergence almost fully accounted for child symptoms for failure to provide. Our results suggest consistent information from different sources reporting on maltreatment is, on average, the best indicator of child risk.

Support Schemas Influence Reactivity for Adult Survivors of Childhood Maltreatment

Adult survivors of childhood maltreatment can be resilient when they have adequate psychosocial resources to cope with maltreatment-related sequelae; however, interpersonal problems may influence the effectiveness of such resources. This study used a schema activation experimental paradigm to test the benefit of social support cognitions on emotional reactivity in adult survivors, while also testing for the moderating role of interpersonal problems and the mediating role of stress appraisal. Young women (N = 126, ages = 18-23) with histories of childhood maltreatment were administered an anger provocation stressor task while their cardiac activity, state anger, and stress appraisals were assessed. Prior to the stressor, women were randomly assigned to either a support schema condition or an acquaintance schema (control) condition, in which they were asked to think and write about either a supportive person or casual acquaintance. The support schema condition demonstrated the least emotional reactivity as evidenced by subjective anger and heart-rate variability, and this outcome was strongest for those with high interpersonal problems. Also, stress appraisals, particularly feeling intimidated, partially mediated the support schema and emotional reactivity relationship. These findings suggest that maltreated women can regulate anger by activating their social support schema. Moreover, support schema may be an important focus of intervention for adult survivors with high interpersonal problems.

The relationship between sensory processing patterns, alexithymia, traumatic childhood experiences, and quality of life among patients with unipolar and bipolar disorders

Several studies documented the involvement of sensory perception in emotional processes. The long-term consequences of traumatic experiences and alexithymia have been demonstrated as well. However, the role of extreme sensory processing patterns, traumatic childhood experiences, and alexithymia has not been thoroughly examined in major affective disorders. The present study aimed to: (1) compare unipolar/bipolar patients with regard to their sensory processing patterns, alexithymia, childhood traumatic experiences and quality of life; (2) examine the correlations between sensory processing patterns and childhood traumatic experiences; (3) investigate the relative contribution of diagnostic groups (unipolar/bipolar), sensory processing patterns, alexithymia, and childhood traumatic experiences in predicting quality of life. The sample included 336 participants, 197 with unipolar and 139 with bipolar disorder. All participants completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale, Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI)-II, and Short Form 12 Health Survey version 2 (SF-12). Bipolar patients showed significantly higher physical neglect, emotional abuse, and emotional neglect compared with unipolar patients. Both in unipolar and bipolar groups, lower registration of sensory input as well as hypersensitivity correlated with enhanced childhood trauma events. Reduced sensory sensitivity accounted for 11% of the variance in physical health composite score (PCS) of SF-12 whereas reduced depression accounted for 8% of the variance in mental health composite score (MCS). Furthermore, elevated MCS was predicted by depression, physical and emotional neglect. Sensory processing patterns and childhood traumatic experiences may specifically characterize individuals with major affective disorders and play a role in the prediction of their quality of life.

The Complex Trauma Questionnaire (ComplexTQ): development and preliminary psychometric properties of an instrument for measuring early relational trauma

Research on the etiology of adult psychopathology and its relationship with childhood trauma has focused primarily on specific forms of maltreatment. This study developed an instrument for the assessment of childhood and adolescence trauma that would aid in identifying the role of co-occurring childhood stressors and chronic adverse conditions. The Complex Trauma Questionnaire (ComplexTQ), in both clinician and self-report versions, is a measure for the assessment of multi-type maltreatment: physical, psychological, and sexual abuse; physical and emotional neglect as well as other traumatic experiences, such rejection, role reversal, witnessing domestic violence, separations, and losses. The four-point Likert scale allows to specifically indicate with which caregiver the traumatic experience has occurred. A total of 229 participants, a sample of 79 nonclinical and that of 150 high-risk and clinical participants, were assessed with the ComplexTQ clinician version applied to Adult Attachment Interview (AAI) transcripts. Initial analyses indicate acceptable inter-rater reliability. A good fit to a 6-factor model regarding the experience with the mother and to a 5-factor model with the experience with the father was obtained; the internal consistency of factors derived was good. Convergent validity was provided with the AAI scales. ComplexTQ factors discriminated normative from high-risk and clinical samples. The findings suggest a promising, reliable, and valid measurement of early relational trauma that is reported; furthermore, it is easy to complete and is useful for both research and clinical practice.

Understanding the Role of Context-Specific Drinking in Neglectful Parenting Behaviors

AIMS

Child neglect is the most common form of child maltreatment, yet little is known about how drinking context may be related to particular subtypes of child neglect. This study examines the relationship between parental drinking in multiple contexts and the use of supervisory and physical neglectful.

METHODS

A sample of 2152 parents of children 12 years or younger in 50 cities in California was obtained using a computer-assisted telephone interview. Past-year prevalence of child neglect was measured using the Multidimensional Neglectful Behavior Scale. Information was collected on past month or past-year frequency of having at least one drink in five contexts, continued drinking measures (e.g. number of drinks after the first drink) and sociodemographics. Data were analyzed using multilevel random effects logit models.

RESULTS

Frequency of drinking in various contexts was related to different neglect subtypes. Specifically, frequency of drinking with friends was positively related leaving a child home alone when an adult should be present. Parents who drank more frequently with family were less likely to leave their child home alone in the past year yet more likely to unsafely monitor their child in the past year. Drinking at parties more often was related to being more likely to leave a child alone in a car sometime during the past year.

CONCLUSIONS

That no single drinking context is universally problematic for supervisory and physical neglect suggests that different social mechanisms may underlie the relationships observed between different drinking contexts and neglect subtypes.

Criminal recidivism of incarcerated male nonviolent offenders in Hong Kong

Criminal recidivism of the incarcerated population in Hong Kong has rarely been studied. The purpose of this study is to explore the recidivism rates and to identify significant predictors of reoffending among incarcerated male offenders convicted of a nonviolent offense in Hong Kong. Using a self-reported methodological design, 278 offenders were sampled. These offenders' immediate past incarceration is used as the benchmark for this recidivism study. The 1-, 2-, and 3-year recidivism rates are 21%, 68%, and 87%, respectively. The findings denote that offending history, psychological attributes, interpersonal relationships, and environmental influences are significant reoffending risk factors. These findings, especially the alarming failure rates, highlight the need to seriously assess the effectiveness of intervention strategies used by the Hong Kong correctional system in preventing future offending. Implications for intervention strategies with emphasis on the risk factors for recidivism are discussed.

The influence of differential response on decision-making in child protective service agencies

Differential response (DR) profoundly changes the decision pathways of public child welfare systems, yet little is known about how DR shapes the experiences of children whose reports receive an investigation rather than an alternate response. Using data from the National Child Abuse and Neglect Data System (NCANDS), this study examined the relationship between DR implementation and decision outcomes in neglect cases, as measured by investigation, substantiation, and removal rates in 297 U.S. counties. Multivariate regression models included county-level measures of child poverty and proportions of African American children. Path analyses were also conducted to identify mediating effects of prior decision points and moderating effects of DR on poverty and race's influence on decision outcomes. Results indicate that compared to non-DR counties, those implementing DR have significantly lower investigation and substantiation rates within county populations but higher substantiation rates among investigated cases. Regression models showed significant reductions in removal rates associated with DR implementation, but these effects became insignificant in path models that accounted for mediation effects of previous decision points. Findings also suggest that DR implementation may reduce the positive association between child poverty rates and investigation rates, but additional studies with larger samples are needed to confirm this moderation effect. Two methods of calculating decision outcomes, population- and decision-based enumeration, were used, and policy and research implications of each are discussed. This study demonstrates that despite their inherit complexity, large administrative datasets such as NCANDS can be used to assess the impact of wide-scale system change across jurisdictions.

Bias in child maltreatment self-reports using interactive voice response (IVR)

Few methods estimate the prevalence of child maltreatment in the general population due to concerns about socially desirable responding and mandated reporting laws. Innovative methods, such as interactive voice response (IVR), may obtain better estimates that address these concerns. This study examined the utility of interactive voice response (IVR) for child maltreatment behaviors by assessing differences between respondents who completed and did not complete a survey using IVR technology. A mixed-mode telephone survey was conducted in English and Spanish in 50 cities in California during 2009. Caregivers (n=3,023) self-reported abusive and neglectful parenting behaviors for a focal child under the age of 13 using computer-assisted telephone interviewing and IVR. We used hierarchical generalized linear models to compare survey completion by caregivers nested within cities for the full sample and age-specific ranges. For demographic characteristics, caregivers born in the United States were more likely to complete the survey when controlling for covariates. Parenting stress, provision of physical needs, and provision of supervisory needs were not associated with survey completion in the full multivariate model. For caregivers of children 0-4 years (n=838), those reporting they could often or always hear their child from another room had a higher likelihood of survey completion. The findings suggest IVR could prove to be useful for future surveys that aim to estimate abusive and/or neglectful parenting behaviors given the limited bias observed for demographic characteristics and problematic parenting behaviors. Further research should expand upon its utility to advance estimation rates.

Consistency analysis of parenting styles in Thailand during children's first year

This descriptive study identifies and examines the consistency of parenting styles during the first year of their children's lives. The data were collected from interviewing 4088 parents or primary care takers of the 6 month old infants during the third wave of data collection of The Prospective Cohort of Thai Children project. The instrument used was the Infant Parenting Styles Questionnaire, developed by the researchers, which reflected parental responses to infant care in five different situations. After the answers were categorized into controlling, reasoning, overprotection, and neglectful parenting styles, the weighted kappa was used for the consistency analysis. The findings revealed that during the first 6 months of life, the overprotection style was the most common, followed by the reasoning style. The controlling and neglectful styles were very seldom used. The consistency of the parental styles in the same care givers using the kappa values showed that agreement between each of the styles was very low (-0.0419 to 0.0688). This suggests that parenting styles during the first year of life seem to occur in random patterns.

Psychological characteristics of male 14- to 20-year-olds on probation and in a residential home in Hong Kong

BACKGROUND

Little research has been conducted with Hong Kong juvenile probationers.

AIMS

The goals of this study are to examine the psychological characteristics of 14- to 20-year-old male probationers and to test their relationship with broad types of offending--violent and nonviolent.

METHODS

Participants were drawn from the only transitional housing facility for juvenile probationers aged 14-20 years. Offence types and numbers were rated from self-report. Various schedules were rated at interview with consenting young men to describe them in terms of eight psychological characteristics: self-esteem, life satisfaction, social bonding, positive affect, negative affect, impulsivity, pro-criminal attitude and self-perceived life problems.

RESULTS

A total of 113 young men completed the assessment, 90% of those eligible. The average psychological profile of these young men was fairly typical for their communities. Pro-criminal attitudes, however, correlated with both main types of offending, whereas main affective state was differently associated. Predominantly, negative affect was associated with violent offending and predominantly positive affect with nonviolent offending.

CONCLUSIONS

Participants in this study generally reported higher levels of positive psychological well-being than in previous nondelinquent Chinese samples. IMPLICATIONS FOR PRACTICE AND FUTURE RESEARCH: A case-control study comparing such offenders with nondelinquents is required to clarify these findings. A longitudinal design is now indicated to test the direction of relationships between psychological indicators and offending. These steps would be useful precursors to a service evaluation of probation hostels for young offenders.

Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies

BACKGROUND

Globally, at least 93 million children have moderate or severe disability. Children with disabilities are thought to have a substantially greater risk of being victims of violence than are their non-disabled peers. Establishment of reliable estimates of the scale of the problem is an essential first step in the development of effective prevention programmes. We therefore undertook a systematic review and meta-analysis to synthesise evidence for the prevalence and risk of violence against children with disabilities.

METHODS

For this systematic review and meta-analysis, we searched 12 electronic databases to identify cross-sectional, case-control, or cohort studies reported between Jan 1, 1990, and Aug 17, 2010, with estimates of prevalence of violence against children (aged ≤18 years) with disabilities or their risk of being victims of violence compared with children without disabilities.

FINDINGS

17 studies were selected from 10,663 references. Reports of 16 studies provided data suitable for meta-analysis of prevalence and 11 for risk. Pooled prevalence estimates were 26·7% (95% CI 13·8-42·1) for combined violence measures, 20·4% (13·4-28·5) for physical violence, and 13·7% (9·2-18·9) for sexual violence. Odds ratios for pooled risk estimates were 3·68 (2·56-5·29) for combined violence measures, 3·56 (2·80-4·52) for physical violence, and 2·88 (2·24-3·69) for sexual violence. Huge heterogeneity was identified across most estimates (I(2)>75%). Variations were not consistently explained with meta-regression analysis of the characteristics of the studies.

INTERPRETATION

The results of this systematic review confirm that children with disabilities are more likely to be victims of violence than are their peers who are not disabled. However, the continued scarcity of robust evidence, due to a lack of well designed research studies, poor standards of measurement of disability and violence, and insufficient assessment of whether violence precedes the development of disability, leaves gaps in knowledge that need to be addressed.

FUNDING

WHO Department of Violence and Injury Prevention and Disability.

Externalizing problems and problematic sexual behaviors: same etiology?

The study sought to determine whether maltreatment subtypes, family sexuality, and personal characteristics predicted and distinguished child problematic sexual behaviors (PSB) and externalizing problems (EP). Participants were families of 188 children, 6-11 years old, referred by child welfare services in four Quebec districts. Caregivers completed interviews and questionnaires. Results suggested that family environment and maltreatment subtypes had partially different impacts on PSB and EP. When EP and gender were controlled, younger children in a sexualized family environment and those verbally victimized were more likely to exhibit PSB. When PSB and gender were controlled, verbal abuse and neglect emerged as predictors of EP. Potential implications for child PSB research and interventions are discussed.

Language delay in severely neglected children: a cumulative or specific effect of risk factors?

OBJECTIVES

This research sought to determine if the language delay (LD) of severely neglected children under 3 years old was better explained by a cumulative risk model or by the specificity of risk factors. The objective was also to identify the risk factors with the strongest impact on LD among various biological, psychological, and environmental factors.

METHODS

Sixty-eight severely neglected children and their mothers participated in this cross-sectional study. Children were between 2 and 36 months of age. Data included information about the child's language development and biological, psychological, and environmental risk factors.

RESULTS

Prevalence of LD is significantly higher in this subgroup of children than in the population as a whole. Although we observed that the risk of LD significantly increased with an increase in the cumulative count of the presence of the child's biological-psychological risk factors, the one-by-one analysis of the individual factors revealed that the cumulative effect mainly reflected the specific impact of the child's cognitive development. When we considered also the environmental risk factors, multivariate logistic regression established that cognitive development, the mother's own physical and emotional abuse experience as a child, and the mother's low acceptability level towards her child are linked to LD in severely neglected children.

CONCLUSIONS

Language development is the result of a complex interaction between risk factors. LD in severely neglected children is better explained by the specificity of risk factors than by the cumulative risk model.

PRACTICE IMPLICATIONS

Most prevention and early intervention programs promote and target an increase in the quantity and quality of language stimulation offered to the child. Our results suggest that particular attention should be given to other environmental factors, specifically the mother's psychological availability and her sensitivity towards the child. It is essential to suggest interventions targeting various ecological dimensions of neglectful mothers to help break the intergenerational neglect transmission cycle. It is also important to develop government policies and ensure that efforts among the various response networks are concerted since in-depth changes to neglect situations can only come about when all interested parties become involved.

ISPCAN Child Abuse Screening Tools Retrospective version (ICAST-R): Delphi study and field testing in seven countries

OBJECTIVES

To gain consensus among an ethnically and linguistically diverse group of international child protection experts on the structure and content of a new survey tool for retrospective measurement of child abuse, and to determine the performance of the instrument through an international field trial with young adults.

METHODS

The questionnaire was developed through focus group discussions with international experts, and then subjected to a Delphi study in two waves to determine the perceived importance and translatability of items. The resultant questionnaire was translated into six languages and field tested in seven countries with convenient samples of young adults aged 18-26 years (N=842).

RESULTS

Child maltreatment experts from 28 countries provided input to questionnaire development. Satisfactory agreement on draft item inclusion and exclusion and the translatability of items was gained. The tool includes 15 primary questions about potentially abusive physical, sexual and emotional events, with follow-up questions about perpetrator characteristics, frequency of acts and periods in childhood when the recalled abuse occurred. The field test revealed lifetime prevalence per item usually exceeded 10% (11/15 items; range 2.1-49.5%). Internal consistency (Cronbach's alpha) was moderate to high for each of three item sub-sets (between .61 and .82) and the rates of missing data were low (less than 1.5% for 14 of 15 items). The great majority of respondents nominated either peer and/or adult perpetrators (between 82.3% and 98.2% depending upon the item), and among these, child/adolescent peers and non-family adults (including teachers for emotional and physical acts) were nominated often.

CONCLUSIONS

The ICAST-R is based on consensus from international experts, translates clearly and has satisfactory properties for adoption as a survey tool to estimate prevalence and describe perpetrators and other contextual aspects of child abuse.

PRACTICE IMPLICATIONS

This tool can be utilized in a broad range of cultures and languages and may contribute to improved research practice. Although the core items are limited to just 15 acts of maltreatment, if these behaviorally specific questions are adopted as key indicators and incorporated into comprehensive local, national or regional surveys, eventually there should be greater comparability in survey estimates.

Burden and consequences of child maltreatment in high-income countries

Child maltreatment remains a major public-health and social-welfare problem in high-income countries. Every year, about 4-16% of children are physically abused and one in ten is neglected or psychologically abused. During childhood, between 5% and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse, and up to three times this number are exposed to any type of sexual abuse. However, official rates for substantiated child maltreatment indicate less than a tenth of this burden. Exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences. Child maltreatment substantially contributes to child mortality and morbidity and has longlasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour, which persist into adulthood. Neglect is at least as damaging as physical or sexual abuse in the long term but has received the least scientific and public attention. The high burden and serious and long-term consequences of child maltreatment warrant increased investment in preventive and therapeutic strategies from early childhood.