Child Maltreatment

Question 1

The original ACEs study

Answer 1

> Showed Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998)
Comprised of 10 distinct events that occur prior to 18yo that are hypothesised to influence wellbeing later in life

Question 2

ACE Household dysfunction examples

Answer 2

> Domestic violence
> Parental separation/divorce
> Substance abuse
> Mental illness
> Imprisonment

Question 3

ACE Childhood abuse and neglect examples

Answer 3

> Physical abuse
> Sexual abuse
> Emotional abuse
> Physical neglect
> Emotional neglect

Question 4

Role of psychology in Child Maltreatment

Answer 4

> Assessment and Treatment (secondary and tertiary levels)
Promising cognitive-behavioural approaches, especially if intervention happens early
Can be effective on its own, but more likely when used in an integrative approach to support children and families
e.g., it can be really hard to get a mother to engage with a treatment if she’s homeless, so it might be worthwhile to get those issues resolved first…

Question 5

Obstacles and challenges in Psychology in Child Maltreatment

Answer 5

> Those most in need are least likely to seek help
Brought to attention as a result of someone else’s concerns
Families may be mandated into treatment who may not want to cooperate
Families may not want to admit to problems - might be scared of having children removed, or because of legal ramifications that might follow

Question 6

Primary prevention of child maltreatment (universal services)

Answer 6

> Legal reform, social and economic policies, challenging societal norms, reducing economic inequalities
Ensuring that everyone knows that it’s not good to maltreat children, but also introducing policies to support families e.g. high quality and affordable housing or childcare

Question 7

Secondary prevention of child maltreatment

target those at risk

Answer 7

> Targeted services for at risk populations (e.g., young mums, families with domestic violence, drug or alcohol abuse, etc.)
Home visitation programs, parenting interventions, access to pre- and post-natal services
Most successful programs tend to be those that continue during and after pregnancy, flexible, and connect families to services after program ends

Question 8

Tertiary prevention of child maltreatment (When child maltreatment has already occurred) (statutory child protection services)

Answer 8

> Statutory child protection systems, therapeutic programs and support for victims
Psychology can really play a role here…
Should be driven by the best interests of the child

Question 9

Resilience/protective factors of child maltreatment include…

Answer 9

> Individual factors, e.g., high intelligence
Family factors, e.g., supportive relationships
Neighbourhood factors, e.g., social cohesion

Question 10

“Attainment of positive adaptation within the context of significant adversity” measured by normative functioning across:

Answer 10

Behavioural competence
>	Low antisociality
Emotional competence
>	Low psychopathology
Social competence
>	Good peer relations
Academic achievement
>	High school performance

Question 11

Child maltreatment increases risk for…

Answer 11

> Mood and anxiety disorders
> Dissociation and suicidal behaviour
> Substance abuse disorders
> Antisocial behaviour
> Psychosis
> Personality disorders

Question 12

Is timing of child maltreatment important?

Children abused earlier..

Answer 12

..have higher risk of internalising problems as adults

Question 13

Is timing of child maltreatment important?

Children abused later..

Answer 13

..have a greater tendency to externalise behaviours as adults

Question 14

Is timing of child maltreatment important?

Maltreatment in adolescence…

Answer 14

..tends to be a bigger predictor for antisocial and offending behaviour

Question 15

Definition:

Equifinality

Answer 15

different factors can lead to the same outcome

Question 16

Definition:

Multifinality

Answer 16

the same factor can lead to different outcomes

Question 17

Development of integrated sense of self :

Negative/grandiose self-representations (pre-school)

Answer 17

> Neglected children are more negative

> Physically abused children are more grandiose (possibly a coping mechanism towards threats)

Question 18

Development of integrated sense of self :

Dissociation and dissociative disorders

Answer 18

> Could be mild - daydreaming, getting immersed in a book
..Or more severe - amnesia
Could be a coping mechanism to tolerate negative emotions and experiences - evidence that this continues into adulthood

Question 19

Development of integrated sense of self :

How internalisations lead to the structure of later social interactions:

Answer 19

> Development of negative expectations regarding the self and others
Usually two different pathways: withdrawal from peers vs. aggression towards peers
Leads to further rejection or peer victimisation (e.g., as a bully or being bullied)
Explained by how children make errors in encoding social cues
Differences depending on maltreatment type and gender
More physical aggression among boys, emotional aggression among girls

Question 20

Data linkage studies ( “Joining up” of population-level data collected by government agencies )
Benefits:

Answer 20

Offers opportunities to study a broader range of outcomes
Not influenced by the same limitations of survey data regardless of cross-sectional or longitudinal designs because it captures everybody (including death records)
More objective insights not limited to a certain group of people

Usually includes datasets containing information on:
Births/perinatal characteristics
Health (emergency department and hospitals)
Education (schools data and national tests)
Child protection
Public housing and homelessness
Mental health and substance use
Criminal justice system 
    Welfare

Question 21

Cross-sectional studies usually involves a clinical sample. Usually uses self-report or retrospective measures

Answer 21

Extreme groups approach is..
> Individuals selected because they have the outcome of interest
> But these are criticised because they sample on the dependent variable…

Survey methods is.. > More representative

Both options aim to identify correlates with maltreatment, but may overestimate these associations (especially the extreme groups approach)
> Can’t tell us much about causation…
> But they can provide insight to accumulation of risk factors

Question 22

Prospective and longitudinal studies

Answer 22

> Follow individuals over time - you start with a general population sample and compare it to the maltreatment group
Maltreatment group risk of offending behaviours is much higher

Question 23

Concordance between self-report and official records

Answer 23

> 60% official records not self-reported in adulthood and 17% of self-reports not found in official records (Brown et al., 2008)
Moderate concordance but prevalence higher in self-reports (Smith et al., 2008)
Might depend on type of maltreatment - more concordance in physical and sexual abuse, whereas less concordance in emotional abuse and neglect (Widom & Morris, 1997; Widom & Shepard, 1996)
We tend to use official records more often just because they can date the maltreatment

Question 24

Pros and cons of self-reports are..

Answer 24

> Subjective
They can be influenced by mood
Susceptible to normal memory decay problems or infantile amnesia (being unaware of events that occurred)
Social desirability bias - people can try and justify their childhoods as a way of explaining current behaviour
But can also…
Can give a richer description of experiences, and can cover children who don’t enter child protection

Question 25

Pros and cons of Official records are..

Answer 25

> “Objective” - still requires someone to report what is happening to a child, someone else records things to decide whether it is worth investigating, and investigators decide whether or not maltreatment actually is occurring
When maltreatment is reported the date gets recorded - important when we want to infer causation, when we need to know whether maltreatment occurs prior to the outcome
False negatives may occur though - if we don’t have enough information, or if a case doesn’t meet the threshold for investigation we may miss some genuine cases of maltreatment
Although,
Arguably only captures the most serious cases that get reported
Some social classes or minority groups are also more likely to be reported - bias

Question 26

Benefits/Disadvantages of Quantitative studies…

Answer 26

> Qualitative research is useful because it can help us operationalise concepts like neglect which can be hard to define

..But it can’t be generalised past one individual

> There are also very few randomised controlled trials in this area - because it is very unethical to randomly assign some children to be maltreated…

> There are some Random Control Trials in terms of treatment, but not so much in terms of how exposure relates to outcomes

Question 27

Child maltreatment has been linked with essentially every aspect of child and adult development, including..

Answer 27

Physical and mental health outcomes
>Neurological problems
> Obesity
> Cardiovascular disease

Mental health problems (e.g., depression, PTSD) > Socio-economic outcomes > Homelessness > Unemployment > Harmful behaviour e.g., drug and alcohol dependence > Re-victimisation > Perpetrating or becoming victim of violence or crime

ALTHOUGH
Child maltreatment is not causal - not all of these risks will eventuate, and children with similar experiences can experience different outcomes

Question 28

Poverty is one of the most robust correlates of child maltreatment, but is this due to increased visibility of the poor or reporting bias?

Answer 28

Defining poverty is difficult
Individual, family or neighbourhood level?
Continuous (e.g., income) or dichotomous (e.g., living above or below poverty line)?
Correlated with a range of other factors (e.g. age, education, family structure) and it is not static - people move in and out of poverty…

So does poverty actually cause child maltreatment, or do these other factors explain or mediate the situation?

Poor children do tend to be maltreated at a 3:1 ratio compared to non-poor children

If poverty alone were a sufficient explanation for child maltreatment, we would expect cases of maltreatment among reported and non-reported poor children to look pretty similar; but if child protection surveillance did have an influence we would expect better outcomes for those who were poor and not reported

Longitudinal study over 12 years found that those who were reported were 3x more likely to display later offending behaviour, 2x more likely to be admitted to hospital, 2x more likely to be a teen parent, and 4x more likely to receive mental health services

> Suggests that there is minimal poverty bias in child protection reporting because those who were poor and reported did have poorer outcomes

But then again - we don't know if there was any child protection intervention, if there was any removal in terms of out of home care, which may lead to poorer outcomes…

Question 29

Causes and correlates of maltreatment.
Etiology Model:

Psychiatric model says...

Answer 29

> Parent as perpetrator
Abuser is somehow pathological and suffering from mental illness
But this approach fails to recognise social conditions and stressors that undermine family functioning
Risk in assuming we can identify an abusive parent, and also labelling could have negative consequences
Similar to victim-blaming with a strong focus on the parents
Treatment would focus on therapy, counselling, parenting skills… very expensive… and impractical

Question 30

Causes and correlates of maltreatment.
Etiology Model:

Social approach says...

Answer 30

> Rather than looking at a social defect within the parent we look at the social stressors, pressure on families and parental isolation
Job loss, unemployment, moving around a lot
Treatment would focus on alleviating these stressors and pressure

Question 31

Causes and correlates of maltreatment.
Etiology Model:

Developmental says..

Answer 31

> Focus on interaction between environmental and psychological factors
e.g. a parent whose maturity is characterised by lower developmental forms, such as teen parents with lower social support and confidence in child rearing
Their method of parenting may be different to other older parents
Different to psychiatric approach, their child maltreatment may be due to “appropriate” responses for their developmental level, rather than an individual pathology

Question 32

Causes and correlates of maltreatment.
Etiology Model:

Ecological model says..

Answer 32

> Focus on multiple interacting and nested systems - merging several factors

Question 33

Causes and correlates of maltreatment.

Developmental/ecological frameworks examines how child maltreatment can result from an interaction of factors at different levels

Answer 33

Biological factors could include genetics, brain chemistry, brain structure, neuropsychological factors, temperament

Individual factors: personality, cognitions, emotions, observed behaviours or mental states

Family: parents, parent-child interactions
Social: peers, extra-familial individuals, role models, risk factors

Cultural: community, social values, practices of violence

These are all interacting and change over time
i.e. parent-child relationships may be more important when younger, but may change to peer relationships as we get older

Question 34

Causes and correlates of maltreatment.

Parental factors include..

Answer 34

Intergenerational transmission of child maltreatment (transference of personal maltreatment onto children and maltreatment practices)

Social learning theory (importance of modelling and imitation (learning what is ‘normal’ behaviour in childhood))

Biases in cognitive processing (e.g. hostile attribution bias, where people incorrectly attribute hostility to the actions of others and react aggressively as a response)

Attachment theory (Child maltreatment consistently linked to disorganised attachment styles. Sets the foundation for poor adaptation later in life. For parents who do have unresolved disorganised attachment styles, their interactions with their child may trigger personal trauma and lead to abusive parenting, thus leading to disorganised attachment in children, etc…)

                        Well-established evidence for these theories ^ but the cycle is continuously broken
                             Many parents with disorganised attachment don't maltreat their children

Question 35

Causes and correlates of maltreatment.

Developmental psychopathology…

Answer 35

Personality and psychological resources

Impulse control, self-esteem, empathy, emotional stability, depression, anxiety, hostility

Parents who maltreat their children are more reactive to their children and experience greater irritation and less sympathy

One or two of these factors alone are insufficient for child maltreatment, but a cumulative build up of these factors is more likely

Cognitive processing leading to cognitive distortions and assumptions
e.g. hostile attribution bias, misattribution bias, internal or stable negative traits, or discriminating failures like allowing perceptions of others to influence perception of someone else (e.g. he’s just like his father)

Question 36

Causes and correlates of maltreatment.

Child factors

Answer 36

Age
Younger age is often a higher risk factor
May be more dependent on caregiver
Smaller and more vulnerable
Lower impulse control, lower emotional regulation

But different types of maltreatment may not be evenly distributed across different periods

Physical abuse more likely in younger children; neglect in adolescents

Physical health
Low birth weight
Disabilities

Both linked to behavioural problems, like…
Behaviour
Disruptive behaviour, hyperactive behaviour, difficult temperament
May be more likely to elicit negative responses from parents

But there is a possibility again for misattribution bias and for parents of maltreated children to be perceived as more problematic than they really are

But longitudinal evidence suggests that maltreatment eliciting behaviour in children is more of a consequence than a cause of child maltreatment

Question 37

Causes and correlates of maltreatment.

The broader context

Answer 37

Family context
> Child maltreatment more common in larger families, single parent families and step families
> Also in families that move around a lot

Community and social support
>Could be a function of unemployment, job dissatisfaction, economic hardship
>Isolation, poor neighbourhood networks
Socio-cultural factors
>Societal attitudes towards violence and discipline
Corporal punishment
>
Legal in Australia as long as it remains at a decent level (hard to define), and not allowed in schools or care sector

Question 38

Definition and types of child maltreatment

Physical abuse

Answer 38

> Acts of commission and physical aggression

> Focus in on identifiable, non-accidental inflictions of physical injury

Question 39

Definition and types of child maltreatment

Sexual abuse

Answer 39

> Use of a child for sexual gratification or exploitation

> Includes attempted or actual conflict, inducement and coercion

Question 40

Definition and types of child maltreatment

Emotional abuse

Answer 40

> Failure to provide an appropriate or supportive environment
Involves extreme thwarting of a child’s basic emotional needs for psychological safety and security, acceptance and self-esteem, and age-appropriate autonomy

Question 41

Definition and types of child maltreatment

Neglect

Answer 41

> Failure to provide for the development of a child
Physical, supervisory, medical and educational
Is dependant on the resources of the parent
Most difficult to define and identify because it is very broad, and neglect needs to have a recurrent pattern, as opposed to a single event