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Exposure to partner violence and child behavior problems: a prospective study controlling for child physical abuse and neglect, child cognitive ability, socioeconomic status, and life stress.

Previous research suggests an association between partner violence and child behavior problems. However, methodological shortcomings have precluded the formation of directional conclusions. These limitations include failure to control for the effects of child physical abuse and general life stress, employment of nonrepresentative samples from battered women's shelters, and reliance on a single contemporaneous reporter, usually the mother, for information on both independent and dependent measures. This study used prospective, longitudinal data (N = 155) and multiple informants to examine the relation between maternal reports of partner violence in the homeand teacher- and youth-report ratings of concurrent and prospective child behavior problems. Hierarchical multiple regression analyses were used to control for the effects of child physical abuse, child physical neglect, socioeconomic status, child cognitive ability, and life stress. The contribution of partner violence to child behavior problems was confirmed for boys' (n = 81) externalizing problems and girls' (n = 74) internalizing problems. Child developmental status at the time of exposure further influenced these relations. For boys, behavior problems in middle childhood were most strongly related to contemporaneous partner violence, whereas behavior problems among both boys and girls at age 16 were most strongly related to partner violence exposure during the preschool years.

Child↗

Individual and group-based parenting programmes for the treatment of physical child abuse and neglect.

BACKGROUND: Child physical abuse and neglect are important public health problems and recent estimates of their prevalence suggest that they are considerably more common than had hitherto been realised. Many of the risk factors for child abuse and neglect are not amenable to change in the short term. Intervening to change parenting practices may, however, be important in its treatment. Parenting programmes are focused, short-term interventions aimed at improving parenting practices in addition to other outcomes (many of which are risk factors for child abuse e.g. parental psychopathology, and parenting attitudes and practices), and may therefore be useful in the treatment of physically abusive or neglectful parents. OBJECTIVES: To assess the efficacy of group-based or one-to-one parenting programmes in addressing child physical abuse or neglect. SEARCH STRATEGY: A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychINFO, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library, Campbell Library (including SPECTR and CENTRAL), National Research Register (NRR) and ERIC, from inception to May 2005. SELECTION CRITERIA: Only randomised controlled trials or randomised studies that compared two treatments were included. Studies had to include at least one standardised instrument measuring some aspect of abusive or neglectful parenting. In the absence of studies using objective assessments of child abuse, studies reporting proxy measures of abusive parenting were included. Only studies evaluating the effectiveness of standardised group-based or one-to-one parenting programmes aimed at the treatment of physical child abuse or neglect were included. Studies were also only eligible for inclusion if they had targeted parents of children aged 0-19 years who had been investigated for physical abuse or neglect. DATA COLLECTION AND ANALYSIS: The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group by the pooled standard deviation, to obtain an effect size. The results for each outcome in each study have been presented, with 95% confidence intervals. It was not possible to combine any results in a meta-analysis. MAIN RESULTS: A total of seven studies of variable quality were included in this review. Only two studies assessed the effectiveness of parenting programmes on the incidence of child abuse or number of injuries. One study showed that there were no reports of abuse in the intervention group compared with one report of abuse in the control group. In the second study the small number of injuries sustained precluded the possibility of statistical analysis. Data were also extracted on over fifty outcomes that are used as proxy measures of abusive parenting. These were on the whole diverse and measured a range of aspects of parenting (e.g. parental child management, discipline practices, child abuse potential and mental health), child health (e.g. emotional and behavioural adjustment) and family functioning, thereby precluding the possibility of undertaking a meta-analysis for most outcomes for which data were extracted. While none of the programmes were effective across all of the outcomes measured, many appeared to have improved some outcomes for some of the participating parents, although many failed to achieve statistical significance. AUTHORS' CONCLUSIONS: There is insufficient evidence to support the use of parenting programmes to treat physical abuse or neglect (i.e. such as the incidence of child abuse using reports of child abuse/linjuries or children on the children protection register). There is, however, limited evidence to show that some parenting programmes may be effective in improving some outcomes that are associated with physically abusive parenting. There is an urgent need for further rigorous evaluation of the effectiveness of parenting programmes that are specifically designed to treat physical abuse and neglect, either independently or as part of broader packages of care. Such evaluation should include the use of objective measures of outcome such as independent assessments of parenting and the number of instances of physical abuse. In order to do this, future studies need to include long-term follow-up.

Child↗

Child physical abuse.

Child abuse is an age-old problem for which we have had documentary records for as long as we have had recorded history. This article reviews the ethical dilemmas, diagnosis, interviewing guidelines, physical examination, and treatment for child physical abuse. Also discussed are unusual manifestations and differential diagnosis.

Child↗

Utility of follow-up skeletal surveys in suspected child physical abuse evaluations.

OBJECTIVE: To evaluate the utility of a follow-up skeletal survey in suspected child physical abuse evaluations. METHODS: In this prospective study, follow-up skeletal surveys were recommended for 74 children who, after an initial skeletal survey and evaluation by the Child Abuse Team, were suspected victims of physical abuse. The number and location of the fractures were recorded for the initial skeletal survey and for the follow-up skeletal survey in each case. RESULTS: Forty-eight of the 74 (65%) children returned for a follow-up skeletal survey. The follow-up skeletal survey yielded additional information in 22 of 48 patients (46%). In three patients (6%) the additional information changed the outcome of cases; child abuse was ruled out in one of these patients and abuse was confirmed in two cases. In three other patients, the follow-up skeletal survey refuted tentative skeletal findings, but did not change the outcome because of other physical findings. CONCLUSION: A follow-up skeletal survey identified additional fractures or clarified tentative findings in children who were suspected victims of physical child abuse. The follow-up skeletal survey should be completed on all patients who have an initial skeletal survey performed for suspected physical child abuse and for whom child abuse is still a concern.

Child↗

Physiological responses to non-child-related stressors in mothers at risk for child abuse.

Physical child abusers and adults at risk for child abuse, relative to comparison subjects, are reported to be more physiologically reactive to child-related stressors. It is not known if the reported physiological reactivity is child specific or if physical child abusers and at-risk parents are also more reactive to other types of stressful stimuli. The present study investigated changes in heart rate and skin conductance in response to four types of non-child-related stressors in at-risk and matched low-risk mothers. The four types of stressful stimuli were: a cold pressor; a stressful film depicting industrial accidents; unsolvable anagrams; and an aversive car horn. At-risk mothers, relative to low-risk mothers, had greater and more prolonged sympathetic activation during presentations of the cold pressor and the stressful film, the stimuli rated as the most stressful. The present data, combined with previous findings, support the view that generalized sympathetic activation to both child and non-child-related stressors may serve as a mediator of physical child abuse.

Adult↗

Evaluations, attributions, affect, and disciplinary choices in mothers at high and low risk for child physical abuse.

OBJECTIVE: The present study investigated several components of a social information-processing model of child physical abuse. The main objective was to examine the extent to which high-risk, relative to low-risk, mothers differed in their evaluations, attributions, negative affect, and disciplinary choices for children's behavior, and to explore whether these differences may be expressed in interactions between risk status and mitigating information. METHOD: Nineteen high- and 19 matched low-risk mothers' evaluations of children transgressions, attributions, affect, and choices of disciplinary techniques were examined using six vignettes depicting a child engaging in moral, conventional, and personal transgressions. One-half of the vignettes contained mitigating information and one-half did not. High- and low-risk mothers were chosen based on their potential for physical child abuse. A three-factor (2 x 3 x 2) design was used to assess the dependent variables. RESULTS: As expected, high-risk, relative to low-risk, mothers reported more hostile intent, stable and global attributions, aversiveness, annoyance, and use of power-assertion discipline. A risk group by type of transgression interaction was found for evaluation and indifference and a risk group by mitigating information interaction was found for evaluation of wrongness, internal attributions, and aversiveness. A risk by type of transgression by mitigating information interaction was found for global/specific attributions, aversiveness, and indifference toward child transgressions. CONCLUSIONS: Results support a social information processing model of child physical abuse, which suggests that high-risk, compared to low-risk, mothers process child-related information differently and use more power-assertive disciplinary techniques.

Analysis of Variance↗

Epidemiologic differences between sexual and physical child abuse.

Sexual and physical child abuse are assumed to differ; however, these differences have not been well characterized epidemiologically. Furthermore, despite assumed differences, these types of abuse are often analyzed as one entity. This can have significant effects on assessment of risk and recommendations for intervention. We compared 735 cases of sexual abuse and 3,486 cases of nonsexual physical abuse confirmed by the Georgia Department of Protective Services. Sexual and physical child abuse cases differed in age, sex, and relationship of perpetrators and victims; demographic and socioeconomic characteristics of families at risk; and morbidity and mortality caused by the event. The most important recommendation based on these findings is that epidemiologically distinct forms of child abuse must be analyzed separately before intervention measures are proposed.

Adolescent↗

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization.

OBJECTIVE: Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization. METHOD: A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms. RESULTS: The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization. CONCLUSIONS: The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.

Adolescent↗

Childhood physical abuse, early social support, and risk for maltreatment: current social support as a mediator of risk for child physical abuse.

OBJECTIVE: The study investigated whether perceptions of social support in adulthood partially mediated the associations between childhood experiences (i.e., receipt of physical abuse and levels of early social support) and adult risk for child physical abuse. METHOD: Participants included 598 general population adults who completed self-report measures designed to assess childhood physical abuse, perceptions of early and current social support, and risk factors for child physical abuse. Structural equation modeling was used to test and cross validate a model that included the direct effects of child physical abuse and early social support on child physical abuse risk, as well as mediated effects through an influence on adult perceptions of social support. RESULTS: Childhood physical abuse and early social support covaried, such that receipt of physical abuse was associated with lower levels of perceived early social support. Early support, but not child physical abuse, had an indirect effect (i.e., through current support) on child physical abuse risk. More specifically, levels of early support were directly related to adult perceptions of support, and adult perceptions of support were inversely associated with child physical abuse risk. Childhood physical abuse was directly related to child physical abuse risk. CONCLUSIONS: Low levels of early support may impact risk for child physical abuse by affecting perceptions of others as supportive in adulthood. The receipt of physical abuse in childhood, however, does not appear to impact perceptions of support in adulthood. Research is needed to identify additional factors that may explain the association between receipt of physical abuse in childhood and increased risk of child physical abuse in adulthood.

Adolescent↗

Physical child abuse and social change. Judicial intervention in families in The Netherlands, 1960-1995.

OBJECTIVE: To show changes in the way juvenile judges and judicial child protection workers deal with physical child abuse in the period 1960-1995 in the Netherlands. METHOD: The study is based on an analysis of files on adolescent and younger children placed by juvenile judges in the Dutch judicial child protection system during the 1960s, 1970s, 1980s, and 1990s. RESULTS: The prevalence of very severe physical violence against children was lower in the recent files than in the older files. Spanking and other minor violence acts were noted more often than in the older files. In the 1960s files, the parents talked still rather openly about the physical punishments they used in child rearing. In spite of the growing attention for and increasing concern about child abuse among professionals, judicial child protection workers intervened less harshly in recent cases of physical child abuse than in the 1960s. CONCLUSION: The decrease in severe physical child abuse may indicate that physical child abuse is actually becoming a less serious problem in the Dutch judicial child protection system. But that may not be the case because of the increased reluctance of parents to report and changes in intervention practices. Other than expected, the growing sensibility for child abuse did not mean more effective control by judicial child protection workers. Possible reasons for these changes are discussed, including the strengthening of the position of perpetrators in law proceedings and the emancipation of children and women in society.

Child↗

Toward an integrated framework for understanding child physical abuse.

OBJECTIVES: The article constructed an integrated conceptual framework for understanding child physical abuse based on a content analysis of different theories. Three major determinants of physical abuse were identified: exposure to aggression, exposure to stressors, and access to resources. To test the framework, we included variables from all three major categories in the analyses. METHODOLOGY: Data from a case-comparison study that included 81 physically abusive and 148 nonabusive mothers was used. Logistic regression determined the relative importance of the predictors. RESULTS: The probability of child physical abuse varied in the expected direction with the number of emotional resources received (listening, help with decision-making, companionship), the number of stressors experienced, and the mothers exposure to physical abuse by their own mothers, current partners, and former partners. The estimation results showed that exposure to aggression in one's own childhood (abused by one's own mother) and exposure to domestic violence in one's adult life (abused by one's previous and current partners) were the most potent factors for predicting whether a mother physically abused her child. CONCLUSION: The results suggest further research on the interdependencies between domestic violence and child physical abuse.

Adult↗

The medical discovery of shaken baby syndrome and child physical abuse.

Although child abuse is an age-old problem, it was not configured as a medical problem in the United States until the 1960s. Prior to that time, physician involvement in child abuse cases was limited. In the 1960s doctors began to medicalize child abuse by reporting on constellations of symptoms and radiographic findings that resulted from intentional trauma. Many social, political, and professional forces combined to make physicians more interested in playing a leadership role in identifying and treating abused children.

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Alcohol outlets and child physical abuse and neglect: applying routine activities theory to the study of child maltreatment.

OBJECTIVE: The purpose of this study is to examine whether or not alcohol access in neighborhood areas is differentially related to substantiated reports of child physical abuse and neglect. METHOD: This cross-sectional ecological study uses spatial regression procedures to examine the relationship between the number of bars, restaurants and off-premise outlets per population and rates of child physical abuse and neglect in 940 census tracts in California, while controlling for levels of social disorganization, population density and county of residence. RESULTS: The number of off-premise outlets per population was positively associated with rates of child physical abuse (b = 3.34, SE = 1.14), and the number of bars per population was positively related to rates of child neglect (b = 1.89, SE = 0.59). CONCLUSIONS: These results suggest that alcohol access is differentially related to type of child maltreatment, with higher densities of bars being related to higher rates of child neglect, and higher rates of off-premise outlets related to higher rates of child physical abuse. The findings suggest there is a spatial dynamic of neighborhoods that can result in child maltreatment and underscore the importance of examining the alcohol environment when developing programs to prevent child maltreatment.

Adult↗

Negative affect and parental aggression in child physical abuse.

OBJECTIVE: Parental negative affect is a risk factor for child physical abuse. As negative affect contributes to aggression, and because physical abuse involves an aggressive act directed at the child, we examined the relationship between negative affect and parent-to-child aggression (PTCA) in parents reported to Child Protective Services for physical abuse. METHOD: Baseline assessment data were retrospectively examined on 49 participants in a treatment study for child physical abuse. The negative affects studied were depression, anxiety, and hostility on the Beck Depression Inventory and the Brief Symptom Inventory. PTCA was assessed using the physical aggression subscales (Minor and Severe Physical Violence) of the Conflict Tactics Scale. The contribution of these negative affects to PTCA was examined after controlling individually for the effects of parental attributions and contextual variables widely regarded as etiological factors in child physical abuse. RESULTS: Contributions of negative affect to PTCA after individually controlling for other predictors were found for Minor Physical Violence but not Severe Physical Violence. Findings were strongest with depression on the Beck Depression Inventory and to a lesser extent with hostility on the Brief Symptom Inventory. CONCLUSIONS: Finding that negative affect contributed to PTCA in this sample suggests that it may be important to study the effects of emotion-focused treatments in physically abusive parents. These findings also suggest that PTCA may have qualities of impulsive aggression, a form of aggression that is conceptualized as driven by negative affect, occurs in response to aversive events, and is not planned.

Adult↗

Perceived neighborhood social disorder and residents' attitudes toward reporting child physical abuse.

OBJECTIVE: This study aimed to explore the relationship between perceived neighborhood social disorder and attitudes toward reporting child physical abuse. METHOD: Data from a national probabilistic sample (N=9,759) were used. Responses about the perception of neighborhood social disorder, perceived frequency of child physical abuse in Spanish families, and willingness to report a case of child physical abuse to the police were collected through face-to-face interviews in respondents' homes. RESULTS: Multivariate logistic regression analysis showed that perceived neighborhood social disorder was negatively related to residents' attitudes toward reporting child physical abuse. These results take into account the potential confounding effects of gender, age, socio-economic status, educational level, size of city, and perceived frequency of child physical abuse on reporting attitudes. CONCLUSION: Results illustrate the important role that community characteristics may play in processes relevant to the prevention of child maltreatment such as residents' attitudes towards reporting child physical abuse, and suggest that especially disadvantaged communities characterized by high levels of social disorder need to be specifically targeted if the aim is to increase the capacity to prevent child maltreatment in the community.

Adolescent↗

An overview of child physical abuse: developing an integrated parent-child cognitive-behavioral treatment approach.

This article reviews and summarizes the extant literature regarding child physical abuse (CPA). Literature is summarized that describes the wide range of short- and long-term effects of CPA on children as well as the documented characteristics of parents/caregivers who engage in physically abusive parenting practices. Although the reviewed research documents that interventions geared only toward the parent have been found to produce significant improvements with respect to parenting abilities, parent-child interactions, and children's behavior problems, there is a paucity of research examining the efficacy of interventions developed specifically to target the child's emotional and behavioral difficulties. Based on the few studies that have shown emotional and behavioral gains for children who have participated in treatment, an integrated parent-child cognitive-behavioral therapy (CBT) approach is proposed here to address the complex issues presented by both parent and child in CPA cases. The direct participation of the child in treatment also may improve our ability to target posttraumatic stress disorder (PTSD), depressive symptoms as well as anger control and dysfunctional abuse attributions in the children themselves. Implications for practice, public policy, and research are also addressed.

Adult↗

Recognizing and reporting child physical abuse: a survey of primary healthcare professionals.

AIM: This paper reports a study of the self-reported ability and behaviours of primary healthcare professionals in Northern Ireland to recognise child physical abuse. A secondary aim was to assess the educational and training needs of these professionals. BACKGROUND: In the United Kingdom, 7% of children suffer serious physical abuse by a parent or carer, and two children aged under 15 years die from abuse each week. Recognizing child physical abuse depends on the knowledge and skills of a variety of healthcare professionals. METHODS: A stratified random sample of 979 nurses, doctors, and dentists working in primary care in Northern Ireland were sent a postal questionnaire; 419 responded, giving a 43% response rate. The data were collected in 2002-2003. FINDINGS: In their working lives 60% (251) said that they had seen a suspicious child physical abuse case; however, only 47% (201) had reported a suspicious case to the authorities, leaving a 13% gap in reporting. Although 74% (310) of respondents were aware of some of the mechanisms for reporting child physical abuse, 79% (332) requested further education on this topic. Ability to recognize and willingness to report abuse cases discriminated between the three professional groups. Compared with doctors or dentists, community nurses were statistically significantly more likely to recognize and report suspicions of child physical abuse, and were the group most aware of child abuse issues and the most willing to become involved in abuse cases. CONCLUSIONS: The findings suggest that professional fears and anxieties and lack of knowledge act as barriers to recognizing and reporting abuse and that more specific education and support for primary care professionals is required.

Adult↗

Childhood parenting experiences, intimate partner conflict resolution, and adult risk for child physical abuse.

This study investigated the relationships between conflict resolution tactics experienced during childhood, intimate partner conflict resolution tactics, alcohol problems and adult child physical abuse risk. Participants were 1,544 Navy recruit trainees who volunteered to complete measures of parenting practices and spousal physical violence experienced during their childhood, the conflict resolution techniques used in their intimate relationships, their personal history of alcohol problems, and child physical abuse potential. Regression analyses indicated that the receipt of intimate partner physical violence accounted for the most variance in predicting who would inflict physical violence against an intimate partner; and the infliction of intimate physical violence accounted for the most variance in predicting who would receive physical violence from an intimate partner. Other analyses indicated that among the parent and intimate partner physically violent events, parent-child violence during childhood accounted for the most variance in explaining child abuse risk in females and males, with the infliction of intimate partner violence adding only to the prediction of child abuse risk in females. Analyses also revealed that after the effects of violent experiences were removed, alcohol problems contributed significantly, albeit very modestly, to the prediction of who expressed intimate partner physical violence for males and females, who was physically injured by an intimate partner (in the case of male injury), and who was at risk of child physical abuse for males and females.

Adult↗