Lessons learned from LONGSCAN
Presented by
Diana English, PhD
Child Welfare Research Group
University of Washington, School of Social Work
Desmond K. Runyan, MD, DrPH
University of North Carolina at Chapel Hill
1
Acknowledgments
U.S. Department of Health and Human
Services
• Administration for Children, Youth, and
Families
• Children's Bureau
• Office on Child Abuse and Neglect
• National Institutes of Health
• National Institute of Child Health and
Human Development
•
2
LONGSCAN Background
•
•
1990 NCCAN funded consortium
Focus on child abuse & neglect
 Need for theory-based longitudinal studies
 Address CAUSES & CONSEQUENCES of abuse
and neglect
 Implications for…
• Preventing maltreatment (initial or
reoccurrence)
• Preventing negative effects of
maltreatment
• Promote recovery
3
Overview of LONGSCAN
•
•
•
•
•
•
•
LONGitudinal Studies of Child Abuse & Neglect
5 distinct studies (East, South, Midwest,
Northwest , & Southwest)
Measurement & data coordinated at UNC
coordinating center
Common measures, coding, training, data entry
Consortium governance agreement
Committees for governance, measurement,
analysis, and publications/dissemination
For more information, see Runyan et al.
1998
4
Current Status
•
•
•
Data collection on-going
- Youth now 14 - 22 years old
Data summarized & updated 4 times a year
- Data are distributed to sites twice a year
Data archived with the National Data Archive
on Child Abuse and Neglect (NDACAN)
- Age 4, 6, 8, and 12 interviews
- Contact interviews through age 11
- Includes CPS record reviews
5
6
Data Collected (Baseline to age 18)
Interviews
Baseline*
4
6
8
12
14+
16+
18+
Child
--
1166 1176 1074 895
872
721
452
Caregiver
--
1247 1225 1130 956
925
752
283
Child or
Caregiver
1354
1250 1236 1140 976
947
789
472
Notes. * Baseline refers to data at age 4 or age 6.
+ Data collection on-going at age 14, 16, and 18.
7
Data Collected (Baseline to age 18)
Interviews
Baseline*
4
6
8
12
14+
16+
18+
East
282
237
255
237
190
197
162
101
Midwest
245
223
225
216
181
173
91
--
South
243
221
222
190
177
176
130
174
Southwest
330
319
299
274
236
216
217
106
Northwest
254
250
235
223
192
185
189
91
Site
Notes. * Baseline refers to data at age 4 or age 6.
+ Data collection on-going at age 14, 16, and 18.
8
Sample Demographics (Baseline to Age 16)
Child Demographics
Baseline
4
6
8
12
14+
16+
% Male
48.5
48.8
48.7
48.1
49.8
48.9
48.2
% Caucasian
26.2
27.1
25.7
25.6
25.4
25.5
26.6
% African American
53.3
51.8
53.9
54.5
54.7
55.5
53.1
% Other Race
20.5
21.1
20.4
19.9
19.9
19.0
20.3
--
4.6
6.4
8.3
12.4
14.4
16.3
Mean Age
Notes. * Baseline refers to data at age 4 or age 6.
+ Data collection on-going at age 14 and 16.
9
Caregiver Demographics (Baseline to Age 16)
Caregiver
Demographics
4
6
8
12
14+
16+
% Married
33.1
33.0
35.5
38.3
37.9
39.4
% Single
44.6
42.6
41.2
34.4
34.1
30.9
% Separated
7.9
8.0
8.6
8.1
8.2
7.6
% Divorced
12.8
13.7
11.8
15.0
15.2
16.2
% Widowed
1.6
2.8
2.9
4.2
4.6
5.9
Mean Income
15k20k
15k20k
20k25k
25k30k
25k30k
30k35k
Mean Education
H. S.
H. S.
H. S.
H. S.
H. S.
H. S.
Notes. + Data collection on-going at age 14 and 16.
10
Measurement
•
Guided by Social-Developmental-Ecological
Theory (NRC, 1993; Bronfenbrenner, 1989; Hawkins &
Catalano, 1996).
•
Domains assessed:
 Child/Youth: Characteristics, functioning
 Caregiver: Characteristic, functioning
 Family microsystem: Home environment,
functioning
 Macrosystem: Neighborhood, school,
support
11
Measurement
•
Multiple sources & methods
•
Reports/ratings/questionnaires (Child/Youth,
Caregiver, and Teacher)
 Performance (Child/Youth)
 Situational tests/samples
 Official records (CPS)
•
Presentation of measures
 Interview & Audio-Computer Assisted Self
Interview (A-CASI)
12
LONGSCAN Publications to Date
Note. Publications as of February ’09.
13
Exposure of LONGSCAN To
Maltreatment
Maltreatment History
•
•
Expand definitions & methods
Look at maltreatment
 Physical & sexual abuse, neglect,
emotional, witnessed violence (home
and community)
 Beyond just the occurrence: yes/no
 Multidimensional (focus on degree or
extent - CAN special issue May, 2005)
 Beyond CPS report
• Age 12 youth self-report
15
# of Maltreatment Records/Referrals
per Child (birth through age 14)
7 Records
(3%)
6 Records
(4%)
8-22 Records
(12%)
5 Records (5%)
4 Records (7%)
3 Records
(9%)
2 Records
(12%)
1 Record
(16%)
Total N = 1354
16
Age of First Record/Referral
(birth through age 14)
# of Children
Descriptive Stats (0-14):
Total N of kids with record = 916
Mean Age = 2.2 years (SD = 2.9)
Range of Ages = 0 – 14.4
Median Age = 1.2
Age of First Record/Referral
17
# of Allegations
# of Allegations by Maltreatment
Type (birth through age 14)
Based on Baseline
Sample (N = 1354)
Age
18
# of Substantiations by Maltreatment
Type (birth through age 14)
# of Substantiations
Descriptive Stats (0-14):
Total # of substantiations (0-14) = 2282
Total # of physical abuse substantiations (0-14) = 369
Total # of sexual Abuse substantiations (0-14) = 99
Total # of neglect substantiations (0-14) = 1456
Total # of emotional abuse substantiations (0-14) = 358
Frequencies (0-14):
49% have 1 or more substantiations
14% have 1 or more physical abuse substantiations
6% have 1 or more sexual abuse substantiations
41% have 1 or more neglect substantiations
17% have 1 or more emotional abuse substantiations
Based on Baseline
Sample (N = 1354)
Age
19
Findings: Maltreatment
Dimensions – Substantiation Status
•
•
Are there outcome differences for children
reported & substantiated compared to
those who are reported and NOT
substantiated?
No differences on 10 developmental, social,
emotional and behavioral outcomes for
substantiated vs. not substantiated (Hussey
et al., 2005).
20
Maltreatment Allegations by Severity
(birth through age 14)
Low
Level of Severity
(percents of rows)
High
1
% (n)
2
% (n)
3
% (n)
4
% (n)
5
% (n)
Overall
M (SD)
33.3 (158)
26.2 (124)
31.0 (147)
8.2 (39)
1.3 (6)
2.2 (1.0)
Sexual Abuse
9.6 (21)
3.2 (7)
33.9 (74)
46.8 (102)
6.4 (14)
3.4 (1.0)
Neglect
8.6 (69)
7.5 (60)
22.6 (180)
30.8 (246)
30.3 (242)
3.7 (1.2)
Overall
5.9 (51)
7.5 (66)
24.2 (213)
33.0 (291)
29.4 (259)
3.7 (1.1)
Allegations
Physical Abuse
Note. Only includes participants who have an allegation.
21
Findings: Maltreatment
Dimensions - Severity
•
•
Severity construction:
 Maximum severity within type
 Maximum severity across type
 Total or sum of maximum severity
 Mean severity
Maximum severity by type best predictor of
outcomes including adaptive functioning
and anger (Litrownik et al., 2005).
22
Chronicity of Maltreatment
(birth through age 14)
Situational: referrals occur in only one
developmental period
16.4%
34.5%
20.3%
Limited Episodic: referrals occur in more
than one developmental period – but not
consecutive periods
Limited Continuous: referrals occur in ONLY
two consecutive developmental periods
13.1%
15.7%
N = 903
Extended Episodic: referrals occur in two
consecutive periods with one intervening
period where no referrals occurred, followed
by a period when one or more referrals
occurred
Extended Continuous: referrals occur in three
or more consecutive periods
23
Findings: Maltreatment
Dimensions - Chronicity
•
•
Developmental vs. Calendar to examine
consequences over time.
The developmental approach across a
child’s lifespan was the most sensitive – as
well as looking at extent (across
developmental stages) and continuity
(whether there are any gaps) (English et al.,
2005).
24
Findings: Maltreatment
Dimensions -Type
Hierarchical Type – prioritized abuse vs. neglect
• Severity/Frequency Type – based on highest
severity or frequency
• Expanded Hierarchical – differentiated multiple
vs. single sub-types
• All three types predicted child social/emotional
and behavioral functioning, however,
differentiating multiple vs. single sub-types was
the more outcomes (Lau et al., 2005).
•
25
Findings: Maltreatment
Dimensions - Combined
•
•
•
Type, severity, chronicity and age at first
report.
Individual maltreatment dimensions have
distinct effects on child functioning.
Type (based on maximum severity of each
type) most consistent predictor across
outcomes, however different types
predicted different outcomes (English et al.,
2005).
26
Findings: Maltreatment
Dimensions - Combined
A comprehensive assessment of a child’s
maltreatment experience (not just the presenting
incident) including type and severity.
• Age of onset
• Pattern (extent and continuity)
• All are important in understanding the outcome of
maltreatment on children’s growth and
development.
•
(see Child Abuse & Neglect Volume 29: 2005)
27
Self Report of Abuse
(birth through age 12)
* Indicators are
NOT mutually
exclusive
(N = 881)
(N = 874)
(N = 883)
28
Comparing Substantiations to Child
Self-Report (birth through age 12)
3.2%
4.3%
18.6%
Psychological Abuse
(N = 883)
14.2%
7.8%
80.9%
7.7%
33.0%
51.2%
8.1%
29
Concordance between Child SelfReport and CPS Substantiations
•
•
Classifying children/youth with profiles
improves ability to identify antecedents and
consequences of maltreatment:
 No PA/SA
 High PA, Low SA
 No PA/Moderate SA
 High PA, High SA
 (35% Youth did not endorse CPS reports)
Agreement between CPS report and selfreport not high (Everson et al.,
2008).
30
Concordance between Child SelfReport and CPS Substantiations
•
•
A-CASI interview rates of abuse 4-6 X higher
than in CPS records (Everson et al., 2008).
Adolescent psychological adjustment
(measured by TSCC & YSR) more strongly
associated with self-report than with CPS
determination (Everson et al., 2008).
31
Discussion
•
Implications of LONGSCAN findings on
maltreatment for policy and practice
Foster Care in LONGSCAN
Foster Care: First 18 months
•
Examined number of placements during first
18 months following removal (N = 415)
 1-15 placements : Mean = 4.23 placements
 Child behavior problems at time of initial
placement predicted subsequent #
placements.
 # prior placements predicted later behavior
problems for those who did not have
problems initially (Newton et al.,
2000).
Long-Term Placement and
Violence Exposure
•
Children placed in out of home care before 3.5
 At age 6 Reunified children:
 Had more exposure to family violence
 Experienced more adverse life events
 Evidenced increased internalizing problems
 Received fewer mental health services
 However, felt less isolated
 Parents of adoptive kids used more minor violence than
foster parents for discipline
 Adoptive kids report witnessing less violence in the home
(Lau et al., 2003; Litrownik et al., 2003).
Long-Term Stability of Early
Foster Care Sample
•
Examine caregiver stability for children age 6 to 8
who were removed prior to age 3.5 (N = 285).
 1 in 7 unstable
 Adoption most stable (compared to reunified, kin
care, and non-kin care)
 Other predictors of stability: father involvement;
child intellectual functioning
 Predictors of instability: Child behavior;
expressive family (Randazzo et al.,
under review).
Foster Care – Discipline Practices
and Child Aggression, Kin & Non-Kin
•
•
Kin use more harsh disciplinary
practice (N = 80).
Parents who use aggressive problem solving
strategies have more aggressive youth
(DeRobertis & Litrownik, 2004).
Discussion
•
Implications of foster care findings on
policy/practice.
Family Context
Caregiver violence exposure as a child/adult
• Current and/or recent domestic
violence/family conflict
• Caregiver depressive symptomatology
• Parenting
•
39
Neglect – A Different
Conceptualization
•
•
•
Definition of neglect as psychological and
physical safety and security.
Unsafe or dirty home & untreated
behavioral problems predicted language
impairments & developmental problems
(Dubowitz et al., 2005).
A stimulating home environment predicted
less impairment in cognitive development
(Dubowitz et al., 2005).
40
Neglect – A Different
Conceptualization
•
•
•
Multiple changes in residence predicted
externalizing behavior problems (Dubowitz
et al., 2005).
Exposure to verbally aggressive discipline
predicted more behavior problems
(Dubowitz et al., 2005).
Conclusion: Important to conceptualize
neglect in terms of child’s developmental
needs (safety and security).
41
Neglect
Examined individual and cumulative
relationship among physical, psychological and
environmental neglect and development (Age
3-5, N =136 - FTT & HIV Risk).
• Psychological neglect associated with increased
internalizing/externalizing problems.
• Cumulative neglect index associated with
internalizing problems
•
42
Influence of Early and Later Maltreatment on
Childhood Aggression at ages 4, 6 & 8
Predictor
Estimate (S.E.)
t
P
Early Neglect
1.29 (0.46)
2.80
<.01
Early Abuse
0.66 (0.68)
0.97
0.33
Later Neglect
0.14 (0.34)
0.42
0.68
Later Abuse
0.53 (0.39)
1.34
0.18
Notes. From Kotch et al., 2008.
N = 1,318; Model Chi-square = 858.49 (p < .0001).
Model includes child gender, child age, child race /ethnicity, caregiver marital
status, caregiver education, income, caregiver depression, neighborhood
safety, early neglect X early abuse, later neglect X later abuse, study site.
43
Influence of Early and Later Maltreatment
on Childhood Aggression at ages 4, 6 & 8
•
•
This study suggests that early neglect may be
a more important precursor of youth violence
than is physical abuse (Kotch et al., 2008).
Limitations:
 not a representative probability sample
 the possibility of false negatives cannot be
ruled out
 site is a potential confounder
44
Caregiver’s History of Violence Exposures
as a Child and/or Adult (age 4)
Of those assaulted (n = 608):
• 52% experienced some form of
physical assault/abuse as a child or
teenager.
• 44% experienced some form of
sexual assault /abuse before age 13.
• 36% experienced some form of
sexual assault/abuse as a teen.
• 75% experienced some form of
physical assault as an adult.
Caregiver Report at Age 4 Interview
(N = 923)
• 22% experienced some form of
sexual assault as an adult.
45
Caregiver’s History of Violence
Exposures as a Child and/or Adult
•
•
Maternal child victimization more powerful
indicator of child behavior problems at age
4 than caregiver adult victimization
(Thompson, 2007).
Caregivers victimized during childhood and
adulthood had worse outcomes than if
victimized either as an adult or child, or no
victimization (Dubowitz et al., 2001).
46
Caregiver’s History of Violence
Exposure as a Child and/or as an Adult
•
•
Chronic victimization in childhood and
adulthood more common than victimization
in childhood alone or as an adult alone
(Dubowitz et al., 2001).
Women who were physically and/or
sexually abused had worse outcomes than
those with only one type of abuse
(Dubowitz et al., 2001).
47
Caregiver’s History of Violence
as a Child and/or as an Adult
•
Caregivers victimized in childhood and
adulthood had:
 More depressive symptomatology;
 Used harsher parenting behaviors;
 Children had higher internalizing and
externalizing scores on the CBCL
(Dubowitz et al., 2001).
48
Caregiver’s History of Violence
Exposure as a Child and/or as an Adult
•
•
Caregivers with a history of CSA at increased
likelihood of a violent adult relationship
(English et al., 2003).
Caregivers with a history of child physical
abuse at increased risk of a violent adult
relationship (English et al., 2003).
49
Caregiver’s History of Violence
Exposures as a Child and/or as an Adult
Caregivers with a history of CSA more depressed
(Thompson, 2006).
• Adult victimization and depression predicted
maltreatment (Thompson, 2006).
• Adult sexual victimization predicted problem
drinking but not maltreatment (Thompson, 2006).
• Maternal adult physical victimization predicted a 23 fold increase in risk of maltreatment (Thompson,
2006).
•
50
Discussion
•
Implications of Caregiver History of
Abuse/Neglect on policy/practice.
Background – “Domestic Violence”
•
2007 - 3.3 million reports of CA/N
•
Co-occurrence of CA/N and adult domestic violence reported at
30-60% in clinical populations
•
Estimates of 47% (2,000/35,000 random sample) of investigated
CPS referrals - based on 1 item in assessment matrix and includes
history & current
•
1999/2000 US national probability sample of 3,931 CPS cases - 14%
current DV, 19% history of DV
•
Between 990,000 – 1,410,000 estimated DV issues (current and/or
past) present in CPS referrals
Background
Lack of clarity in definition of DV/IPAV/IPC – “woman
battering vs. common couple violence”
• Research on special populations or community
populations may not be applicable to at-risk or CPS
referred populations
• Limited examination of female IPAV/IPC and child
maltreatment and child outcomes
•
Aggressive and Violent Behavior
Violence Items (English et al., in press)
Mean (SD)
Mean (SD) Mean (SD)
Mean (SD) Males in BiFemaleFemales in
Male-Only Lateral AV
Only
Bi-Lateral
AV Perps.
Couples
Mann- AV Perps. AV Couples Mann(N = 24)
(N = 351) Whitney (N = 77)
(N = 351) Whitney
Minor Violence Scale (# times)
0.21 (0.83)
0.68 (1.83)
ns
0.16 (0.54)
1.1 (2.24)
p < .001
…person threw something at other person
0.04 (0.20)
0.19 (0.61)
ns
0.06 (0.37)
0.42 (0.97)
p < .001
…person push-shove-grab other person
0.17 (0.63)
0.34 (0.89)
ns
0.09 (0.40)
0.49 (1.05)
p < .001
…person slapped other person
0.00 (0.00)
0.14 (0.60)
ns
0.00 (0.00)
0.21 (0.68)
p < .005
Conflict Tactics Scale (Partner to Partner)
54
Aggressive and Violent Behavior
Violence Items (English et al., in press)
Mean (SD)
Mean (SD) Mean (SD)
Mean (SD) Males in BiFemaleFemales in
Male-Only Lateral AV
Only
Bi-Lateral
AV Perps.
Couples
Mann- AV Perps. AV Couples Mann(N = 24)
(N = 351) Whitney (N = 77)
(N = 351) Whitney
Severe Violence Scale (# times)
0.25 (1.20)
0.38 (1.59)
ns
0.15 (0.80)
0.78 (2.29)
p < .005
…person kick-bit-hit other person with fist
0.08 (0.41)
0.11 (0.52)
ns
0.05 (0.46)
0.24 (0.78)
p < .05
…person hit other person with something
0.04 (0.20)
0.12 (0.51)
ns
0.03 (0.23)
0.29 (0.81)
p < .005
…person beat other person up
0.12 (0.61)
0.09 (0.51)
ns
0.03 (0.23)
0.14 (0.59)
ns
…person choked other person
0.00 (0.00)
0.04 (0.28)
ns
0.05 (0.36)
0.04 (0.34)
ns
…person threatened other with knife-gun
0.00 (0.00)
0.03 (0.24)
ns
0.00 (0.00)
0.08 (0.44)
ns
…person used knife-gun on other person
0.00 (0.00)
0.01 (0.09)
ns
0.00 (0.00)
0.01 (0.13)
ns
Conflict Tactics Scale (Partner to Partner)
55
Results – CTS P-to-P
(Overall prevalence)
Male
Female
Significance
Verbal Aggression
82.7%
93.6%
p<.001
Minor Aggression
15.5%
24.6%
p<.005
Severe Aggression
7.7%
15.3%
p<.001
Children Exposed to IPAV
•
•
Significant child behavior problems for all
types of IPAV (verbal, minor and severe) and
for male and/or female perpetrators
(English et al., in press).
Conclusion: Need for comprehensive
assessment of IPAV when assessing risk,
safety and harm issues for children.
Discussion
•
Majority of IPAV in this sample is bilateral, and
women report more IPAV than their partners.
•
No difference in rates or type of IPAV in unilateral
IPAV homes (males/ females), however, females
may sustain greater injury
•
The majority of reported IPAV is verbal – but not
necessarily benign for children
Discussion
Child outcomes are best in homes where no
maltreatment/no IPAV is reported
• From the maltreated child’s perspective the impact of
witnessing IPAV appears not to vary based on gender of
perpetrator
• From the non-maltreated child’s perspective,
witnessing female-only IPAV does have an impact, as
does witnessing bilateral IPAV (both compared to
homes without IPAV)
•
Intimate Partner Violence/Aggression and
Child Outcomes
•
Conclusion: Need for comprehensive
assessment of IPAV when assessing risk,
safety and harm issues for children in
homes where IPAV reported as an issue.
Domestic Violence (DV)
DV associated with higher alcohol use by
female caregiver (English et al., 2003).
• DV associated with poor family health and
competence, poor family cohesion & high
family conflict (SFI) (English et al., 2003).
• DV was not related to child outcome when
other factors taken into account,
• The effect on children through mother’s
depression and reduced capacity to parent
(English et al., 2003).
•
Domestic Violence (DV)
•
•
Poor quality mother/father relationships
predicted higher child internalizing
problems (Black, Papas et al., 2002).
Black/Papas findings consistent with Katz &
Gottman – children exhibit externalizing
problems with mutually hostile caregiver(s)
and internalizing when father figure is angry
(Katz & Gottman).
Witnessing Violence
Caregivers report higher youth internalizing
scores than youth, and internalizing scores
increase with exposure to violence (Lewis et al.,
in preparation).
• Child maltreatment associated with higher
externalizing scores and higher caregiver
depression (Lewis et al., in preparation).
• Higher witnessed violence scores associated
with higher externalizing scores (Lewis et al., in
preparation).
•
Domestic Violence (DV)
•
•
Poor quality mother/father relationships
predicted higher child internalizing
problems (Black, Papas et al., 2002).
Black/Papas findings consistent with Katz &
Gottman – children exhibit externalizing
problems when caregiver(s) mutually hostile
and internalizing when father figure is angry
(Katz & Gottman).
64
Domestic Violence (DV)
•
•
In homes with DV, young age of caregiver,
low education level, low income, & low
religious involvement > risk of maltreatment
(Cox et al., 2003).
Social support moderates relationship
between DV & maltreatment (Cox et al.,
2003).
65
Witnessing Violence
Caregivers report higher youth internalizing
scores than youth,
• internalizing scores increase when there is any
exposure to violence (Lewis et al., in prep.).
• Child maltreatment associated with higher
externalizing scores and higher caregiver
depression (Lewis et al., in preparation).
• Greater witnessed violence associated with
higher externalizing scores (Lewis et al., in
preparation).
•
66
Caregiver Depression (4, 6,
8, 12, and 14)
9%
31%
30%
69%
70%
27%
91%
73%
27%
73%
Note. + At ages 4, 6, 12, and 14 the CES-D was utilized. A score of16 or higher has been used
extensively as the cut-off point for high depressive symptoms however, false positives on the
order of 15% to 20% have resulted from use of this cut-off point, leading some researchers to
suggest that a higher cut-off point be used (Boyd, Weissman, Thompson, & Myers, 1982; Zich,
Attkisson, & Greenfield, 1990).
* At age 8, the Brief Symptom inventory (BSI) was utilized. A cut-off of 63 or higher was used to
determine clinical depression for the BSI.
67
Discussion
•
Implication for findings on intimate partner
aggression/violence, child exposure on
policy/practice?
Depression and Child
Maltreatment
•
If Caregiver is victim of child abuse or neglect as
child:
 More depressed (Dubowitz et al., 2001)
69
Depression & Child Maltreatment
If Caregiver depressed:
 Perceive partner relationship more negatively (Black,
Papas et al., 2002).
 Children are 1.6 times more likely to be maltreated
(Radhakrishna et al., 2006; Thompson, 2006).
 Not related to neglect in adolescence (Black,
Papas et al., 2002).
70
Depression & Child Maltreatment
Perceive child needs services but child not
necessarily involved in services (Thompson et
al., 2007; Dubowitz et al., 2001).
Perceive more behavioral problems but effect
of maltreatment on child outcome not
mediated by caregiver depression (Thompson
et al., 2007; Black, Papas et al., 2002).
Maternal Depressive Symptoms
•
Depression symptoms did not predict re-referral
when controlling for type of maltreatment and
whether or not maltreatment was substantiated
(Thompson & Wiley, 2009).
72
Quality of Parenting
•
•
Parental warmth (empathy) moderates
caregiver’s use of physical discipline and
externalizing behavior (Lau et al., 2006).
Physical discipline not effective with
children predisposed to impulsive,
aggressive or non-compliant behavior (Lau
et al., 2006).
73
Quality of Parenting
•
•
•
If behavior already problem at age 4, parental
use of physical discipline predicts behavior
problems at older ages (Lau et al., 2006).
Harsh discipline predicts child’s internalizing and
externalizing problems (Dubowitz et al., 2001).
Caregivers with violent & aggressive behaviors
toward each other more likely to use verbal
aggression and minor violence with child
(English et al., 2003).
74
Discussion
•
Caregiver depression and quality of
parenting – implications for policy/practice?
Maltreatment outcomes
% of Kids in the Normal/Borderline/
Clinical Range for Externalizing
Behaviors (ages 4-16)
Child Behavior Checklist
Teacher Report Form
Youth Self
Report
Form
77
Highlights of LS Findings Examining
Externalizing Behaviors
•
•
•
•
About 20% of LONGSCAN children in clinical
range across ages
Teachers report more clinical problems than
parents
Children self-report fewer behavior
problems
By any source, 60% of LONGSCAN children
are in the NORMAL range on externalizing
behavior
78
% of Kids in the Normal/Borderline/
Clinical Range for Internalizing
Behaviors (ages 4-16)
Child Behavior Checklist
Teacher Report Form
Youth Self
Report
Form
79
Highlights of LS Findings
Examining Internalizing Behaviors
•
•
•
•
Caregivers report more problems as
children age
At 8, teachers noted more internalizing
problems than did caregivers
Youth self report had lowest sense of
problems
By any reporter, over 70% of the children
were normal on internalizing behaviors!
80
% of Kids in the Normal/Borderline/
Clinical Range for Total Problems
(ages 4-16)
Child Behavior Checklist
Teacher Report Form
Youth Self
Report
Form
81
Highlights of LS Findings
Examining Total Problems
•
•
•
•
Children looked worse at age 8
No overall pattern of doing better or worse
Teachers more likely to note problem
behaviors
By any source of report 60% of children
were in the normal range on total
problems!
82
Trauma Symptom Checklist (ages 8, 12, 16)
Mean T Scores
Higher scores,
indicate greater
distress.
Age 8 Frequencies:
- 9% Clinical on Anger T Score
- 24% Clinical on Anxiety T Score
- 18% Clinical on Depression T Score
- 16% Clinical on PTSD T Score
Age 12 Frequencies:
- 2% Clinical on Anger T Score
- 2% Clinical on Anxiety T Score
- 2% Clinical on Depression T Score
- 2% Clinical on PTSD T Score
Age 16 Frequencies:
- 2% Clinical on Anger T Score
- 2% Clinical on Anxiety T Score
- 2% Clinical on Depression T Score
- 4% Clinical on PTSD T Score
83
Highlights of LS Findings using Trauma
Symptom Checklist as an Outcome
•
•
•
Stability of trauma symptoms in a high risk
sample under examination (Lewis et al., in
preparation).
Adolescent psychological adjustment
(Trauma Symptom Checklist & Youth Self
Report) more strongly associated with selfreports than with CPS determinations
(Everson et al., 2008).
Children appear to do better on
psychological symptoms as they age!
84
Mean Standard Scores
Vineland Screener (ages 6, 8, 12)
Higher scores,
indicate greater
competence.
85
Highlights of LS Findings using
Vineland Screener as an Outcome
While psych distress score are better for
older children
• Daily living and socialization scores decline
• Impact of other forces on these high risk
children? Education, neighborhoods?
•
86
% of Standard Scores
WPPSI (age 6) and WRAT (age 12)
9%
15%
12%
16%
79%
69%
N = 1144
N = 840
87
Highlights of LS Findings using
WPPSI/WRAT as Outcomes
•
•
Pattern again is that 60% of the children are
in the normal range!
Increase in 10% of sample with cognitive
problems.
88
Suicidality (age 8)
•
•
More maltreatment was associated with an
increased likelihood of suicidal ideation (OR
2.0) (Thompson et al., 2005).
Witnessed violence also increased the risk
of > suicidal ideation (OR 1.6) (Thompson et
al., 2005).
89
Relative Contributions of
Violence at ages 8 and 12
Sample
•
Children from five sites who had completed the
Youth Self Report (n=872) at age 12
Variable
N
%
Male Gender
416
49
Minority Race
648
76
Self-report of abuse
Physical
Sexual
Psychological
199
138
346
23
16
40
Analysis
•
Hierarchical Linear Regression will be presented
• We predict the outcomes: Youth Self-Report scores for total
•
•
•
•
•
problems, internalizing & externalizing scales
1: we examine how race, gender, and site predict scores
2: we add witnessing community violence
3: we add witnessing family violence
4: we add self-reported exposure to child abuse
At each stage, we see how much better the model
predicts child distress on Youth Self Report
Standardized Betas for Internalizing YSR Scores
Beta
p
Beta
p
Beta
p
Female
0.05
NS
0.05
NS
0.03
NS
Black Race
-0.04
NS
-0.04
NS
-0.04
NS
East site
-0.09
NS
-0.08
NS
-0.04
NS
Central site
-0.05
NS
-0.04
NS
-0.02
NS
South site
-0.01
NS
0.00
NS
0.00
NS
SW site
-0.05
NS
-0.04
NS
-0.05
NS
Witness violence
0.16
<.001
0.11
<.001
0.12
<.001
0.13
<.001
0.11
<.01
Physical abuse
0.12
<.001
Sexual abuse
0.11
<.01
Psych abuse
0.17
<.001
Witness IPV
R square
R square change
0.02
0.04
0.13
-
0.02
0.09
Looking Back at Age 8
•
•
•
Exposure Data used Child Protective Services Records
Outcomes: Trauma Symptom Checklist & CBCL
For TSC Depression Score- 13% of variance explained
•
•
•
•
•
•
Standardized Beta for neglect = 0
Standardized Beta for Sexual abuse =.02
Standardized Beta for physical abuse=.04
Standardized Beta for emotional abuse = .04
Standardized Beta for violence in home = .15
Standardized Beta for neighborhood violence = .23
•
•
•
•
At age 8, exposure to domestic violence and
neighborhood violence were predictive of
depression
At age 8, abuse, neglect, & sexual abuse did
not strongly predictor depression
Age 12 self-reported psychological
maltreatment predicted most of the child
outcome
CPS allegations containing reports of
psychological maltreatment explain almost
none of the child outcome
Abuse, Neglect and HIV Risky
Behaviors
Trajectory Modeling of LONGSCAN
Children
HIV Risk and Sexual Abuse
•
•
•
•
•
•
•
5000 teens diagnosed with HIV each year
234 teens died of HIV in 2005
Acquired through risky sexual behavior &
substance abuse
7% of teens sexually active before age 13
Extensive literature links CSA to risky behavior
Cross-sectional and retrospective
Need to understand the relative contribution of
CSA to risky behaviors
Methods & approach
Examine trajectories of sexual abuse, other forms of
maltreatment, & risky behavior
• 725 subjects (all 5 sites) with Age 14 interview
• Maltreatment exposure classified by MMCS
• Witnessed violence by Coddington Life Events
• Risky behaviors by DISC questions about drugs &
alcohol and separate sexual activity questionnaire
• Most youth denied either behavior
• “Proc Traj” groups children by longitudinal patterns of
exposure
•
Sexual Abuse & Physical Abuse Trajectories
Figure 1
0.3
0.4
0.5
32.2 percent
67.8 percent
0.0
0.0
0.1
0.1
0.2
0.2
0.3
0.4
0.5
14.4 percent
85.6 percent
Physical Abuse Report
0.6
0.6
Figure 2
2
4
6
8
10
Age
12
2
4
6
8
10
12
Age
2 groups for SA: 14% who had a
pattern of sexual abuse & most
with no CSA
2 groups for PA: 32% with a
pattern of physical abuse & most
with no PA
Group Trajectories for Emotional Abuse,
Neglect, & Witnessed Violence
Figure 3
1.0
0.8
0.4
0.2
0.4
3 group
model of
neglect
0.2
28.6 percent
28.6 percent
42.8 percent
0.6
Neglect Report
0.8
0.6
9.3 percent
23.5 percent
67.2 percent
3 groups for
emotional
abuse
0.0
0.0
6
8
10
12
Figure 5
4
6
8
3
Age
24.1 percent
58.4 percent
17.5 percent
2
3 groups on
witnessed
violence
2
4
Age
1
4
0
2
Witnessed Violence Report
Emotional Abuse Report
1.0
Figure 4
5
6
7
8
9
Age
10
11
12
10
12
CSA, PA, EA, neglect & witnessed violence
explaining alcohol use, sexual activity or both.
Model 1
SA Only
Eithe r Both
Model 2
SA & PA
Eithe r Both
Model 3
SA & EA
Eithe r Both
Model 4
Model 5
SA & Neglect SA & WV
Eithe r Both
Eithe r Both
Abuse/Vio lence
______________________________________________________________________________
Chi ld Genderab
Sexual Abuse
c
ns
S-
S+
S+
Physical Abuse d
ns
S+
Emotiona l Abuse 1e
ns
ns
Emotiona l Abuse 2f
ns
S+
Neglect 1g
ns
ns
Neglect 2h
ns
ns
Witnessed Violence 1i
ns
ns
Witnes sed Violence 2j
ns
ns
Summing it up!
•
•
•
•
•
•
•
Largest Longitudinal study of child maltreatment to
date
Sample demographics have held pretty well (>50%AA)
Attrition has been acceptable
Standard coding of maltreatment is important
Most of sample reported 0-2 times
Most maltreatment low to moderate severity
50% of reported maltreatment in single
developmental period or limited - not chronic
102
Summing it up II
•
•
•
•
•
Substantiation versus allegation- little difference
Astounding differences between self-report and
what DSS knows
Behavior at placement predicted # foster care
placements
For children with few problems: # placements
predict problems later
Early Neglect, not physical abuse, associated with
aggression at ages 4,6, & 8
Summing it up III
•
•
•
•
•
•
•
Maternal exposure to maltreatment has impact on
next generation
IPV has strong influences on children and risk of
maltreatment recurrence
About 30% of mothers has clinical depression
Harsh discipline predicted more behavior problems
Majority of children not in clinical range on TSCC,
CBCL, YSR, etc.
At age 8, witnessing IPV more hazardous that SA or
PA
At age 12, psychological abuse greatest risk
Summing it up IV
•
•
•
Among teens, HIV risk behaviors associated
with sexual abuse and physical abuse, not
so much CPS reported emotional abuse or
neglect
Maltreatment explains just a small portion
of risky behavior
Lots of work left to do with LONGSCAN data
LONGSCAN Website
(http://www.iprc.unc.edu/longscan/)
Public website:
• Provides background information, helpful links,
and contact information.
• Access to publications, measures manuals,
presentations, policies, and research briefs
(Vol. 1 - Hunter & Knight, 1998; Vol. 2 -The
LONGSCAN Investigators, 2006).
Internal website:
• Access to electronic publications, data
dictionaries, retrieval information, grant
submissions, final reports, &
manuscript proposals.
106