Long-Term Placement Trajectories of Children Who Were Maltreated and Entered the Child Welfare System at an Early Age: Consequences for Physical and Behavioral Well-Being.

OBJECTIVE: This study aimed to identify children's long-term placement trajectories following early child welfare involvement and the association of these trajectories with subsequent physical and behavioral well-being. METHOD: Participants were 330 children who entered out-of-home care following a substantiated report of child abuse or neglect during infancy/early childhood and their caregivers. Participants were interviewed at child ages 4 and 12 years to assess children's physical and behavioral well-being and every 2 years in between to determine child placements. RESULTS: Latent Class Analyses identified four stable placement trajectories (i.e., adopted [32%], kinship care [15%], stable reunified [27%], and stable foster care [9%]), and two unstable trajectories (i.e., disrupted reunified [12%] and unstable foster care [5%]). Logistic regressions revealed that children in the unstable trajectories had significantly poorer physical and behavioral well-being than children in stable trajectories. CONCLUSIONS AND RELEVANCE: Maltreated children placed in out-of-home care are at risk for long-term placement instability and poorer physical and behavioral well-being.

Developmental transitions in presentations of externalizing problems among boys and girls at risk for child maltreatment.

The present study examined the impact of children's maltreatment experiences on the emergence of externalizing problem presentations among children during different developmental periods. The sample included 788 youth and their caregivers who participated in a multisite, prospective study of youth at-risk for maltreatment. Externalizing problems were assessed at ages 4, 8, and 12, and symptoms and diagnoses of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder were assessed at age 14, during interviews with youth and caregivers. Information about maltreatment allegations was coded from official records. Latent transition analysis identified three groups of youth with similar presentations of externalizing problems ("well adjusted," "hyperactive/oppositional," and "aggressive/rule-breaking") and transitions between groups from ages 4, 8, and 12. A "defiant/deceitful" group also emerged at age 12. Girls were generally more likely to present as well adjusted than boys. Children with recent physical abuse allegations had an increased risk for aggressive/rule-breaking presentations during the preschool and preadolescent years, while children with sexual abuse or neglect allegations had lower probabilities of having well-adjusted presentations during middle childhood. These findings indicate that persistently severe aggressive conduct problems, which are related to the most concerning outcomes, can be identified early, particularly among neglected and physically and sexually abused children.

Correlates of parent-youth discordance about youth-witnessed violence: a brief report.

Studies have consistently demonstrated a lack of agreement between youth and parent reports regarding youth-witnessed violence (YWV). However, little empirical investigation has been conducted on the correlates of disagreement. Concordance between youth and parents about YWV was examined in 766 parent-youth dyads from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Results showed that significantly more youth (42%) than parents (15%) reported YWV. Among the dyads in which at least one informant reported YWV (N = 344), we assessed whether youth delinquency, parental monitoring, parent-child relationship quality, history of child maltreatment, income, and parental depression were predictive of parent-youth concordance. Findings indicated that youth engagement in delinquent activities was higher in the groups in which the youth reported violence exposure. More empirical study is needed to assess correlates of agreement in high-risk youth to better inform associations found between exposures and outcomes as well as practice and policy for violence exposed youth.

Trajectories of adolescent psychopathology among youth who were maltreated and placed in out-of-home care.

BACKGROUND: Although researchers have found an increased risk for psychopathology among maltreated adolescents placed in out-of-home care, different trajectories of psychopathology by out-of-home placements have not been previously studied. OBJECTIVE: The current study is built on previous investigation of youth in different long-term out-of-home placements and examined the trajectories of adolescent psychopathology by out-of-home placement classes. PARTICIPANTS AND SETTING: We leveraged data from the Southwestern site of the Longitudinal Studies of Child Abuse and Neglect. Participants included caregiver-youth dyads (N = 273), who had substantiated reports of child maltreatment (CM) prior to children's age four and were placed in out-of-home care. METHODS: Five out-of-home placement classes from ages 4 to 12 (i.e., stable adopted, stable reunified, stable kinship care, stable non-kin foster care, and unstable placement) were identified from previous study and participants were interviewed at youth ages 12, 14, and 16 to assess adolescent psychopathology. Latent Growth Curve Analysis was used to examine trajectories of psychopathology by placement classes. RESULTS: Adolescents in unstable placement and stable adopted classes had higher intercepts and more positive or less negative slopes for psychopathology compared to those in stable kinship care and stable reunified classes. CONCLUSIONS: Adolescents in unstable placement and stable adopted classes were at similarly elevated risk for psychopathology, whereas adolescents in stable kinship care and stable reunified classes were at lower risk for psychopathology. We discuss the clinical implication to preventing and intervening risks for psychopathology among maltreated youth in unstable and adopted placements.

Unexplained gastrointestinal symptoms after abuse in a prospective study of children at risk for abuse and neglect.

PURPOSE: Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediated by psychological distress. METHODS: Data were obtained from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 prospective studies of child maltreatment. The 845 children who were observed from the age of 4 through 12 years were the subjects of this study. Every 2 years information on gastrointestinal symptoms was obtained from parents, and maltreatment allegations were obtained from Child Protective Services (CPS). At the age of 12 years children reported gastrointestinal symptoms, life-time maltreatment, and psychological distress. Data were analyzed by logistic regression. RESULTS: Lifetime CPS allegations of sexual abuse were associated with abdominal pain at age 12 years (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.1-2.47). Sexual abuse preceded or coincided with abdominal pain in 91% of cases. Youth recall of ever having been psychologically, physically, or sexually abused was significantly associated with both abdominal pain and nausea/vomiting (range, OR = 1.5 [95% CI, 1.1-2.0] to 2.1 [95% CI, 1.5-2.9]). When adjusting for psychological distress, most effects became insignificant except for the relation between physical abuse and nausea/vomiting (OR = 1.5; 95% CI, 1.1-2.2). CONCLUSION: Youth who have been maltreated are at increased risk for unexplained gastrointestinal symptoms, and this relation is partially mediated by psychological distress. These findings are relevant to the clinical care for children who complain of unexplained gastrointestinal symptoms.

Trajectories of childhood sexual abuse and early adolescent HIV/AIDS risk behaviors: the role of other maltreatment, witnessed violence, and child gender.

Childhood sexual abuse (CSA) has been associated with HIV/AIDS risk behavior; however, much of this work is retrospective and focuses on women. The current study used semi-parametric mixture modeling with youth (n = 844; 48.8% boys) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to examine the link between trajectories of CSA (2 to 12 years old) and HIV/AIDS risk behavior at age 14 (i.e., sexual intercourse & alcohol use). Trajectory analyses revealed a link between a history of CSA and the development of risky behavior. In addition, trajectories for physical and emotional abuse, but not neglect or witnessed violence, contributed to risky behavior over and above the role of CSA. Child gender did not moderate the findings. Findings highlight the significance of CSA histories, as well as the broader context of maltreatment, for better understanding the development of risk behaviors in both girls and boys.

Household composition and maltreatment allegations in the US: Deconstructing the at-risk single mother family.

BACKGROUND: Previous research has demonstrated the association between child maltreatment and household composition, with increased maltreatment risk generally present in single mother households. However, existing research does not fully examine the complexity and configuration of single mother households. In particular, less is known about important variants of single parent family structures, such as grandparents residing in the home, and the extent to which household compositions change across time. OBJECTIVE: The present study examines rates of maltreatment allegations across various household compositions in a sample of single biological mother households. PARTICIPANTS AND SETTING: Youth participants (N = 417) were part of the larger multi-site Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) study. METHODS: Participants completed longitudinal assessments of household composition and maltreatment allegations from ages 4 to 10. RESULTS: The present study illustrates substantial variability in the rate of maltreatment allegations across different types of single mother household compositions. In particular, the presence of non-relatives, especially unrelated males, demonstrated an increased risk for maltreatment allegations in the home. Conversely, single mother homes with two or more adult relatives, especially grandmothers, were at reduced risk for child maltreatment allegations. CONCLUSIONS: This study highlights variability in maltreatment allegations among single mother homes, including how maltreatment allegations vary across different household configurations, across child age periods and across different risk levels.

Beyond sexual abuse: the impact of other maltreatment experiences on sexualized behaviors.

This study sought to broaden research findings linking maltreatment to sexualized behaviors by investigating whether maltreatment experiences other than sexual abuse predict such behaviors. The sample included 690 children without reported sexual abuse histories who are participants in the LONGSCAN Consortium, a prospective multisite investigation of childhood maltreatment. Child Protective Service reports before age 8 years and caregiver reports on the Child Sexual Behavior Inventory-II at age 8 years were used to examine the relationship between maltreatment timing and type, and sexualized behaviors. Logistic regression analyses suggested that early (< 4) and late (4-8) reports of physical abuse were associated with more sexualized behaviors (odds ratios = 1.9-2.6). The pattern differed by gender, with physical abuse predicting sexual intrusiveness and displaying private parts in boys, and boundary problems in girls. Findings suggest that maltreatment other than sexual abuse, and the developmental periods in which it occurs, may be linked to the development of sexualized behaviors.

Concordance between adolescent reports of childhood abuse and Child Protective Service determinations in an at-risk sample of young adolescents.

This study examines the concordance between adolescent reports of abuse and abuse determinations from Child Protective Service (CPS) agencies. It also compares the utility of adolescent reports of abuse, relative to CPS determinations in predicting adolescent psychological adjustment. The sample included 350 early adolescents, ages 12 to 13 years, who were initially identified prior to age 2 years as being at elevated risk of maltreatment. An Audio-Computer Assisted Self Interview (A-CASI) was used to assess lifetime experiences of physical, sexual, and psychological abuse. The A-CASI interview elicited prevalence rates of abuse 4 to 6 times higher than those found in CPS records. However, 20 of 45 adolescents with CPS determinations of abuse failed to report abuse during the study interview. Adolescent psychological adjustment was more strongly associated with self-reports than with CPS determinations. The implications of these findings are discussed for validity of adolescent self-reports of childhood abuse and for the ongoing debate about disclosure patterns among victims of child sexual abuse.

Child maltreatment and age of alcohol and marijuana initiation in high-risk youth.

INTRODUCTION: Youth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation. MATERIALS AND METHODS: Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children. RESULTS: Path analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance. CONCLUSIONS: Externalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems.

Child Maltreatment and Risky Sexual Behavior.

Risky sexual behavior is a serious public health problem. Child sexual abuse is an established risk factor, but other forms of maltreatment appear to elevate risky behavior. The mechanisms by which child maltreatment influence risk are not well understood. This study used data from 859 high-risk youth, followed through age 18. Official reports of each form of maltreatment were coded. At age 16, potential mediators (trauma symptoms and substance use) were assessed. At age 18, risky sexual behavior (more than four partners, unprotected sex, unassertiveness in sexual refusal) was assessed. Neglect significantly predicted unprotected sex. Substance use predicted unprotected sex and four or more partners but did not mediate the effects of maltreatment. Trauma symptoms predicted unprotected sex and mediated effects of emotional maltreatment on unprotected sex and on assertiveness in sexual refusal and the effects of sexual abuse on unprotected sex. Both neglect and emotional maltreatment emerged as important factors in risky sexual behavior. Trauma symptoms appear to be an important pathway by which maltreatment confers risk for risky sexual behavior. Interventions to reduce risky sexual behavior should include assessment and treatment for trauma symptoms and for history of child maltreatment in all its forms.

Effect of early childhood adversity on child health.

OBJECTIVE: To examine the effect of child abuse and other household dysfunction on child health outcomes. DESIGN: Data from the Longitudinal Studies of Child Abuse and Neglect collected through interviews and questionnaires administered when target children were 4 years old and 6 years old. SETTING: Children in the South, East, Midwest, Northwest, and Southwest United States. PARTICIPANTS: One thousand forty-one children at high risk for child abuse and neglect (3 cohorts derived primarily from among children recruited through social service mechanisms, 1 cohort recruited at birth from among high-risk infants, and 1 cohort recruited from a medical setting). MAIN OUTCOME MEASURES: (1) Association of 7 adverse exposures (3 categories of child abuse [physical abuse, sexual abuse, and psychological maltreatment] and 4 categories of household dysfunction [caregiver problem drinking, caregiver depression, caregiver treated violently, and criminal behavior in the household]) derived from data collected when the child was 4 years old. (2) Indexes of child physical health at age 6 years (caregiver overall assessment of child health and reports of illness requiring medical attention). RESULTS: Two thirds of the sample had experienced at least 1 adverse exposure. One adverse exposure almost doubled the risk of overall poor health (odds ratio, 1.89; 95% confidence interval, 1.02-3.48), and 4 adverse exposures or more almost tripled the risk of illness requiring medical attention (odds ratio, 2.83; 95% confidence interval, 1.10-7.31). CONCLUSION: Adverse environmental exposures, including child abuse and other household dysfunction, are associated with poor child health even at an early age, although our data do not support a dose-response relationship.

Reporting participants in research studies to Child Protective Services: limited risk to attrition.

This study examines the impact of Child Protective Services (CPS) reports made by research study staff on participant retention and discusses human subjects protocols that may minimize either the need to make such reports or the negative impact of reporting on participants and on participant retention. Among 1, 354 primary caregiver-child pairs in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) studies, a total of 15 were reported to CPS by study staff. Within this group, rates of study-generated reports and study participation subsequent to having been reported by researchers were examined. There was an overall retention rate of 93% across a minimum of three interview waves in this sample. Reporting research participants to CPS may have little impact on attrition.

The relationship between child disability and living arrangement in child welfare.

The influence of disabilities on placement outcomes was examined for 277 children who were removed from their biological parents due to substantiated maltreatment. Results indicated that children with a disability were less likely to reunify and more likely to reside in nonkin foster care two years later than typical children. Children with cognitive, emotional /behavioral, and physical disabilities were over four times more likely to be permanently living in nonkin foster care than to be reunified.

Unstable child welfare permanent placements and early adolescent physical and mental health: The roles of adverse childhood experiences and post-traumatic stress.

Although researchers have found that child welfare placement disruptions are associated with elevated youth physical and mental health problems, the mechanisms that explain this association have not been previously studied. The present study built on a previous investigation of the physical and behavioral consequences of long-term permanent placement patterns among youth who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). The current investigation (n=251) aimed to (a) report the early adolescent living situations of youth with different long-term placement patterns, and (b) to delineate the roles of adverse childhood experiences (ACEs) and post-traumatic stress (PTS) reactions in the association between unstable long-term placement patterns and physical and mental health problems during the transition to adolescence. Information about youth's living situations, ACEs, and physical and mental health was gathered prospectively from child protective services records and biannual caregiver and youth interviews when youth were 4-14 years old. The majority of youth remained with the same caregiver during early adolescence, but youth with chronically unstable permanent placement patterns continued to experience instability. Path analyses revealed that ACEs mediated the association between unstable placement patterns and elevated mental, but not physical, health problems during late childhood. Additionally, late childhood PTS mediated the association between unstable placement patterns and subsequent escalations in physical and mental health problems during the transition to adolescence. Findings highlight the importance of long-term permanency planning for youth who enter the child welfare system and emphasize the importance of trauma-focused assessment and intervention for these youth.

Defining child neglect based on child protective services data.

OBJECTIVES: To compare neglect defined by Child Protective Services official codes with neglect defined by a review of CPS narrative data, and to examine the validity of the different neglect measures using children's functioning at age 8 years. METHODS: Data are from 740 children participating in a consortium of longitudinal studies on child abuse and neglect; 481 had at least one CPS report prior to age 8. CPS records were reviewed to ascertain both broad CPS types of neglect as well as specific subtypes of neglect using a modified version of the Maltreatment Classification System (MMCS). Frequencies of, and correlations among, the types and subtypes of neglect were examined. The validity of the neglect measures was evaluated by examining their relationships with children's functioning at age 8. RESULTS: The CPS neglect types and MMCS subtypes were moderately correlated, as were the MMCS subtypes of neglect. In general, neglect was only modestly associated with children's functioning at age 8 (r2=1-4%), with few differences between the CPS neglect types and the MMCS subtypes. There were significant associations with children's total and externalizing behavior problems, impaired socialization, and impaired daily living skills. Among the specific subtypes, neglect of children's medical needs was related to externalizing behavior problems, impaired socialization, and impaired daily living skills. Neglect of children's hygiene needs was related to impaired socialization. CONCLUSION: The moderate correlations among CPS and MMCS types and subtypes of neglect and their similar associations with children's functioning suggest that the considerable effort involved in coding neglect subtypes from CPS narrative data may yield limited incremental knowledge regarding the types of neglect children experience and their sequelae. However, the MMCS does offer useful descriptive information on the nature of neglect children experience, and may guide future research and practice on optimal ways to conceptualize neglect.

Defining maltreatment chronicity: are there differences in child outcomes?

OBJECTIVE: For nearly 25 years researchers have suggested that better taxonomic systems conceptualizing and reliably differentiating among different dimensions of maltreatment are required. This study examines the utility of three different characterizations of one dimension of maltreatment, chronicity, to predict child behavioral and emotional functioning in a sample of maltreated children. A secondary objective of the study is to examine additional parameters of maltreatment inherent in our definitions of chronicity: age at first report to CPS, extent and continuity of maltreatment. METHOD: The study consists of children reported for maltreatment (N=519) from the larger LONGSCAN study cohort. Lifetime maltreatment data were collected from CPS records and coded into two chronicity constructs: "developmental" and "calendar" definitions. Variables for age at first report, frequency, extent and continuity of maltreatment reports also were constructed. Hierarchical regression analyses were utilized to determine the extent to which the various chronicity constructs contributed to the prediction of child outcomes. RESULTS: The most salient definition of chronicity, in terms of its effects on child behavioral and emotional functioning, varied by outcome. The developmental definition was found to have the most balanced sensitivity across outcomes. Among other significant findings, extent and continuity of maltreatment contributed respectively to the prediction of behavior and emotional trauma symptoms. Early age at first report was a predictor of poor daily living skills. CONCLUSION: Chronicity is a complex construct. Findings indicate there are multiple parameters that make up the chronicity construct itself that may be important for understanding child outcomes.

Measuring the severity of child maltreatment.

OBJECTIVE: The purpose was to identify different operational definitions of maltreatment severity, and then to examine their predictive validity. METHOD: Children and their primary caregivers participating in a consortium of ongoing longitudinal studies were interviewed when they were approximately 4 and 8 years of age to assess behavior problems, and developmental and psychological functioning. Four different severity definitions were identified and applied to 519 children who were reported for alleged maltreatment between Birth and the Age 8 interview. A taxonomy for defining maltreatment characteristics (Barnett, Manly, & Cicchetti, 1993) was applied to Child Protective Service records to define severity as (a) Maximum Severity within each of five maltreatment types, (b) Overall Maximum Severity across the five types, (c) Total Severity or the sum of the maximum severity for each of five types, and (d) Mean Severity or the average severity for those types of maltreatment alleged, during each of two time periods-Birth to Age 4, and Age 4 to Age 8. RESULTS: Regression analyses that controlled for socio-demographic factors, early maltreatment (Birth to Age 4), prior functioning (Age 4), and site revealed that (a) all four severity definitions for maltreatment reports between Age 4 and Age 8 predicted Age 8 behavior problems, (b) Maximum Severity by Type and Mean Severity predicted adaptive functioning at Age 8, and (c) only Maximum Severity by Type was related to anger, at Age 8. Follow-up regression analyses indicated that only Maximum Severity by Type, specifically physical abuse, accounted for outcomes, beyond maltreatment occurrence versus non-occurrence. CONCLUSION: The results suggest that maltreatment severity definitions that preserve ratings within types of maltreatment may be the optimal approach to measure the severity of children's experiences.

Maltreatment's wake: the relationship of maltreatment dimensions to child outcomes.

OBJECTIVE: The aim of this exploratory study was to examine the extent to which, in combination, the best constructions of basic dimensions of maltreatment, identified in other papers from LONGSCAN, predict child outcomes. METHOD: Maltreatment records of a sample of 203 children were used to define dimensions of maltreatment related to Type, Severity, Chronicity, and Age at First Report. The definitions were based upon findings presented in other papers in this special issue. Children's behavioral and emotional functioning was examined at age 8 using standardized measures of problem behaviors, socialization and adaptation, and trauma symptomatology. Backward elimination regression was used to screen for interactions among the dimensions; regression models including dimensions and significant interactions were then run for each child outcome. Stratified partial correlations were utilized to explicate significant interactions. RESULTS: Individual maltreatment dimensions were found to have distinct effects on child functioning. Additionally, dimensions of maltreatment were interrelated and interacted in determining outcomes. Type of maltreatment (as indicated by the maximum severity rating of each type) was the most consistent predictor across outcomes, albeit different types predicted different outcomes. Various dimensional interactions were significant predictors of different outcomes. CONCLUSION: The results suggest that a comprehensive assessment of a child's maltreatment experience, including type and severity, when the maltreatment began and the pattern of maltreatment across the life span, is important to understanding the effects of maltreatment on children's growth and development.

Examination of a conceptual model of child neglect.

This study attempted to provide empirical support for conceptual definitions of child neglect. We identified 12 types of needs, conceptualizing neglect as occurring when children's basic needs are not adequately met. We examined measures administered to 377 children and caregivers at ages 4 and 6 years participating in longitudinal studies on child mal-treatment to identify potential indicators of these needs. Indicators were found for latent constructs, operationalizing three of the basic needs (emotional support and/or affection, protection from family conflict and/or violence, and from community violence). These latent constructs were used in a measurement model; this supported the conceptual definitions of neglect. A structural equation model then assessed whether the latent constructs were associated with child adjustment at age 8 years. Low level of perceived support from mother was associated with internalizing and externalizing behavior problems. Exposure to family conflict was also linked to these problems, and to social difficulties. Finally, children's sense of experiencing little early affection was associated with subsequent externalizing behavior and social problems. The approach of conceptualizing neglect in terms of unmet child needs, developing a measurement model to define latent neglect constructs, and relating these constructs to subsequent adjustment can build our understanding of neglect.