How Heritable are Parental Sensitivity and Limit-Setting? A Longitudinal Child-Based Twin Study on Observed Parenting.

We examined the relative contribution of genetic, shared environmental and non-shared environmental factors to the covariance between parental sensitivity and limit-setting observed twice in a longitudinal study using a child-based twin design. Parental sensitivity and parental limit-setting were observed in 236 parents with each of their same-sex toddler twin children (Mage  = 3.8 years; 58% monozygotic). Bivariate behavioral genetic models indicated substantial effects of similar shared environmental factors on parental sensitivity and limit-setting and on the overlap within sensitivity and limit-setting across 1 year. Moderate child-driven genetic effects were found for parental limit-setting in year 1 and across 1 year. Genetic child factors contributing to explaining the variance in limit-setting over time were the same, whereas shared environmental factors showed some overlap.

The Prevalence of Child Sexual Abuse in Out-of-home Care: Increased Risk for Children with a Mild Intellectual Disability.

BACKGROUND: Children without disabilities in out-of-home care have a higher risk of child sexual abuse [CSA (Euser et al. 2013)]. In this study, we examined the year prevalence of CSA in out-of-home care for children with a mild intellectual disability, and compared it with the prevalence in out-of-home care for non-disabled children and children in the general population. MATERIALS AND METHODS: Professionals (N = 104) from out-of-home care facilities reported cases of CSA that occurred in 2010 for the children they worked with (N = 1650). RESULTS: In out-of-home care for children with a mild intellectual disability, 9.8 per 1000 children were victims of CSA. This prevalence was significantly higher than in regular out-of-home care and in the general population. CONCLUSION: Children with a mild intellectual disability in out-of-home care have an increased risk of CSA. Adequate education and support for both children and caregivers is necessary to recognize and prevent further sexual abuse.

A gloomy picture: a meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment.

BACKGROUND: Consistent findings about the effectiveness of parent programs to prevent or reduce child maltreatment are lacking. METHODS: In the present meta-analysis we synthesized findings from 27 independent samples from randomized controlled trials (RCTs) on the effectiveness of 20 different intervention programs aimed at (i) preventing the occurrence of child maltreatment in the general population or with at-risk but non-maltreating families, or (ii) reducing the incidence of child maltreatment in maltreating families. RESULTS: A significant combined effect on maltreatment (d = 0.13; N = 4883) disappeared after the trim-and-fill approach that takes into account publication bias against smaller studies without significant outcomes. However, moderator analyses showed that larger effect sizes were found for more recent studies, studies with smaller samples, programs that provide parent training instead of only support, programs that target maltreating instead of at-risk families, and programs with a moderate length (6-12 months) or a moderate number of sessions (16-30). CONCLUSIONS: More RCTs are needed to further unravel which factors are associated with program effectiveness. Because currently existing programs appeared to only reduce and not prevent child maltreatment, efforts in the field of preventive intervention should also focus on the development and testing of preventive programs for families at risk for child maltreatment.

Is elevated risk of child maltreatment in immigrant families associated with socioeconomic status? Evidence from three sources.

In this study we tested whether children from Dutch-immigrant families are at increased risk for maltreatment, and if so, what factors could explain this risk. Three data sources from the second Netherlands Prevalence Study of Maltreatment of Youth (NPM-2010) were used to answer these questions. First, 1127 professionals from various occupational branches (sentinels) were asked to report each child (including some background information on the child and family) for whom they suspected child maltreatment during a period of three months. Second, we included the 2010 data from the Dutch Child Protective Services and third, 1759 high school students aged 11-17 years filled out a questionnaire on their experiences of maltreatment in the past year. We found that children from traditional immigrant families with a relatively long migration history in the Netherlands (Turkish, Moroccan, Surinamese, and Antillean) and from nontraditional immigrant families (African [except Morocco], Eastern European, Central Asian, and South and Central American; often refugees) were at increased risk for child maltreatment compared to native Dutch families. However, in the professionals' and CPS data this risk disappeared for the traditional immigrant families after correction for educational level of the parents and for step-parenthood. Within the group of families with low education or step-parents, the risk for child maltreatment was similar for traditional immigrant families as for native Dutch families. Nontraditional families remained at increased risk after correction for sociodemographic and family factors. In conclusion, we found that children from both traditional and nontraditional immigrant families are at increased risk for maltreatment as compared to children from native Dutch families. For the traditional immigrants this risk could partially be explained by socioeconomic status. This implies that socioeconomic factors should be taken into account when outlining policies to fight child maltreatment.

General Mental Health, Loneliness, and Life Satisfaction in the Context of COVID-19 Policies: A 2-Year Cohort Study in the Netherlands, April 2020-January 2022.

OBJECTIVE: Although the COVID-19 pandemic has affected mental health, understanding who has been affected most and why is incomplete. We sought to understand changes in mental health in the context of transmission numbers and pandemic (social) restrictions and whether changes in mental health varied among population groups. METHODS: We analyzed data from 92 062 people (aged ≥16 years and able to read Dutch) who participated in the Corona Behavioral Unit cohort study at the National Institute for Public Health and the Environment, the Netherlands, from April 17, 2020, through January 25, 2022. Participants self-reported mental well-being through multiple rounds of surveys. We used a multivariable linear mixed-effects model to analyze loneliness, general mental health, and life satisfaction. RESULTS: As strictness of pandemic prevention measures and social restrictions increased, people's feelings of loneliness increased and mental health and life satisfaction decreased. As restrictions were relaxed, loneliness decreased and general mental health improved. Younger people (aged 16-24 y) versus older people (aged ≥40 y), people with low (vs high) education levels, and people living alone (vs living together) were more likely to have negative well-being outcomes. We observed that trajectories over time differed considerably only by age, with participants aged 16-24 years affected substantially more than participants aged ≥40 years by pandemic social restrictions. These patterns were consistent across multiple waves of SARS-CoV-2 infection. CONCLUSIONS: Our findings suggest that the social restrictions imposed by the Dutch government during the study period were associated with reduced mental well-being, especially among younger people. However, people appeared resilient as they recovered during periods when restrictions were relaxed. Monitoring and supporting well-being, in particular to reduce loneliness, may help younger people during periods of intense social restrictions.

Cohort profile: The Corona Behavioral Unit cohort, a longitudinal mixed-methods study on COVID-19-related behavior, well-being and policy support in the Netherlands.

This 'cohort profile' aims to provide a description of the study design, methodology, and baseline characteristics of the participants in the Corona Behavioral Unit cohort. This cohort was established in response to the COVID-19 pandemic by the Dutch National Institute for Public Health and the Environment (RIVM) and the regional public health services. The aim was to investigate adherence of and support for COVID-19 prevention measures, psychosocial determinants of COVID-19 behaviors, well-being, COVID-19 vaccination, and media use. The cohort also examined specific motivations and beliefs, such as for vaccination, which were collected through either closed-ended items or open text responses. In April 2020, 89,943 participants aged 16 years and older were recruited from existing nation-wide panels. Between May 2020 and September 2022, 99,676 additional participants were recruited through online social media platforms and mailing lists of higher education organizations. Participants who consented were initially invited every three weeks (5 rounds), then every six weeks (13 rounds), and since the summer of 2022 every 12 weeks (3 rounds). To date, 66% of participants were female, 30% were 39 years and younger, and 54% completed two or more questionnaires, with an average of 9.2 (SD = 5.7) questionnaires. The Corona Behavioral Unit COVID-19 cohort has published detailed insights into longitudinal patterns of COVID-19 related behaviors, support of COVID-19 preventive measures, as well as peoples' mental wellbeing in relation to the stringency of these measures. The results have informed COVID-19 policy making and pandemic communication in the Netherlands throughout the COVID-19 pandemic. The cohort data will continuously be used to examine COVID-19 related outcomes for scientific analyses, as well as to inform future pandemic preparedness plans.

Understanding COVID-19 vaccination willingness among youth: A survey study in the Netherlands.

Vaccination of youth could be key to preventing future outbreaks of SARS-CoV-2. Given the limited direct health benefit for young people, it is important to understand how youth themselves perceive obtaining a vaccination. This survey study in a representative sample of Dutch youth aged 12-18 showed that 73% were willing to get vaccinated against COVID-19. In regression analyses, vaccination willingness was strongly related to age, perceived personal (protect own health) and societal benefits (to get rid of restrictive policies), and their peers' and parents' vaccination uptake. Negative associations with vaccination willingness were perceived side-effects and potential unknown long term consequences. On-going and transparent communication with up-to-date information about safety and risks, delivered by independent and trusted experts (as perceived by the recipients) seems important for addressing questions and concerns. Local information sessions for youth and parents where a vaccination can be obtained without appointment could have merit in addition to mass media communication.

Does neural face processing explain effects of an attachment-based intervention on maternal sensitivity? A randomized controlled study including pre- and postintervention measures.

BACKGROUND: Although there is a large body of literature highlighting the behavioral effects of parenting interventions, studies on the neurocognitive mechanisms involved in such intervention effects remain scarce. PURPOSE: The aim of the current study was to test whether changes in neural face processing (as reflected in N170 amplitudes) would act as a mediator in the association between the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and maternal sensitivity. METHODS: A total of 66 mothers of whom a random 33% received the VIPP-SD and the others a "dummy" intervention participated in pre- and postintervention assessments. We recorded mothers' electroencephalographic (EEG) activity in response to photographs of children's neutral, happy, and angry facial expressions. Maternal sensitivity was observed while mothers interacted with their offspring in a semi-structured play situation. RESULTS: In contrast with our expectations, we did not find evidence for mediation of intervention effects on maternal sensitivity by the N170. CONCLUSION: We discuss that parenting support programs may yield different effects on neurocognitive processes depending on the population and provide recommendations for future research. Our study underscores the importance of reporting null findings and preregistering studies in the field of neurocognitive research.

Actigraphic sleep and cortisol in middle childhood: A multivariate behavioral genetics model.

To date, behavioral genetic studies investigated either sleep or cortisol levels in middle childhood, but not both simultaneously. Therefore, a pertinent question is the degree to which genetic factors and environmental factor contribute to the correlation between sleep and cortisol levels. To address this question, we employed the classical twin design. We measured sleep in 6-9-year-old twins (N = 436 twin pairs, "Together Unique" study) over four consecutive nights using actigraphy, and we measured morning cortisol on two consecutive days. Sleep duration, sleep efficiency, and wake episodes were used as indicators of sleep. Morning cortisol level was used as cortisol indicator. A structural equation model was fitted to estimate the contribution of additive genetic effects (A), shared (common) environmental effects, (C) and unique environmental effects (E) to phenotypic variances and covariances. Age, cohort, and sex were included as covariates. The heritability of sleep duration, sleep efficiency, and wake episodes were 52%, 45%, and 55%, respectively. Common environmental factors played no significant role. High genetic correlations between sleep duration and sleep efficiency and high genetic correlations between sleep efficiency and wake episodes were found. Shared environmental (29%) and unique environmental factors (53%) explained the variance in morning cortisol levels. Because the sleep and cortisol measures were found to be uncorrelated, we did not consider genetic and environmental contributions to the association between the sleep and cortisol measures. Our findings indicate that sleep duration, sleep efficiency, and wake episodes in children are mostly impacted by genetic factors and by unique environmental factors (including measurement error).

Video-feedback promotes sensitive limit-setting in parents of twin preschoolers: a randomized controlled trial.

BACKGROUND: Primary aim of the current randomized controlled trial was to test the effectiveness of the parenting intervention 'Video-feedback to promote Positive Parenting and Sensitive Discipline' (VIPP-SD) in a sample of parents of preschool-aged twins, as well as differential susceptibility to intervention efforts, that is, whether more temperamentally reactive parents would profit more from the VIPP-SD than parents with lower reactivity. METHODS: The sample consisted of 202 families with same-sex twins [N = 404 children, mean age 45 months (SD = 6.81)]. Randomization was done at the family level in a 2:3 ratio, with 83 families (41%) randomized to the VIPP-SD group, and 119 families (59%) to the control group. After two pre-tests in year 1 and year 2 of the study, the VIPP-SD was implemented in the third year, with a post-test assessment 1 month after the five intervention sessions. Parental sensitivity was observed during structured play in which parent and child copied a drawing together in a computerized Etch-A-Sketch paradigm. Parental limit-setting was observed in a 'don't touch' task in which the parent required from the child to abstain from playing with attractive toys. Parents interacted with each of their twins in separate sessions. RESULTS: The VIPP-SD intervention had a positive impact on the level of parents' positive limit-setting in interaction with their preschool twins, and this positive effect was most pronounced when the parents completed at least five intervention sessions. However, the intervention did not enhance parental sensitivity during structured play. Parents with higher reactivity were not more open to the impact of the intervention, thus for this temperamental marker differential susceptibility in adults was not supported. CONCLUSIONS: The current study is unique in targeting families with twin preschoolers, providing proof of principle that coaching parents with video-feedback promotes parental sensitive limit-setting to both children. It remains to be seen whether this finding can be replicated in families with non-twin siblings, or other parental susceptibility markers. Trial registration Trial NL5172 (NTR5312), 2015-07-20.

Neural and behavioral signatures of social evaluation and adaptation in childhood and adolescence: The Leiden consortium on individual development (L-CID).

The transition period between early childhood and late adolescence is characterized by pronounced changes in social competence, or the capacity for flexible social adaptation. Here, we propose that two processes, self-control and prosociality, are crucial for social adaptation following social evaluation. We present a neurobehavioral model showing commonalities in neural responses to experiences of social acceptance and rejection, and multiple pathways for responding to social context. The Leiden Consortium on Individual Development (L-CID) provides a comprehensive approach towards understanding the longitudinal developmental pathways of, and social enrichment effects on, social competence, taking into account potential differential effects of such enrichment. Using Neurosynth based brain maps we point towards the medial prefrontal cortex as an important region integrating social cognition, self-referential processing and self-control for learning to respond flexibly to changing social contexts. Based on their role in social evaluation processing, we suggest to examine medial prefrontal cortex connections with lateral prefrontal cortex and the ventral striatum as potential neural differential susceptibility markers, in addition to previously established markers of differential susceptibility.

Effects of parental sensitivity in different contexts on children's hot and cool effortful control.

To thrive as an individual and within society, children need to develop the ability to control their behavior. Using a twin design, we estimated the relative influence of genetic, shared, and unique environmental factors on hot and cool effortful control (EC). Furthermore, we investigated whether parental sensitivity in a play, task, or discipline context when the children were on average 3.78 years old, was differentially related to children's hot and cool EC 1 year later (Mage 4.77 years). We included 476 children from 238 twin pairs (48% boys, 58% monozygotic) and their primary parent. Hot EC (delay of gratification) was measured with the marshmallow test and cool EC (response inhibition) was measured with a stop-signal task. The behavioral genetics analyses showed that individual differences in hot and cool EC were mostly explained by unique environmental factors, whereas their association was mostly explained by shared environmental factors. Controlling for sensitivity in the other contexts, task sensitivity contributed to the prediction of cool EC, and sensitive discipline contributed to both cool and hot EC. Play sensitivity did not contribute to the prediction of hot or cool EC over and above parental sensitivity in the other contexts. Our study contributes to a better understanding of the unique and shared antecedents of hot and cool EC, suggesting parental sensitive discipline as a focus for preventive interventions targeting both hot and cool EC. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Social judgments, frontal asymmetry, and aggressive behavior in young children: A replication study using EEG.

Early in their lives young children are confronted with social judgments by peers. Previous studies have shown that in adults negative social judgments are associated with more aggressive behavior. However, little is known about the relation between social judgments and aggressive behavior, or the underlying neurocognitive mechanisms, in early childhood. We developed the Social Network Aggression Task - Early Childhood (SNAT-EC) to examine the mediating role of frontal EEG asymmetry in the relation between social judgment and aggressive behavior in 4-6 year old children. To replicate our findings, we included three samples: a pilot sample, test sample 1 and test sample 2 (total N = 78). In the SNAT-EC, children receive positive, negative and neutral social judgments about their chosen cuddly animal by same-aged unfamiliar peers. EEG was acquired to measure frontal asymmetry during the processing of social judgments. Aggressive behavior was measured as the duration of a button press with which children could destroy balloons of the judging peer, thus reducing the number of remaining balloons for that peer. We used a within-subject mediation model to test whether frontal asymmetry mediated the effect of social judgment (negative vs. positive) on aggressive behavior. Results show that the SNAT-EC robustly elicits more aggressive behavior in response to negative social judgments about the cuddly animal compared to positive judgments. Meta-analysis revealed a large combined effect size (r = .42) for the relation between negative (vs. positive) social judgments and aggressive behavior. However, frontal asymmetry in response to the social judgments did not mediate the relation between social judgment and aggressive behavior. Future studies should search for other neural mediators to bridge the brain-behavior gap between social judgments and aggressive behavior, in particular in early childhood.

Stressful family environments and children's behavioral control: A multimethod test and replication study with twins.

Young children's behavioral control predicts a broad range of developmental outcomes in child- and adulthood. It is therefore important to study how individual differences in behavioral control arise. Previous studies suggest that there are both genetic and environmental influences, which were estimated in the current study using a sample of mono- and dizygotic same-sex twins. Furthermore, we examined the associations between indicators of a stressful family environment like household chaos, parenting daily hassles, and parental depressive symptoms and children's behavioral control in 2 samples. Children of the same twin pair were randomly divided over 2 samples; a test (N = 201, 48.3% boys, M age 46.53 months) and replication sample (N = 201, 49.8% boys, M age 46.06 months). Both parents reported on their children's effortful control via the Child Behavior Questionnaire and children's cheating behavior was observed during a throwing game. We found that AE models fitted the data for effortful control (A = 31%, E = 69%) and cheating (A = 16%, E = 84%) best. Path analyses revealed that children of parents experiencing more parenting daily hassles and depressive symptoms had lower levels of effortful control in the test sample. Furthermore, we found that children growing up in more chaotic households (parent report) had an increased risk of being in the cheating group versus the possible intention to cheat group in the test sample. These results were partially replicated. We suggest that the role of stressful family environments in the development of behavioral control should be considered when setting up prevention and intervention programs targeting children's behavioral control. (PsycINFO Database Record

The neural and behavioral correlates of social evaluation in childhood.

Being accepted or rejected by peers is highly salient for developing social relations in childhood. We investigated the behavioral and neural correlates of social feedback and subsequent aggression in 7-10-year-old children, using the Social Network Aggression Task (SNAT). Participants viewed pictures of peers that gave positive, neutral or negative feedback to the participant's profile. Next, participants could blast a loud noise towards the peer, as an index of aggression. We included three groups (N=19, N=28 and N=27) and combined the results meta-analytically. Negative social feedback resulted in the most behavioral aggression, with large combined effect-sizes. Whole brain condition effects for each separate sample failed to show robust effects, possibly due to the small samples. Exploratory analyses over the combined test and replication samples confirmed heightened activation in the medial prefrontal cortex (mPFC) after negative social feedback. Moreover, meta-analyses of activity in predefined regions of interest showed that negative social feedback resulted in more neural activation in the amygdala, anterior insula and the mPFC/anterior cingulate cortex. Together, the results show that social motivation is already highly salient in middle childhood, and indicate that the SNAT is a valid paradigm for assessing the neural and behavioral correlates of social evaluation in children.

Which neural mechanisms mediate the effects of a parenting intervention program on parenting behavior: design of a randomized controlled trial.

BACKGROUND: The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) has proven effective in increasing parental sensitivity. However, the mechanisms involved are largely unknown. In a randomized controlled trial we examine parental neurocognitive factors that may mediate the intervention effects on parenting behavior. Our aims are to (1) examine whether the intervention influences parents' neural processing of children's emotional expressions and the neural precursors of response inhibition and to (2) test whether neural changes mediate intervention effects on parenting behavior. METHODS: We will test 100 mothers of 4-6 year old same-sex twins. A random half of the mothers will receive the VIPP-SD Twins (i.e. VIPP-SD adapted for twin families), consisting of 5 home visits in a 3-months period; the other half will receive a dummy intervention. Neurocognitive measures are acquired approximately 2 weeks before and 2 weeks after the intervention. Mothers' electroencephalographic (EEG) activity is measured while performing a stop signal task and in response to children's facial expressions. To obtain a complementary behavioral measure, mothers also perform an emotion recognition task. Parenting behavior will be assessed during parent-child interactions at pre and post intervention lab visits. DISCUSSION: Our results will shed light on the neurocognitive factors underlying changes in parenting behavior after a parenting support program, which may benefit the development of such programs. TRIAL REGISTRATION: Dutch Trial Register: NTR5312 ; Date registered: January 3, 2017.

Efficacy of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline in Twin Families (VIPP-Twins): Study protocol for a randomized controlled trial.

BACKGROUND: Intervention programs with the aim of enhancing parenting quality have been found to be differentially effective in decreasing negative child outcomes such as externalizing behavioral problems, resulting in modest overall effect sizes. Here we present the protocol for a randomized controlled trial to examine the efficacy of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline for Twin Families (VIPP-Twins) on parenting quality and children's behavioral control and social competence. In addition, we aim to test the differential susceptibility theory; we examine differential efficacy of the intervention based on genetic make-up or temperament for both parents and children. Lastly, we explore neurobiological mechanisms underlying intervention effects on children's developmental outcomes. METHODS/DESIGN: The original VIPP-SD was adapted for use in families with twins. The VIPP-Twins consists of five biweekly sessions in which the families are visited at home, parent-child interactions are videotaped and parents receive positive feedback on selected video fragments. Families (N = 225) with a same sex twin (mean age = 3.6 years) were recruited to participate in the study. The study consists of four assessments. After two baseline assessments in year 1 and year 2, a random 40 % of the sample will receive the VIPP-Twins program. The first post-test assessment will be carried out one month after the intervention and there will be a long term follow-up assessment two years after the intervention. Measures include observational assessments of parenting and children's social competence and behavioral control, and neurobiological assessments (i.e., hormonal functioning and neural (re-)activity). DISCUSSION: Results of the study will provide insights in the efficacy of the VIPP-Twins and reveal moderators and mediators of program efficacy. Overall the randomized controlled trial is an experimental test of the differential susceptibility theory. TRIAL REGISTRATION: Dutch Trial Register: NTR5312 ; Date registered: July 20, 2015.

The prevalence of child sexual abuse in out-of-home care: a comparison between abuse in residential and in foster care.

We investigated the 2010 year prevalence of child sexual abuse (CSA) in residential and foster care and compared it with prevalence rates in the general population. We used two approaches to estimate the prevalence of CSA. First, 264 professionals working in residential or foster care (sentinels) reported CSA for the children they worked with (N = 6,281). Second, 329 adolescents staying in residential or foster care reported on their own experiences with CSA. Sentinels and adolescents were randomly selected from 82 Dutch out-of-home care facilities. We found that 3.5 per 1,000 children had been victims of CSA based on sentinel reports. In addition, 58 per 1,000 adolescents reported having experienced CSA. Results based on both sentinel report and self-report revealed higher prevalence rates in out-of-home care than in the general population, with the highest prevalence in residential care. Prevalence rates in foster care did not differ from the general population. According to our findings, children and adolescents in residential care are at increased risk of CSA compared to children in foster care. Unfortunately, foster care does not fully protect children against sexual abuse either, and thus its quality needs to be further improved.

The prevalence of child maltreatment in the Netherlands across a 5-year period.

The prevalence of child maltreatment in the Netherlands was in 2005 first systematically examined in the Netherlands' Prevalence study on Maltreatment of children and youth (NPM-2005), using sentinel reports and substantiated CPS cases, and in the Pupils on Abuse study (PoA-2005), using high school students' self-report. In this second National Prevalence study on Maltreatment (NPM-2010), we used the same three methods to examine the prevalence of child maltreatment in 2010, enabling a cross-time comparison of the prevalence of child maltreatment in the Netherlands. First, 1,127 professionals from various occupational branches (sentinels) reported each child for whom they suspected child maltreatment during a period of three months. Second, we included 22,661 substantiated cases reported in 2010 to the Dutch Child Protective Services. Third, 1,920 high school students aged 12-17 years filled out a questionnaire on their experiences of maltreatment in 2010. The overall prevalence of child maltreatment in the Netherlands in 2010 was 33.8 per 1,000 children based on the combined sentinel and CPS reports and 99.4 per 1,000 adolescents based on self-report. Major risk factors for child maltreatment were parental low education, immigrant status, unemployment, and single parenthood. We found a large increase in CPS-reports, whereas prevalence rates based on sentinel and self-report did not change between 2005 and 2010. Based on these findings a likely conclusion is that the actual number of maltreated children has not increased from 2005 to 2010, but that professionals have become more aware of child maltreatment, and more likely to report cases to CPS.