Most Cited Child Abuse and Neglect Articles

http://www.journals.elsevier.com/child-abuse-and-neglect/most-cited-articles

Poly-victimization: A neglected component in child victimization

Volume 31, Issue 1, January 2007, Pages 7-26
Finkelhor, D. | Ormrod, R.K. | Turner, H.A.

Objective: To assess the role of multiple victimization, or what is termed in this article "poly-victimization," in explaining trauma symptomatology. Method: In a nationally representative sample of 2,030 children ages 2-17, assessment was made of the past year's victimization experiences and recent trauma symptoms. Results: Children experiencing four or more different kinds of victimization in a single year (poly-victims) comprised 22% of the sample. Poly-victimization was highly predictive of trauma symptoms, and when taken into account, greatly reduced or eliminated the association between individual victimizations (e.g., sexual abuse) and symptomatology. Poly-victims were also more symptomatic than children with only repeated episodes of the same kind of victimization. Conclusion: Researchers and practitioners need to assess for a broader range of victimizations, and avoid studies and assessments organized around a single form of victimization. © 2006 Elsevier Ltd. All rights reserved.

Long-term physical and mental health consequences of childhood physical abuse: Results from a large population-based sample of men and women

Volume 31, Issue 5, May 2007, Pages 517-530
Springer, K.W. | Sheridan, J. | Kuo, D. | Carnes, M.

Objective: Child maltreatment has been linked to negative adult health outcomes; however, much past research includes only clinical samples of women, focuses exclusively on sexual abuse and/or fails to control for family background and childhood characteristics, both potential confounders. Further research is needed to obtain accurate, generalizable estimates and to educate clinicians who are generally unaware of the link between childhood abuse and adult health. The purpose of this project is to examine how childhood physical abuse by parents impacts mid-life mental and physical health, and to explore the attenuating effect of family background and childhood adversities. Methods: We analyzed population-based survey data from over 2,000 middle-aged men and women in the Wisconsin Longitudinal Study using self-reported measures of parental childhood physical abuse, mental health (depression, anxiety, anger), physical health (physical symptoms and medical diagnoses), family background, and childhood adversities. Results: Parental physical abuse was reported by 11.4% of respondents (10.6% of males and 12.1% of females). In multivariate models controlling for age, sex, childhood adversities, and family background, we found that childhood physical abuse predicted a graded increase in depression, anxiety, anger, physical symptoms, and medical diagnoses. Childhood physical abuse also predicted severe ill health and an array of specific medical diagnoses and physical symptoms. Family background and childhood adversities attenuated but did not eliminate the childhood abuse/adult health relationship. Conclusions: In a population-based cohort of middle-aged men and women, childhood physical abuse predicted worse mental and physical health decades after the abuse. These effects were attenuated, but not eliminated, by age, sex, family background, and childhood adversities. © 2007 Elsevier Ltd. All rights reserved.

Exposure to childhood sexual and physical abuse and adjustment in early adulthood

Volume 32, Issue 6, June 2008, Pages 607-619
Fergusson, D.M. | Boden, J.M. | Horwood, L.J.

Objective: This research examined linkages between exposure to childhood sexual abuse (CSA) and childhood physical punishment/abuse (CPA) and mental health issues in early adulthood. Method: The investigation analyzed data from a birth cohort of over 1,000 New Zealand young adults studied to the age of 25. Results: Exposure to CSA and CPA was associated with increased risks of later mental disorders including depression, anxiety disorder, conduct/anti-social personality disorder, substance dependence, suicidal ideation, and suicide attempts at ages 16-25. Control for social, family, and individual factors reduced the associations between CPA and mental health outcomes to the point of statistical non-significance. However, there was a consistent finding for CSA to remain associated with increased risks of later mental health problems. After adjustment, those exposed to CSA including attempted or completed sexual penetration had rates of disorder that were 2.4 times higher than those not exposed to CSA. Those exposed to harsh or abusive physical punishment had rates of disorder that were 1.5 times higher than those exposed to no or occasional physical punishment. It was estimated that exposure to CSA accounted for approximately 13% of the mental health problems experienced by the cohort. Findings showed that exposure to CPA had only weak effects on later mental health. It was estimated that exposure to CPA accounted for approximately 5% of the mental health problems experienced by the cohort. Conclusions: Exposure to CSA was associated with consistent increases in risks of later mental health problems. Exposure to CPA had weaker and less consistent effects on later mental health. These findings suggest that much of the association between CPA and later mental health reflects the general family context in which CPA occurs, whereas this is less the case for CSA. © 2008 Elsevier Ltd. All rights reserved.

Resilience to adult psychopathology following childhood maltreatment: Evidence from a community sample

Volume 31, Issue 3, March 2007, Pages 211-229
Collishaw, S. | Pickles, A. | Messer, J. | Rutter, M. | Shearer, C. | Maughan, B.

Objective: Child abuse is an important risk for adult psychiatric morbidity. However, not all maltreated children experience mental health problems as adults. The aims of the present study were to address the extent of resilience to adult psychopathology in a representative community sample, and to explore predictors of a good prognosis. Methods: Data are drawn from a follow-up of the Isle of Wight study, an epidemiological sample assessed in adolescence and at midlife. Ratings of psychiatric disorder, peer relationships and family functioning were made in adolescence; adult assessments included a lifetime psychiatric history, personality and social functioning assessments, and retrospective reports of childhood sexual and physical abuse. Results: Ten percent of individuals reported repeated or severe physical or sexual abuse in childhood. Prospective measures revealed increased rates of adolescent psychiatric disorders in this group. Rates of adult psychopathology were also high. A substantial minority of abused individuals reported no mental health problems in adult life. Resilience of this kind was related to perceived parental care, adolescent peer relationships, the quality of adult love relationships, and personality style. Conclusion: Good quality relationships across childhood, adolescence and adulthood appear especially important for adult psychological well being in the context of childhood abuse. © 2007 Elsevier Ltd. All rights reserved.

The impact of exposure to domestic violence on children and young people: A review of the literature

Volume 32, Issue 8, August 2008, Pages 797-810
Holt, S. | Buckley, H. | Whelan, S.

Objective: This article reviews the literature concerning the impact of exposure to domestic violence on the health and developmental well-being of children and young people. Impact is explored across four separate yet inter-related domains (domestic violence exposure and child abuse; impact on parental capacity; impact on child and adolescent development; and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted. Method: A comprehensive search of identified databases was conducted within an 11-year framework (1995-2006). This yielded a vast literature which was selectively organized and analyzed according to the four domains identified above. Results: This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioral problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother. Conclusion: Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life. Practice implications: This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child-centered approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience, and responsive to their individual needs. © 2008 Elsevier Ltd. All rights reserved.

Re-victimization patterns in a national longitudinal sample of children and youth

Volume 31, Issue 5, May 2007, Pages 479-502
Finkelhor, D. | Ormrod, R.K. | Turner, H.A.

Objective: To understand to the degree to which a broad variety of victimizations, including child maltreatment, conventional crime, peer, and sexual victimizations, persist for children from 1 year to the next. Design: A national sample of 1467 children aged 2-17 recruited through random digit dialing and assessed via telephone interviews (with caretakers and youth themselves) about a comprehensive range of victimization experiences in the previous year, and then re-assessed (72.3% of baseline sample) after a 1-year interval. Results: The risk for re-victimization in Year 2 was high for children victimized in Year 1, with risk ratios ranging from 2.2 for physical assault to 6.9 for sexual victimization. Victimization of any one type left substantial vulnerability even for different types of subsequent re-victimization (e.g., property crime victimization was associated with higher risk of sexual victimization the next year). Children with four or more types of victimization in Year 1 ("poly-victims") were at particularly high risk of persisting poly-victimization. Persisting poly-victimization was more likely for children who scored high on anger/aggression and who had recent life adversities. Desistence from poly-victimization was associated with having more good friends. Onset of poly-victimization in Year 2, in contrast to persistence from Year 1, was associated with violent or maltreating families, family problems such as alcohol abuse, imprisonment, unemployment and family disruption. Having more older siblings acted as both a risk factor and a protective factor for different groups of youth. Conclusion: Children previously victimized in 1 year are at higher risk of continued victimization, and the poly-victims are at particular risk. These findings suggest the potential merit of identifying these high-risk children and making them priority targets for prevention efforts. © 2007 Elsevier Ltd. All rights reserved.

Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: A cumulative stressors model

Volume 31, Issue 3, March 2007, Pages 231-253
Jaffee, S.R. | Caspi, A. | Moffitt, T.E. | Polo-Tomás, M. | Taylor, A.

Objective: Children who are physically maltreated are at risk of a range of adverse outcomes in childhood and adulthood, but some children who are maltreated manage to function well despite their history of adversity. Which individual, family, and neighborhood characteristics distinguish resilient from non-resilient maltreated children? Do children's individual strengths promote resilience even when children are exposed to multiple family and neighborhood stressors (cumulative stressors model)? Methods: Data were from the Environmental Risk Longitudinal Study which describes a nationally representative sample of 1,116 twin pairs and their families. Families were home-visited when the twins were 5 and 7 years old, and teachers provided information about children's behavior at school. Interviewers rated the likelihood that children had been maltreated based on mothers' reports of harm to the child and child welfare involvement with the family. Results: Resilient children were those who engaged in normative levels of antisocial behavior despite having been maltreated. Boys (but not girls) who had above-average intelligence and whose parents had relatively few symptoms of antisocial personality were more likely to be resilient versus non-resilient to maltreatment. Children whose parents had substance use problems and who lived in relatively high crime neighborhoods that were low on social cohesion and informal social control were less likely to be resilient versus non-resilient to maltreatment. Consistent with a cumulative stressors model of children's adaptation, individual strengths distinguished resilient from non-resilient children under conditions of low, but not high, family and neighborhood stress. Conclusion: These findings suggest that for children residing in multi-problem families, personal resources may not be sufficient to promote their adaptive functioning. © 2007 Elsevier Ltd. All rights reserved.

Resilience, competence, and coping

Volume 31, Issue 3, March 2007, Pages 205-209
Rutter, M.

Bullying, violence, and risk behavior in South African school students

Volume 31, Issue 2, February 2007, Pages 161-171
Liang, H. | Flisher, A.J. | Lombard, C.J.

Objectives: To examine the prevalence of bullying behavior in adolescents from Cape Town and Durban, South Africa, and the association of these behaviors with levels of violence and risk behavior. Method: Five thousand and seventy-four adolescent schoolchildren in grade 8 (mean age 14.2 years) and grade 11 (mean age 17.4 years) at 72 Government schools in Cape Town and Durban, South Africa completed self-report questionnaires on participation in bullying, violent, anti-social and risk behaviors. Results: Over a third (36.3%) of students were involved in bullying behavior, 8.2% as bullies, 19.3% as victims and 8.7% as bully-victims (those that are both bullied and bully others). Male students were most at risk of both perpetration and victimization, with younger boys more vulnerable to victimization. Violent and anti-social behaviors were increased in bullies, victims and bully-victims compared to controls not involved in any bullying behavior (p < .01 in all cases). Risk taking behavior was elevated for bullies and bully-victims, but for victims was largely comparable to controls. Victims were less likely to smoke than controls (odds ratio .83, p < .05). Bully-victims showed largely comparable violent, anti-social and risk taking behavior profiles to bullies. Bully-victims showed comparable suicidal ideation and smoking profiles to victims. Conclusions: Results were in keeping with Western findings. Involvement in bullying is a common problem for young South Africans. Bullying behavior can act as an indicator of violent, anti-social and risk-taking behaviors. © 2007 Elsevier Ltd. All rights reserved.

How neighborhoods influence child maltreatment: A review of the literature and alternative pathways

Volume 31, Issues 11-12, November 2007, Pages 1117-1142
Coulton, C.J. | Crampton, D.S. | Irwin, M. | Spilsbury, J.C. | Korbin, J.E.

Objective: To review the literature on the relationships between neighborhoods and child maltreatment and identify future directions for research in this area. Method: A search of electronic databases and a survey of experts yielded a list of 25 studies on the influence of geographically defined neighborhoods on child maltreatment. These studies were then critically reviewed by an interdisciplinary research team. Results: Numerous studies demonstrate that child maltreatment cases are concentrated in disadvantaged areas. A number of socio-economic characteristics of neighborhoods have been shown to correlate with child maltreatment rates as measured by official reports to child protective service agencies. Only a few studies examine direct measures of parenting behaviors associated with maltreatment, and these show a weaker relationship with neighborhood disadvantage. Moreover, the processes that link neighborhood conditions to either maltreatment reports or parenting behaviors are not yet confirmed by the research literature. Selection bias, neighborhood definitions and spatial influences are largely uncontrolled in the existing research. Conclusions: We propose a framework for pursuing further study of neighborhoods and child maltreatment that addresses the gaps in the current literature. Neighborhood-based strategies to prevent and reduce child maltreatment will be enhanced by research that provides a better understanding of how neighborhood conditions act as stressors or supports for families at risk of child maltreatment. © 2007 Elsevier Ltd. All rights reserved.

Childhood victimization and lifetime revictimization

Volume 32, Issue 8, August 2008, Pages 785-796
Widom, C.S. | Czaja, S.J. | Dutton, M.A.

Objective: To examine the fundamental hypothesis that childhood victimization leads to increased vulnerability for subsequent (re)victimization in adolescence and adulthood and, if so, whether there are differences in rates of experiencing traumas and victimizations by gender, race/ethnicity, and type of childhood abuse and/or neglect. Methods: Using a prospective cohort design, participants are individuals with documented cases of childhood physical and sexual abuse and neglect from the years 1967 through 1971 and a matched control group. Both groups were interviewed in-person (mean age 39.5 years) in 2000-2002 using a new instrument to assess lifetime trauma and victimization history. Results: Abused and neglected individuals reported a higher number of traumas and victimization experiences than controls and all types of childhood victimization (physical abuse, sexual abuse, and neglect) were associated with increased risk for lifetime revictimization. Significant group (abuse/neglect vs. control) by gender and group by race/ethnicity interactions were found. Childhood victimization increased risk for physical and sexual assault/abuse, kidnapping/stalking, and having a family friend murdered or commit suicide, but not for general traumas, witnessing trauma, or crime victimization. Conclusions: These findings provide strong support for the need for early intervention with abused and neglected children and their families to prevent subsequent exposure to traumas and victimization experiences. © 2008 Elsevier Ltd. All rights reserved.

Childhood emotional maltreatment and later psychological distress among college students: The mediating role of maladaptive schemas

Volume 33, Issue 1, January 2009, Pages 59-68
Wright, M.O. | Crawford, E. | Del Castillo, D.

Objective: Theoretically, exposure to experiences of emotional abuse (EA) and emotional neglect (EN) in childhood may threaten the security of attachment relationships and result in maladaptive models of self and self-in-relation to others. The purpose of this study was to explore the extent to which EA and EN treatment by parents contributed uniquely to young adult maladaptive long-term outcome with respect to symptoms of anxiety, depression, and dissociation. The extent to which the relationships between EA and EN and later symptoms were mediated by specific internalized maladaptive interpersonal schemas was also explored. Methods: Questionnaires completed by 301 college men and women (52% female) assessed perceptions of experiences of childhood abuse and neglect, exposure to parental alcoholism, current symptoms of psychological distress, and endorsement of maladaptive interpersonal schemas. Results: Hierarchical regression analyses revealed that perceptions of childhood EA and EN each continued to exert an influence on later symptoms after controlling for gender, income, parental alcoholism, and other child abuse experiences. Both EA and EN were associated with later symptoms of anxiety and depression and were mediated by schemas of vulnerability to harm, shame, and self-sacrifice. Only EN was related to later symptoms of dissociation; this relationship was mediated by the schemas of shame and vulnerability to harm. Conclusion: The findings are discussed from an attachment perspective, focusing on how early interactions with parents contribute to the development of internal working models of self and self-in-relation to others that influence later cognitive schemas and psychological adjustment. Practice implications: Although emotional abuse and emotional neglect are the least studied of all forms of child maltreatment, they may be the most prevalent. The current findings suggest that how college students have evaluated and internalized these experiences may be even more important than the events themselves in determining the extent to which these experiences exert a long-term impact. For this reason, early intervention might be particularly important in helping to modify internal working models of the self as worthless, others as abusive, or the world as threatening and dangerous as a result of past abuse experiences. This study underscores the need for counselors to actively elicit and explore experiences of emotional abuse and neglect in clients, in addition to inquiring about other abuse experiences and types of family dysfunction. The results of this study also support existing data suggesting that internalized representational models of self and others are a key mechanism underlying the relationship between emotional maltreatment and later psychopathology. Young's schema questionnaire proved to be quite sensitive in detecting specific maladaptive schemas that mediated later difficulties with depression, anxiety, and dissociation. Targeting these negative schemas in therapy may help to ameliorate such symptoms. The therapeutic relationship provides a particularly effective context for developing more positive models of self and others, as well as providing a context to explore core relationship themes across different relationship contexts (e.g., intimate partner, parent, friend, and work relationships). In particular, if the assessment of the client reveals that dissociative symptoms are present, counselors can acknowledge the adaptive function that this strategy once served, while also addressing potential limitations to over-reliance on this coping strategy. © 2008 Elsevier Ltd. All rights reserved.

Differential correlates of multi-type maltreatment among urban youth

Volume 31, Issue 4, April 2007, Pages 393-415
Arata, C.M. | Langhinrichsen-Rohling, J. | Bowers, D. | O'Brien, N.

Objective: The aim of this study was to examine the differential effects of multi-types of maltreatment in an adolescent sample. Different combinations of maltreatment (emotional, sexual, physical, neglect) were examined in relation to both negative affect and externalizing symptoms in male and female youth. Method: One thousand four hundred fifty-two middle and high school youth were recruited from urban schools and a mandated early warning truancy program. Youth completed an anonymous survey that included measures of child maltreatment, depression, suicide proneness, hopelessness, delinquency, hostility, substance use, and promiscuity. Respondents were categorized into groups of different combinations of maltreatment by their reports of sexual abuse, physical abuse, neglect (emotional and physical), and emotional abuse. Results: Nearly two-thirds of boys and girls reported some form of maltreatment, and multi-type maltreatment was common (e.g., 13% reported experiencing both physical and sexual abuse and neglect). Individuals with maltreatment histories were more depressed (F = 52.78, p < .0001), suicide prone (F = 24.29, p < .001), and hopeless (F = 32.07, p < .0001) than non-abused individuals. Maltreated adolescents were also more hostile (F = 35.03, p < .0001), and they engaged in more delinquent behavior (F = 26.76, p < .0001), promiscuity (F = 8.54, p < .0001), and drug and alcohol use (F = 9.61, p < .0001). Individuals experiencing multi-type maltreatment were the most symptomatic, particularly youth with histories of physical abuse, sexual abuse, and neglect. In general, gender differences in effects were not observed. Conclusions: The results highlight the importance of studying combined types of maltreatment, as well as understanding the particularly deleterious effects of neglect and emotional abuse. The results are generally consistent with an additive model of maltreatment effects. © 2007 Elsevier Ltd. All rights reserved.

Child multi-type maltreatment and associated depression and PTSD symptoms: The role of social support and stress

Volume 31, Issue 1, January 2007, Pages 71-84
Vranceanu, A.-M. | Hobfoll, S.E. | Johnson, R.J.

Objective: This retrospective, cross-sectional study explored the hypothesis that multiple forms of child abuse and neglect (child multi-type maltreatment; CMM) would be associated with women's lower social support and higher stress in adulthood, and that this, in turn, would amplify their vulnerability to symptoms of depression and posttraumatic stress disorder (PTSD). Method: Participants were 100 women recruited from an inner-city gynecological treatment center for low-income women. Data were analyzed via structural equation modeling (SEM) with Lisrel 8.0. Results: CMM was directly predictive of decreased social support and increased stress in adulthood. CMM was also directly predictive of PTSD symptoms, but not depression symptoms in adulthood. Social support partially mediated the relationship between CMM and adult PTSD symptoms, and stress fully mediated the relationship between CMM and adult symptoms of depression. Conclusions: Findings support both direct and mediational effects of social resources on adult depression and PTSD symptoms in women with histories of CMM, suggesting that resources are key factors in psychological adjustment of CMM victims. © 2006 Elsevier Ltd. All rights reserved.

Lifetime assessment of poly-victimization in a national sample of children and youth

Volume 33, Issue 7, July 2009, Pages 403-411
Finkelhor, D. | Ormrod, R.K. | Turner, H.A.

Objective: To use a lifetime assessment of victimization experiences to identify children and youth with high cumulative levels of victimization (poly-victims). Also to compare such children to other victims and non-victims, and assess the contribution of cumulative victimization to levels of psychological distress. Design: A national sample of 1,467 children aged 2-17 recruited through random digit dialing and assessed via telephone interviews (with caretakers and youth themselves) about a comprehensive range of 33 types of victimization experiences in the previous year and at any time in their lives. Results: Nearly 80% of the children and youth reported at least one lifetime victimization. The mean number of lifetime victimizations was 3.7 and the median 2.6. The total number of different lifetime victimizations was highly predictive of symptoms of current distress. The best linear prediction of distress on the basis of cumulative victimization entailed weighting child maltreatment and sexual assault by factors of 4 and 3 respectively compared to other victimizations. We proposed classifying poly-victims as those 10% of children and youth with the highest victimization scores, and calculating different thresholds for children at different ages. Poly-victims designated in this way had significantly more distress, more non-victimization adversities than other youth and were less likely to come from an intact family. Conclusion: Lifetime assessment of victimization has value as a means of identifying groups of highly victimized children and youth. Practice Implications: This paper describes a procedure under which practitioners can assess for a group of children, termed "poly-victims," who have a very high burden of lifetime victimization. These children merit identification because they have high levels of psychological distress, some of the most serious victimization profiles, and a presumed vulnerability for further victimization. © 2009 Elsevier Ltd. All rights reserved.

A structured forensic interview protocol improves the quality and informativeness of investigative interviews with children: A review of research using the NICHD Investigative Interview Protocol

Volume 31, Issues 11-12, November 2007, Pages 1201-1231
Lamb, M.E. | Orbach, Y. | Hershkowitz, I. | Esplin, P.W. | Horowitz, D.

Objective: To show how the results of research on children's memory, communicative skills, social knowledge, and social tendencies can be translated into guidelines that improve the quality of forensic interviews of children. Method: We review studies designed to evaluate children's capacities as witnesses, explain the development of the structured NICHD Investigative Interview Protocol, and discuss studies designed to assess whether use of the Protocol enhances the quality of investigative interviews. Results: Controlled studies have repeatedly shown that the quality of interviewing reliably and dramatically improves when interviewers employ the NICHD Protocol. No other technique has been proven to be similarly effective. Conclusions: Use of the structured NICHD Protocol improves the quality of information obtained from alleged victims by investigators, thereby increasing the likelihood that interventions will be appropriate. © 2007 Elsevier Ltd. All rights reserved.

Re-referral to child protective services: The influence of child, family, and case characteristics on risk status

Volume 31, Issue 5, May 2007, Pages 573-588
Connell, C.M. | Bergeron, N. | Katz, K.H. | Saunders, L. | Tebes, J.K.

Introduction: This study examines child, family, and case characteristics that impact rates of re-referral to Child Protective Services (CPS) using data on all closed CPS investigations for the state of Rhode Island between 2001 and 2004. Method: A longitudinal dataset of all referrals to CPS was created using state submissions to the National Child Abuse and Neglect Data System (NCANDS). After excluding children whose initial CPS investigation resulted in removal from the home, a Cox proportional hazards model was tested to examine factors impacting the likelihood of re-referral. Results: Consistent with other research in this area, the initial 6-month period following case disposition is the period of greatest risk of re-referral. Approximately 13% of cases experienced a recurrent allegation during the first 6-month period; an additional 14% experienced a re-referral over the following 12-month period; 7% during the next 12-month period. Family poverty was the strongest predictor of re-referral, though a number of child and case characteristics were significantly related to recurrence. Cases that were substantiated at index were significantly less likely to result in a new allegation, though substantiated cases of physical abuse or those receiving post-investigation services were at higher risk. Conclusions: Children from families facing multiple stressors (e.g., low SES, parental substance abuse child disability) are at highest risk of re-referral to CPS and may benefit from the development of preventive services targeted immediately following case closings within CPS. © 2007 Elsevier Ltd. All rights reserved.

Predictors of resilience in abused and neglected children grown-up: The role of individual and neighborhood characteristics

Volume 31, Issue 3, March 2007, Pages 255-274
DuMont, K.A. | Widom, C.S. | Czaja, S.J.

Purpose: This paper examines individual, family, and neighborhood level predictors of resilience in adolescence and young adulthood and describes changes in resilience over time from adolescence to young adulthood in abused and neglected children grown up. Method: We use documented cases of childhood physical and sexual abuse and neglect (n = 676) from a Midwestern county area during the years 1967-1971 and information from official records, census data, psychiatric assessments, and self-reports obtained through 1995. Analyses involve logistic regressions, replicated with Mplus to test for possible contextual effects. Results: Almost half (48%) of the abused and neglected children in adolescence and nearly one-third in young adulthood were resilient. Over half of those who were resilient in adolescence remained resilient in young adulthood, whereas 11% of the non-resilient adolescents were resilient in young adulthood. Females were more likely to be resilient during both time periods. Being white, non-Hispanic decreased and growing up in a stable living situation increased the likelihood of resilience in adolescence, but not in young adulthood. Stressful life events and a supportive partner promoted resilience in young adulthood. Neighborhood advantage did not exert a direct effect on resilience, but moderated the relationship between household stability and resilience in adolescence and between cognitive ability and resilience in young adulthood. Conclusions: Ecological factors appear to promote or interfere with the emergence and stability of resilience following childhood maltreatment. © 2007 Elsevier Ltd. All rights reserved.

Childhood abuse, chronic pain, and depression in the National Comorbidity Survey

Volume 31, Issue 5, May 2007, Pages 531-547
Sachs-Ericsson, N. | Kendall-Tackett, K. | Hernandez, A.

Objective: The current study examined the effects of childhood sexual and physical abuse on reports of pain in men and women (N = 1,727). Methods: Data from the National Comorbidity Survey, a nationally representative sample, were utilized. Childhood experiences of physical and sexual abuse were assessed, and pain reports in relation to current health problems were obtained. Regression and mediation analyses were used to examine the relationship between childhood abuse and current pain reports and to determine whether depression mediated this relationship. Results: Individuals who experienced abuse reported more health problems compared to those participants without abuse histories. Among participants with a current health problem, those who experienced abuse reported more pain compared to those participants without abuse histories. Because childhood abuse is associated with depression and depression is associated with more reported pain, the influence of depression on the relationship between childhood abuse and adult pain reports was examined. After controlling for differences between the abused and non-abused participants on specific health problems, depression was not found to have mediated the relationship. Conclusions: Childhood abuse was associated with more reported pain. The higher rate of depression found among adults who experienced childhood abuse was not the primary factor for these increased pain reports. Rather, childhood abuse and depression independently contributed to pain reports. Treatment of both underlying problems (i.e., pain and depression) is recommended in addressing the needs of abused individuals with these comorbid disorders. © 2007 Elsevier Ltd. All rights reserved.

The international epidemiology of child sexual abuse: A continuation of Finkelhor (1994)

Volume 33, Issue 6, June 2009, Pages 331-342
Pereda, N. | Guilera, G. | Forns, M. | Gómez-Benito, J.

Objective: The purpose of this paper was to compare the prevalence rates of child sexual abuse reported by [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] with those found in recent publications in order to confirm the widespread prevalence of child sexual abuse. Methods: Relevant articles about prevalence of child sexual abuse were identified through searches of computerized databases and a handsearch of Child Abuse & Neglect and the Journal of Child Sexual Abuse. Results: Thirty-eight independent articles were identified, corresponding to 39 prevalence studies; these articles report the prevalence of childhood sexual abuse in 21 different countries, ranging from 0 to 53% for women and 0 to 60% for men. Conclusions: Comparison of the present study with that of [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] shows a similarity between prevalence distributions; there appears to be a general pattern that remains more or less constant over the years, especially in women. Practice implications: Twelve years after the first revision study about the international prevalence of child sexual abuse, there is still a need for new data about this topic. The present study shows child sexual abuse is still a widespread problem in the society. In this research, carried out on 38 independent studies, there is new data for 21 countries over the world, being especially relevant the results obtained from other countries different from those pertaining to North America or Europe. It is important to point out the high prevalence found in most of the countries, so this information could be a new warning to make society and governments aware of this problem and undertake actions to prevent sexual abuse in childhood. © 2009 Elsevier Ltd. All rights reserved.

Prevalence of child sexual abuse reported by a cross-sectional sample of New Zealand women

Volume 31, Issue 9, September 2007, Pages 935-945
Fanslow, J.L. | Robinson, E.M. | Crengle, S. | Perese, L.

Objective: The objective is to describe the prevalence of child sexual abuse (CSA) among women in New Zealand, document ethnic specific rates, and outline the frequency of abuse experienced and the most commonly identified perpetrators. Associations between CSA and later adverse consequences were also explored. Methods: Retrospective report from a random sample of 2,855 women aged 18-64 years old in two regions in New Zealand. Face-to-face interviews with one randomly selected woman from each household were conducted. Results: The overall prevalence rates for CSA were 23.5% for women from the urban region and 28.2% from the rural region. In both urban and rural regions, Māori women more frequently reported experiences of CSA than women from European and other ethnic groups (urban: 30.5% vs. 17.0% and rural: 35.1% vs. 20.7%). The median age of onset of the abuse was 9 years, and the median estimated age of the abuser was 30 years. Half of those who experienced CSA reported that it occurred once or twice, 27% "a few times," and 23% "multiple times." Sole perpetrators were involved in 83% of cases. The majority of cases were perpetrated by a family member, most frequently male. Compared with non-victims, victims of CSA were twice as likely to experience later intimate partner violence and violence by others. Conclusions: This study reports on a large, population-based sample in an ethnically diverse population in New Zealand, providing the first ethnic-specific rates of CSA available. Findings suggest important priorities for prevention and intervention activities. © 2007 Elsevier Ltd. All rights reserved.

Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect

Volume 32, Issue 3, March 2008, Pages 295-315
DuMont, K. | Mitchell-Herzfeld, S. | Greene, R. | Lee, E. | Lowenfels, A. | Rodriguez, M. | Dorabawila, V.

Objective: To evaluate the effects of a home visiting program modeled after Healthy Families America on parenting behaviors in the first 2 years of life. Methods: A sample of 1173 families at risk for child abuse and neglect who met the criteria for Healthy Families New York (HFNY) was randomly assigned to either an intervention group that was offered HFNY or a control group that was given information and referrals to other services. Data were collected through a review of CPS records, and maternal interviews at baseline and the child's first birthday (90% re-interviewed) and second birthday (85% re-interviewed). Results: HFNY mothers reported committing one-quarter as many acts of serious abuse at age 2 as control mothers (.01 versus .04, p < .05). Two sets of interactions were tested and found to have significant effects (p < .05). At age 2, young, first-time mothers in the HFNY group who were randomly assigned at 30 weeks of pregnancy or less were less likely than counterparts in the control group to engage in minor physical aggression in the past year (51% versus 70%) and harsh parenting in the past week (41% versus 62%). Among women who were "psychologically vulnerable," HFNY mothers were one-quarter as likely to report engaging in serious abuse and neglect as control mothers (5% versus 19%) at age 2. Conclusions: These findings suggest that who is offered home visitation may be an important factor in explaining the differential effectiveness of home visitation programs. Improved effects may be realized by prioritizing the populations served or by enhancing the model to meet program objectives for hard-to-serve families. © 2008 Elsevier Ltd. All rights reserved.

Multiple victimization experiences of urban elementary school students: Associations with psychosocial functioning and academic performance

Volume 31, Issue 5, May 2007, Pages 503-515
Holt, M.K. | Finkelhor, D. | Kantor, G.K.

Objective: This study explored the victimization experiences of urban elementary school students to determine whether subsets of youth emerged with similar victimization profiles (e.g., no victimization, multiple types of victimization). It also evaluated whether multiple victimization was associated with greater psychological distress and lower academic performance. Methods: Participants were 689 fifth grade students from an urban, ethnically diverse school district in the Northeast. Youth completed self-report measures in school about bullying victimization, victimization in the home and community, and psychosocial functioning. Results: Cluster analysis suggested the existence of three distinct youth profiles: those with minimal victimization, those victimized primarily by their peers, and those with multiple types of victimizations. As hypothesized, youth with multiple victimizations experienced more psychological distress and earned lower grades than their peers. Conclusions: Findings highlight the heterogeneity of youth victimization experiences and their relations to functioning, and have implications for treatment planning among practitioners working with youth. © 2007 Elsevier Ltd. All rights reserved.

The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth

Volume 33, Issue 1, January 2009, Pages 45-58
Wekerle, C. | Leung, E. | Wall, A.-M. | MacMillan, H. | Boyle, M. | Trocme, N. | Waechter, R.

Objective: For child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse-teen dating violence link. Methods: A random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales. Results: Over 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63-67%) and nearly half of males (44-49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings. Conclusions: These results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others. Practice implications: The present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths' conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare. © 2009 Elsevier Ltd. All rights reserved.

Child sexual abuse is largely hidden from the adult society. An epidemiological study of adolescents' disclosures

Volume 32, Issue 12, December 2008, Pages 1095-1108
Priebe, G. | Svedin, C.G.

Objectives: The aim of this study was to investigate disclosure rates and disclosure patterns and to examine predictors of non-disclosure in a sample of male and female adolescents with self-reported experiences of sexual abuse. Method: A sample of 4,339 high school seniors (2,324 girls, 2,015 boys) was examined with a questionnaire concerning sexual experiences in this study with a focus on disclosure of sexual abuse (non-contact, contact or penetrating abuse, and including peer abuse). Results: Of the sample, 1,505 girls (65%) and 457 boys (23%) reported experience of sexual abuse. The disclosure rate was 81% (girls) and 69% (boys). Girls and boys disclosed most often to a friend of their own age. Few had disclosed to professionals. Even fewer said that the incident had been reported to the authorities. Logistic regression showed that it was less likely for girls to disclose if they had experienced contact sexual abuse with or without penetration, abuse by a family member, only a single abuse occasion or if they had perceived their parents as non-caring. Boys were less likely to disclose if they studied a vocational program, lived with both parents or had perceived their parents as either caring and overprotective or non-caring and not overprotective. Conclusions: Disclosing sexual abuse is a complex process. Much is hidden from the adult society, especially from professionals and the legal system. Since peers are the most common receivers of abuse information, programs for supporting peers ought to be developed. Differences in disclosure patterns for girls and boys indicate that a gender perspective is helpful when developing guidelines for professionals. Practice implications: Professionals, especially in the school system, need to be more aware of the finding that few sexually abused children seek help from professionals or other adults and that support offers should be directly addressed not only to the vulnerable young persons themselves but also to peers who wish to help a friend. © 2008 Elsevier Ltd. All rights reserved.