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Child Abuse & Neglect 45 (2015) 21–34

Contents lists available at ScienceDirect

Child Abuse & Neglect

esearch article

he moderating effect of relationships on intergenerationalisk for infant neglect by young mothers�

essica Dym Bartletta,∗, M. Ann Easterbrooksb

Boston Children’s Hospital/Harvard Medical School, Brazelton Touchpoints Center, Division of Developmental Medicine, 1295 Boylstont., Suite 320, Boston, MA 02215, USATufts University, Medford, MA, USA

r t i c l e i n f o

rticle history:eceived 9 December 2014eceived in revised form 19 February 2015ccepted 26 February 2015vailable online 29 March 2015

eywords:nfant neglecthild maltreatmentreventionocial supportelationships

ntergenerational transmissionrotective factors

a b s t r a c t

Infant neglect is the form of child maltreatment that occurs most often, yet has been leastamenable to prevention. A maternal history of childhood maltreatment is a potent riskfactor for child neglect, yet most maltreated mothers break intergenerational cycles ofchild abuse and neglect. Little is known about what protective factors support discontinu-ity in intergenerational transmission. This study examined whether certain factors (positivechildhood care, older maternal age, social support) buffer intergenerational risk for neglectamong the infants of young mothers, a population at high risk of being victimized. Foryoung mothers in the sample (<21 years at birth; n = 447), the effect of a maternal historywas assessed separately for different maltreatment types according to data on substan-tiated reports from Child Protective Services. Early risk for neglect was assessed usingmaternal self-report of parenting empathy. The results revealed that both infants andtheir mothers experienced neglect more often than any other maltreatment type. How-ever, approximately 77% of maltreated mothers broke the cycle with their infants (<30months). Maternal age moderated the relation between a maternal history of neglect andinfant neglect, and social support moderated the relation between childhood neglect andmaternal empathy. Neglected mothers had considerably higher levels of parenting empathywhen they had frequent access to social support than when they had less frequent support,whereas the protective effect of social support was not nearly as strong for nonmaltreatedmothers. Study findings highlight resilience in parenting despite risk for infant neglect, butunderscore the context specificity of protective processes.

© 2015 Elsevier Ltd. All rights reserved.

ntroduction

Infant neglect is the most common form of child maltreatment and arguably poses the greatest threat to children’sell-being, yet it has received limited public attention (Dubowitz, 2007). In 2012, Child Protective Services (CPS) identified

pproximately 679,000 children who were victims of abuse and neglect. Over three-quarters (78%) of these children sufferedeglect, a figure that far exceeds physical abuse (18%) and sexual abuse (9%) combined (U.S. Department of Health & Humanervices, Administration for Children & Families, Children’s Bureau, 2013). Children birth to one year have the highest rate

� This research was supported by the Massachusetts Children’s Trust (MA 5014) to A. Easterbrooks, F. Jacobs, and J. Mistry; and by a dissertation grantrom the National Quality Improvement Center on Early Childhood (QIC-EC) funded by the U.S. Department of Health and Human Services, Administrationor Children, Youth and Families, Office on Child Abuse and Neglect (under Cooperative Agreement 90CA1763), to J.D. Bartlett.∗ Corresponding author.

http://dx.doi.org/10.1016/j.chiabu.2015.02.018145-2134/© 2015 Elsevier Ltd. All rights reserved.

22 J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34

of victimization (21 per 1,000 children of the same age in the U.S.) and incur the most serious harm from neglect (Sedlaket al., 2010).

Infant exposure to neglect, especially when severe and prolonged, has been found to have adverse and long lastingconsequences for children’s physical, cognitive, and socioemotional development in ways that are that are distinct fromother forms of maltreatment (De Bellis, 2005; Erickson & Egeland, 2002; Hildyard & Wolfe, 2002; Kim & Cicchetti, 2006;Pollak et al., 2010). Exposure to neglect during this sensitive period may undermine neuronal development and limit over-all brain growth (De Bellis, 2005), lead to serious health concerns (DePanfilis, 2006; Shonkoff, Boyce, & McEwen, 2009),result in cognitive, academic, and language problems (Erickson & Egeland, 2002), and lead to insecure attachments, poorself-regulation, difficulty with peers, internalizing and externalizing problems, and mental illness (Cyr, Euser, Bakermans-Kranenburg, & Van IJzendoorn, 2010; Kim & Cicchetti, 2006; Erickson & Egeland, 2002). Neglect also causes the majority(70%) of maltreatment-related deaths, half (48%) of which occur before a child’s first birthday (U.S. Department of Health &Human Services, Administration for Children & Families, Children’s Bureau, 2013).

The perpetrators of child maltreatment are most often parents (80%; U.S. Deparment of Health, Administration for Children& Families, Children’s Bureau, 2013), and this is especially true in cases of neglect. An estimated 92% of neglected children arevictimized by a biological parent, compared to 64% of abused children (Sedlak et al., 2010). Young mothers, in particular, areat heightened risk for neglecting their offspring (Sidebotham & Golding, 2001; Slack, Holl, McDaniel, Yoo, & Bolger, 2004).

Infant neglect

We assessed infant neglect using cumulative records from the state CPS agency prenatally until their most recent report atTime 2 data collection (up to May 2011). We utilized a dummy variable for infant neglect by any perpetrator (1 = substantiatedreport of neglect but no substantiated reports of abuse; 0 = no substantiated reports of maltreatment of any kind). Six casesof physical abuse (with or without neglect) were removed to maintain “clean” maltreatment categories. No other forms ofmaltreatment (e.g., sexual abuse, emotional abuse, congenital drug addiction) were reported for infants in the study. Wecoded alternative response cases with a disposition of “concern” as maltreatment when a family received services (n = 2),but “concern” with no services and “no concern” as non-maltreated (n = 1).

Infant neglect by adolescent mothers. Research on the relation between infant maltreatment and maternal age suggests thatyoung mothers are more likely to neglect their infants than are adult mothers (Coley & Chase-Lansdale, 1998; Whitman,Borkowski, Keogh, & Weed, 2001). Furthermore, the youngest mothers may be at highest risk for neglectful parenting(Stier, Leventhal, Berg, Johnson, & Mezger, 1993; Zuravin & DiBlasio, 1992). For example, a study by Stier et al. (1993)found that the rate of neglect was 2.4 times as high for parents under age 18 than for mothers age 19 to 34. Anotherstudy by Zuravin and DiBlasio (1992) found higher risk for neglect even when restricting maternal age to the teenageyears (18 years or younger at first birth); neglectful adolescent mothers were more likely than their nonmaltreating peersto have had their first child at a younger age. The etiology of infant neglect by young mothers may be explained in partby their lack of developmental preparedness for parenthood, but also by their disproportionate exposure to risk condi-tions compared to women who delay parenting until adulthood. More than their older counterparts, young mothers tendto endure difficult life circumstances linked to neglect, such as a maternal history of childhood maltreatment, poverty,social isolation, and single parent status, that, when compounded with their immaturity, may compromise their ability todemonstrate empathy and provide adequate care (Borkowski, Whitman, & Farris, 2007; Goldman & Salus, 2003; Slack et al.,2004).

Prominent theories on child maltreatment, including ecological systems approaches, explain infant neglect as a conse-quence of dynamic transactions among children, young parents, and their environments (Belsky, 1993; Cicchetti & Lynch,1993). This view also is reflected in Relational Developmental Systems theories (Lerner et al., 2013; Overton, 2013) thatconsider multiple aspects of a developmental system (e.g., individual history, social relationships, and environmental con-text). The ontogeny of social relationships appears to play a prominent role in such approaches. A mother’s experiencesof childhood positive care and maltreatment influence her affective and cognitive interpretations of her parenting role, aswell as her interactions with her current social context. Maltreated mothers have smaller and less satisfying social supportnetworks (Vranceanu, Hobfoll, & Johnson, 2007) and are more likely to experience higher levels of parenting stress and tomaltreat their offspring (Deater-Deckard, 2004; Gaudin, 2001).

Understanding how such risk factors are implicated in the etiology of neglect is only half of the picture, however.A resilience framework, defining resilience as “positive adaptation within the context of significant adversity” (Luthar,Cicchetti, & Becker, 2000, p. 543), offers a complimentary perspective, in which interventionists and policymakers seek tounderstand how to offset risk for neglect (Masten & Powell, 2003; Werner, 2000). At present, the empirical literature oninfant maltreatment is replete with findings on maladaptive parenting in high-risk contexts rather than successful parent-

ing under similar conditions. This approach unnecessarily limits prevention research to identifying risks to be amelioratedrather than avenues for promoting healthy parenting. For example, the majority of maltreatment researchers emphasizecontinuity versus discontinuity in intergenerational transmission of maltreatment, despite the fact that most parents breakthese cycles (Kaufman & Zigler, 1987; Ertem, Leventhal, & Dobbs, 2000).

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J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34 23

nfant neglect and discontinuity in intergenerational cycles of child maltreatment

The study of intergenerational cycles of maltreatment has garnered considerable interest from researchers (Ertem et al.,000; Kaufman & Zigler, 1987; Thornberry, Knight, & Lovegrove, 2012), including recent attention from investigators

nterested in adolescent parenting (Borkowski et al., 2007; Dixon, Browne, & Hamilton-Giachritsis, 2009). The theoreticalnderpinning is that exposure to maltreatment in childhood increases the odds that an individual will become a perpetra-or as an adult, through insecure attachments and dysfunctional internal working models of relationships (Bowlby, 1977),earned behaviors (Bandura, 1973), or a “cascade” effect, in which maltreatment disturbs key developmental processes thategatively affect relational competence over time (Masten & Cicchetti, 2010). However, the field currently lacks universalgreement on the extent of intergenerational transmission (Kaufman & Zigler, 1987; Pears & Capaldi, 2001; Thornberryt al., 2012). Some critics have noted that few studies are methodologically rigorous, and actual continuity may be lowerhan Kaufman and Zigler’s (1987) widely cited estimate of 30% (Ertem et al., 2000; Thornberry et al., 2012). The controversyurrounding intergenerational cycles suggests the need for more refined research. For example, studies rarely distinguisheglect from abuse in each generation, or delineate findings by age of the child or parent (Bartlett & Easterbrooks, 2012).

rotective factors associated with discontinuity. The extent of intergenerational continuity may be unclear, but mostesearchers agree that discontinuity is the most common outcome (Kaufman & Zigler, 1987; Ertem et al., 2000; Thornberryt al., 2012). Prospective longitudinal investigations have shown only modest correlations across generations (Conger,cCarty, Yang, Lahey, & Burgess, 2009). Identifying moderators of transmission is a promising place to begin to under-

tand the processes that underlie discontinuity and can inform prevention (Berlin, Appleyard, & Dodge, 2011; Dixon, Brown, Hamilton-Giachritsis, 2005a; Dixon, Hamilton-Giachritsis, & Brown, 2005b).

In recent years, resilience-based research has begun to elucidate protective factors that reduce child maltreatment,ncluding nurturing attachments, knowledge about parenting and child development, concrete supports, parental resilience,nd social connections (Children’s Bureau, Child Welfare Information Gateway, FRIENDS National Resource Center forommunity-Based Child Abuse Prevention, & the Center for the Study of Social Policy, 2011). Nevertheless, little is knownbout which of these factors moderate intergenerational cycles of maltreatment and reduce risk for infant neglect morepecifically. Several decades of research on protective factors suggests that positive relationships with caregivers, familyembers, and other members of social support networks increase the odds that individuals will interact with their offspring

n sensitive and empathetic ways (Werner, 2000). A reasonable inference from this literature, then, is that these factorsay play a key role in explaining why a parental history of childhood maltreatment increases the chances for, yet does not

uarantee, maltreatment in the next generation (Ertem et al., 2000; Kaufman & Zigler, 1987).The small number of studies that examine a parent’s childhood history of maltreatment as a risk factor for infant neglect

mplicate social and financial protective factors in particular (Belsky, Conger, & Capaldi, 2009; Dixon et al., 2009). Dixont al. (2009) determined that the presence of social support and financial solvency distinguished “cycle breakers” fromamilies referred to CPS. Egeland and colleagues (e.g., Egeland, Jacobvitz, & Sroufe, 1988) showed that nonrepeating parentsere more likely to have: had a supportive parent, experienced fewer stressful events, participated in psychotherapy, had a

upportive intimate relationship, and exhibited a conscious resolve not to repeat negative patterns. More recently, Bartlettnd Easterbrooks (2012) found that when mothers reported physical abuse and also positive care in childhood, they wereot at increased risk for neglect, suggesting a compensatory effect of nurturing parenting in the context of an abusivehildhood. Taken together, the literature indicates that supportive relationships may be a key factor in ending cycles of childaltreatment related to neglect (Dixon et al., 2005a,b; Dixon et al., 2009; Egeland et al., 1988; Kaufman & Zigler, 1987).

upportive relationships

Beginning at birth, and perhaps even before, individuals are embedded in social and caregiving systems (Winnicott,965). Consequently, relationships with others in these systems exert influence on individual development (Chase-Lansdale

Brooks-Gunn, 1994) and impact parenting in the next generation (Vondra & Belsky, 1993). However, the nature of relation-hips in childhood (e.g., nurturing, abusive, neglectful) and social support (e.g., quantity, quality, type) are as consequentialo parenting as are their presence or absence (Coley & Chase-Lansdale, 1998; Voight, Hans, & Bernstein, 1996). Lieberman,adrón, van Horn, and Harris (2005) suggested that children who experience maltreatment “may be able to register simulta-eously the ‘bad’ and the ‘good’ parts of their parents” (p. 512) and subsequently repeat positive care receiving experiencesithin parent–child interactions in the present. From this vantage point, discontinuity in intergenerational cycles of mal-

reatment may be partially explained by the presence of nurturing relational experiences that a mother can draw upon toormulate more adaptive caregiving strategies with her own child. Since mothers’ perceptions of the care they received earlyn life may differentiate neglectful parents from nonmaltreating parents (Gaudin, 2001), incorporating maternal perceptionsf positive care into explanatory models of transmission may be useful.

Support received in the context of healthy relationships, whether from family members, informal social networks, or

ervice providers and formal programs, enhances young mothers’ overall well-being and maternal functioning (Leadbeater

Linares, 1992). Adequate social support is associated with less parental stress and depression, and greater parental sen-itivity; thus, it may be a key factor in counteracting risk for infant neglect (Gaudin, 2001; Li, Godinet, & Arnsberger, 2010;

hitman et al., 2001; Zolotor & Runyan, 2006) and in distinguishing young mothers who break cycles of maltreatment from

24 J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34

those who do not (Dixon et al., 2009). The buffering model of social support (Armstrong, Birnie-Lefcovitch, & Ungar, 2005),the notion that “social support protects individuals from the potentially harmful effects of stressful events” (p. 272), is widelyembraced by maltreatment policymakers, researchers, and interventionists, yet it is based on a surprisingly unrefined empir-ical literature (Thompson, 1995). The role of social support in preventing child neglect is complex (Gaudin, 2001; Li et al.,2010), and this study seeks to identify particular relational mechanisms of protection that moderate cycles of maltreatmentleading to infant neglect, and to begin to explain how they operate in young families’ lives.

Conceptualizing infant neglect for prevention research

Researchers do not yet have conceptual clarity with regard to definition and operationalization of infant neglect, andinconsistencies in the literature have made research and cross-study comparison difficult (Dubowitz, 2007). Just whatconstitutes neglect is perhaps more vague than for other forms of maltreatment because it is frequently evidenced byan act of omission rather than a prominent parental behavior or visible injury. As a result, neglect is greatly underreportedand not well-examined (DePanfilis, 2006). One of the most hotly debated issues related to identifying neglect is what sourceof information to use. Data from CPS have a number of advantages—they are routinely collected, widely available, andidentify cases in which neglect is highly likely to have occurred. However, CPS data miss up to half of actual instances thatoccur (Cross & Casanueva, 2009; Dubowitz et al., 2005) and represent a conservative estimate. Assessment of early risk formaltreatment may help to identify children who are not reported to CPS. Research suggests that parental lack of empathymay be related to early neglect risk (de Paúl & Guibert, 2008; Shahar, 2001).

Lack of maternal empathy. Several researchers have found that a parental lack of empathy is associated with child neglect(Lounds, Borkowski, & Whitman, 2006; Schatz & Lounds, 2007; Shahar, 2001), and that sensitive, empathetic motheringis “woefully lacking in the caregiving environments of maltreated infants” (Cicchetti, Rogosch, Toth, & Sturge-Apple, 2011,p. 789). Neglectful mothers are less able to “read” and respond to their babies’ emotional cues or to engage in emotionalperspective taking (Dubowitz et al., 2005), and they are less expressive, offer little exchange of emotional information, andacknowledge their children less than do non-maltreating mothers (Gaudin, Polansky, Kilpatrick, & Shilton, 1996). This mayreflect an inability to empathize with their children (de Paúl & Guibert, 2008). Adolescent parents, in particular, lack empathyin interactions with their babies (Schatz & Lounds, 2007; Shahar, 2001) and may be especially unlikely to pick up on andrespond to an infant’s needs when they have been maltreatment victims (Leerkes, Crockenberg, & Burrous, 2004).

The present study

The aim of the present study was to investigate the effect of relationships and maternal age on intergenerational risk forneglect in a high-risk sample—adolescent mothers with infants. Specifically, we examined whether positive care in childhood,social support while parenting, and older maternal age at birth moderated the association between young mothers’ childhoodhistory of abuse and neglect and neglect of their own infants. Because a prevention-based approach to research suggeststhat early indicators of risk also require attention, we also examined maternal lack of empathy as a correlate of infantneglect risk. In light of prior findings (Ertem et al., 2000; Thornberry et al., 2012), we expected that a maternal history ofchildhood maltreatment would be associated with more likelihood of infant neglect and less likelihood of parental empathy,but that the majority of mothers who were victims of childhood maltreatment would not neglect their children. We alsohypothesized that older age, positive childhood care, and access to frequent, reliable social support would moderate cyclesleading to infant neglect.

Method

Sample and procedures

The sample consisted of 447 young mothers who participated in an evaluation of [program name], a newborn homevisiting program available to all first-time young parents (≤20 years at childbirth) in the state of [state name]. Based onthe Healthy Families America (HFA) model, the program provides parenting support, information, and services to youngparents beginning prenatally and continuing until the child’s third birthday. The program goals are: (1) to prevent childabuse and neglect by supporting positive, effective parenting; (2) to achieve optimal health, growth, and development ininfancy and early childhood; (3) to encourage educational attainment, job, and life skills among parents; (4) to preventrepeat pregnancies during the teen years; and (5) to promote parental health and well-being.

The evaluation was a three-wave, mixed methods study with a randomized controlled trial design. Participants wererecruited from eight sites across the state. The eight sites were selected based on three criteria: (a) represented each ofthe Department of Health and Human Services regions in the state; (b) they offered a mix of urban and exurban/suburban

communities with diverse populations; and (c) each was large enough to accommodate evaluation enrollment within a6-8 month period. Recruitment and data collection began in February 2008. Once recruited from each site, participantswere interviewed at three time points (Time 1-Time 3) over two years. This study used data from Time 1 (T1) (shortly afterprogram enrollment) and Time 2 (T2) (one year later).

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Every eligible referral (female, 16 years or older, new to the program, either English- or Spanish-speaking, and cognitivelyble to provide informed consent) was asked to participate in the study. Participants were included in the study sample ifhey agreed to: (a) participate in three interviews over two years; (b) receive home visits by researchers; and (c) releaseocial service agency records. Mothers who agreed to these conditions were randomly assigned either to the Home Visitingervices Group (HVS; program group), or the Referrals and Information Only Group (RIO; control group) by the central homeisiting program office. As incentive to participate, mothers were given gift cards to local stores (HVS participants received35 at Time 1, $40 at Time 2, and $45 at Time 3; RIO participants received $15 more than HVS participants at each time pointn order to keep them engaged in the study despite receiving no home visiting services).

A total of 806 mothers enrolled in the study and agreed to a single telephone interview; 475 (68.54%) agreed to participaten the full study (Integrative Study). Within a day or two of the participant’s assignment to a study group, a trained researchssistant (overseen by a Research Coordinator) contacted the participant to explain the study procedure. Every participantho consented to the evaluation was asked to sign a consent form to access her administrative data from state agencies,

ncluding the Massachusetts Department of Public Health and the Department of Children and Families (formerly, Socialervices).

Mothers who were recruited and gave consent to release their agency data were given the option of participating in phone interview only (the Intake Interview), or participating in this phone interview and a two-hour Research Visit.epending on which she option she selected, the participant was assigned to either the Impact Study (a phone call andccess to state agency data) or the Integrative Study (a phone call, access to state agency data, and a research home inter-iew). The Intake Interviews consisted of a 30-min semi-structured phone interview. Home research visits included aemi-structured interview, completion of written questionnaires, and observations of mother–child interactions. Visitsypically lasted 2 h and were used to collect in-depth information about program services (both the home-visiting pro-ram and other programs), social relationships and support networks, mothers’ childhood history, and current personalunctioning/well-being. Both telephone and home interviews were conducted once per year at the three different timeoints (Time 1–Time 3). By Time 2, several participants had switched from the Integrative Study to the Impact Study orice versa, others withdrew from the study altogether, and two participants were removed from the sample following aiscarriage and maternal death, resulting in an Integrative Study n of 447 mothers, which comprised the sample for this

tudy.The 447 mothers in the sample averaged 18.73 years old upon study enrollment. At the time of the first home interview,

4.21% (n = 287) of mothers were pregnant and 35.79% (n = 160) were parenting. At Time 2, the average age of infants wasust under one year old (M = 11.95 months) and ranged from 1.81 to 29.03 months of age. Young mothers in the sample repre-ented similar racial/ethnic diversity to the population of teen parents in the state, 34.90% identifying themselves as White,1.54% Hispanic, 19.46% Black, 9.84% Multi-racial/ethnic, and 4.25% Other. More than half of mothers (56.60%) reportedeceiving welfare at Time 2, and the average median block income was $38,453 (SD = 16.95; Range = $7,480–$115,460)1.he majority of mothers (88.14%, n = 394) participated in a parenting program during the evaluation study, whether theurrent or another home visiting program, Early Intervention, Early Head Start, parenting education classes, or parentingupport groups. Sample retention rate was 84%, which represents a low attrition rate for studies on home visiting (Avellar &ilman, 2014); reasons for attrition included residential moves, failure to locate families, maternal loss of child custody, andhild death. Equivalency tests were conducted on maternal sociodemographic characteristics (e.g., maternal and child age,ace/ethnicity, preferred language, education, employment, program participation) to determine whether sample charac-eristics changed over time. Only one equivalency test was significant, revealing that mothers who dropped out of the studyere more likely to be Spanish speakers.

easures

Control variable were derived from maternal demographic data, information on family resources, and program partici-ation. Young mothers’ childhood history of maltreatment (physical abuse, sexual abuse, neglect) comprised the predictorariables. Moderator variables included a maternal history of positive care in childhood, social support, and maternal age.nfant neglect and maternal empathy were the two study outcome variables assessed in separate analyses.

aternal and infant demographics. We used a continuous variable for maternal age at first birth as well as for infant aget Time 2 (when all mothers in the study had given birth), and a dummy variable for co-residence with grandmotherdid/did not live with their own mothers at any time during the study period). To establish racial/ethnic backgrounds ofarticipants, mothers selected choices in two U.S. Census categories: (a) ethnicity (Hispanic/Latina, Not Hispanic/Latina); and

b) race (American Indian/Native American/Alaska Native, East Asian, South Asian, Native Hawaiian/Other Pacific Islander,lack/African American, White, Other). We collapsed the categories to form five groups: Hispanic, Black, Multiracial, Other,nd White and used dummy variables, with White as the reference group.

1 Median block income is the smallest geographic entity for which the decennial census tabulates and publishes sample data and was a preferableeasure to self-report by adolescents, as many adolescents did not have detailed knowledge about their family income.

26 J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34

Family resources. To determine mothers’ perception of their family’s access to resources, participants completed the FamilyResource Scale (FRS) (Dunst & Leet, 1987), a 30-item standardized self-report measure that assesses the extent to whichresources are adequate in households (including food, shelter, financial resources, transportation, health care, and time forthe family and self). The FRS uses a 5-point Likert scale (1 = not at all adequate, 5 = almost always adequate) for each resource.Scores were averaged over two time points to create a single continuous score. Original internal reliability (Cronbach’s alpha)of the instrument was .92; split-half reliability (Spearman–Brown) was .95; test-retest reliability (2–3 month interval)was .52. The FRS has good construct validity in samples of economically diverse families (Brannan, Manteuffel, Holden, &Heflinger, 2006).

Program participation. We used a dummy variable to indicate whether each participant was randomly assigned to the programgroup or to the control group. See Easterbrooks et al. (2013) for a discussion of home visiting effects on child maltreatment.In the current analysis, we include program participation as a control variable only, as program effects were not a focus ofthe current study.

Maternal childhood history of maltreatment. Cumulative records of CPS substantiated cases of abuse and neglect were obtainedfrom the [state agency name], dating from mothers’ birth until approximately T2 data collection. The records provided dataon the number of substantiated reports and type of maltreatment (physical abuse, sexual abuse, neglect, congenital drugaddiction). Further details were not provided (e.g., subtype, severity, chronicity). We created a dummy variable for eachof four different types of maltreatment (1 = history of maltreatment, 0 = no history of maltreatment): neglect only, physicalabuse only, sexual abuse only, and multiple type (i.e., two or more types of maltreatment). The cases in which mothers weredrug addicted at birth (congenital drug addiction, n = 3) were coded as neglect, as substance-exposed newborns often areconsidered neglected (DePanfilis, 2006).

Positive care in childhood. Participants’ perceptions of the quality of childhood care they received from their mothers weremeasured at T2 using the Parental Bonding Instrument (Care subscale) (PBI; Parker, Tupling, & Brown, 1979), which assessespositive care and parental involvement. Participants responded to statements such as “spoke to me in a warm and friendlyvoice” and “was affectionate to me,” indicating the extent to which the behavior was present prior to age 16. Scores (1 = never,2 = sometimes, 3 = often) were totaled, resulting in a continuous score (maximum = 36). The care subscale has good test-retest reliability (mean ICC of .78 over 90 months and up to 20 years in nonclinical samples (Wilhelm, Niven, Parker, &Hadzi-Pavlovic, 2005).

Social support. The Personal Network Matrix (PNM; Trivette & Dunst, 1988) was administered at T2 to assess mothers’ supportnetworks. Participants identify sources of social support (e.g., partners, neighbors, friends, therapists, doctors, social serviceagencies) available through face-to-face, telephone, or group contact. Part I of the PNM establishes the frequency of contactwith each source in the past month (1 = not at all, 5 = almost every day); Part 2 assesses the extent to which they coulddepend upon each source (1 = not at all, 5 = all of the time). Continuous summary scores (frequency, dependability) wereused. Reliability and validity for this measure have not been established. The internal consistency scores for social supportfrequency and dependability in the current study were .67 and .69, respectively.

Maternal age at first birth. See above section on maternal demographics.

Infant neglect. We assessed infant neglect using cumulative records from the state CPS agency prenatally until their mostrecent report at Time 2 data collection (up to May 2011). We utilized a dummy variable for infant neglect by any perpetrator(1 = substantiated report of neglect but no substantiated reports of abuse; 0 = no substantiated reports of maltreatment ofany kind). Six cases of physical abuse (with or without neglect) were removed to maintain “clean” maltreatment categories.No other forms of maltreatment (e.g., sexual abuse, emotional abuse, congenital drug addiction) were reported for infantsin the study. We coded alternative response cases with a disposition of “concern” as maltreatment when a family receivedservices (n = 2), but “concern” with no services and “no concern” as non-maltreated (n = 1).

Maternal empathy. Maternal empathy was measured using the “Parental Lack of Empathy Toward the Child’s Needs” subscaleof the standardized Adult-Adolescent Parenting Inventory (AAPI-2; Bavolek & Keene, 2001). The AAPI-2 was designed tomeasure parenting attitudes; the “empathy” subscale assesses the extent to which a parent understands and values a child’sdevelopmental needs, expresses negative attitudes about nurturing, recognizes a child’s feelings, and expresses fear ofspoiling a child. Mothers indicated their level of agreement with statements such as “Children who receive praise will thinktoo much of themselves” and “Children should keep their feelings to themselves.” Items were scored on a five point Likertscale (1 = strongly agree, 5 = strongly disagree). Responses were converted to Sten scores (1–10) comparing responses to a

normal distribution; lower scores reflect higher risk. The AAPI was developed with large, geographically diverse samplesof Black and White parents and adolescents; normed versions are available in English and in Spanish. Construct validityand reliability for the empathy subscale (Spearman Brown = .86; Cronbach’s alpha = .85); validity was established with 1,500adults and adolescents (Bavolek & Keene, 2001).

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nalytic plan

To answer research questions, descriptive, bivariate, and multivariate data analyses were run using IBM SPSS 19.0. Theignificance level was set at p = .05. Predictor variables were centered (by subtracting the mean from each value) to reduceroblems of multicollinearity and to simplify subsequent interpretation of main effects (Dearing & Hamilton, 2006).

issing data. We used Multiple Imputation (MI) on the entire dataset in SPSS 19.0 to address missing data. Approximately7.59% of values were missing across the dataset, with the percentage of missing values for individual variables ranging from

00% (substantiated reports of maltreatment) to 44.30% (videotaped observations of maternal sensitivity—a parent–childehavior construct that was not included in the present study but which was part of the larger evaluation dataset and

nformed the imputation). MI maximizes sample size for variables that have incomplete data by replacing missing valueseveral times based on observed variables, and then generates “pooled” results for data analyses based on “Rubin’s rules”Rubin, 1987). MI has advantages over other methods such as introducing random error, allowing for unbiased estimatesf parameters, and providing good estimates of the standard errors (Allison, 2002; Rubin, 1987). A prerequisite conditionf using MI is that the data are missing at random (MAR) (Rubin, 1987). Little’s MCAR test was 37.44 (df = 5177; p = 1.00),emonstrating no identifiable patterns in the missing data. We used one imputation for each percent of missing valuesBodner, 2008), resulting in 30 imputed datasets.

ata analysis. The first step in data analysis was to generate descriptive statistics and distributions for all predictor andutcome variables. Bivariate analysis tested associations between pairs of study variables using the appropriate statisticalechnique (Pearson’s correlations, t-tests, or bivariate regression). We used hierarchical multiple regression to test relationsith continuous dependent variables and hierarchical logistic regression to test relations with dichotomous dependent

ariables. In the first model (Model 1), control variables were entered alone in a single block. In the second model (Model 2),e entered maternal childhood variables (maltreatment and positive care) along with control variables. In the third model

Model 3), we tested control variables and the two social support variables. In the fourth model (Model 4), we entered allontrol variables, maternal childhood variables, and social support variables together. The fifth and final model (Model 5)ested the effect of all independent variables and interactions (moderators) together on parenting outcomes. A fifth modelas not included in the results when interactions were found to be nonsignificant. Regression analyses were run separately

o examine potential moderating effects for the three most common types of maternal childhood history of maltreatmentneglect, physical abuse, multiple type).

esults

Unless a maltreatment type is referred to as “multiple maltreatment,” only one form of maltreatment has occurred.or example, when a rate of “neglect,” is reported, no other forms of maltreatment aside from neglect occurred, whereasmultiple maltreatment” refers to any combination of maltreatment types. The rate of sexual abuse in the sample is reportedut excluded from analysis, as young mothers are not typically perpetrators of sexual abuse.

hild maltreatment in the sample

Less than half of young mothers (46.09%, n = 206) had substantiated cases indicating a history of childhood maltreatment.eglect occurred most often (25.50%, n = 114), followed by multiple type (16.33%, n = 73), physical abuse (3.36%, n = 15), and

exual abuse (.90%, n = 4). Fewer infants were maltreated than were their mothers: 79 infants (17.67%) were maltreated, allases of neglect. Six infants also were physically abused (i.e., multiply maltreated). There were no cases of sexual or physicalbuse alone. The results revealed intergenerational cycles of maltreatment, but a strong trend of discontinuity. Over three-uarters (76.70%, n = 158) of the 206 mothers with a history of substantiated childhood maltreatment had infants who did notxperience neglect. However, a history of substantiated intergenerational maltreatment was common—almost two-thirds60.76%, n = 48) of the mothers of maltreated infants were identified as victims during their own childhoods. Approximately0.27% (n = 44) of mothers of neglected infants (n = 73) were maltreated, and the proportion differed significantly by whetherothers did or did not have a history of maltreatment, �2 (1, 447) = 7.38, p = .007.

nfant neglect risk

Binary logistic regression analyses confirmed several hypothesized associations with infant neglect. Maternal history ofultiple type maltreatment predicted infant neglect. Specifically, infants born to mothers who had been multiply maltreated

n childhood were more than 2.5 times (OR = 2.61, p = .004) as likely to be neglected as were children of nonmaltreatedothers. A nonsignificant trend emerged for childhood neglect (OR = 1.77, p = .062). Infants whose mothers reported frequent

ocial support were 6% less likely to be neglected (OR = .94, p = .002). Positive maternal care histories did not predict infanteglect.

28 J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34

Table 1Regression models describing the relation between a maternal history of childhood neglect and infant neglect (n = 447).

Predictor variable Model 1 Model 2 Model 3 Model 4 Model 5

OR (SE) 95% CI OR (SE) 95% CI OR (SE) 95% CI OR (SE) 95% CI OR (SE) 95% CI

Intercept .18 (.57)** .06–.54 .11 (.72)** .03–.46 .17 (.58)** .05–.51 .11 (.73)** .09–.63 .10 (.75) .02–.43Maternal age .96 (.11) .78–1.19 .86 (.13) .66–1.11 .94 (.11) .76–1.17 .85 (.13) .65–1.10 1.08(.17) .77–1.52Hispanic .52 (.33)* .27–.98 .46 (.41) .21–1.04 .56 (.34) .29–1.08 .49 (.42) .22–1.12 .50 (.43) .22–1.15Black .44 (.40)* .20–.98 .51 (.48) .20–1.32 .48 (.41) .22–1.07 .56 (.49) .21–1.46 .59 (.51) .22–1.60Multiracial .43 (.52) .16–1.18 .46 (.59) .14–1.45 .45 (.53) .16–1.25 .50 (.61) .15–1.64 .53 (.62) .16–1.79Other .92 (.61) .28–3.03 .55 (.80) .12–2.62 .97 (.62) .29–3.27 .61 (.81) .13–2.99 .57 (.82) .12–2.85Infant age 1.05 (.02) 1.00–1.10 1.04 (.03) .98–1.09 1.04 (.02) .99–1.09 1.03(.03) .98–1.09 1.03(.03) .98–1.09Grandmother

co-residence.99 (.27) .58–1.69 .71 (.33) .37–1.37 1.00 (.28) .58–1.75 .76 (.34) .39–1.47 .71 (.34) .36–1.40

Family resources 1.0 (.01) .98–1.01 1.00 (.01) .98–1.02 1.00 (.01) .98–1.02 1.00 (01) .98–1.03 1.00 (.01) .98–1.03Program participation

.58 (.27) .58–1.65 1.32 (.32) .71–2.47 .99 (.27) .58–1.67 1.30(.32) .69–2.45 1.31(.33) .68–2.50Childhood neglect – – 1.56 (.33) .82–2.97 – – 1.50 (.33) .79–2.93 1.40 (.38) .66–2.97Childhood positive care – – .98 (.03) .93–1.05 – – .99 (.03) .93–1.06 .97 (.44) .89–1.05Social support

frequency– – – – .94 (.03)* .89–.99 .94 (.03)* .89–1.00 .92 (.04)* .85–1.00

Social supportdependability

– – – – 1.01 (.02) .97–1.04 1.0 (.02) .95–1.04 1.01 (.03) .95–1.07

Childhood neglect×Maternal age – – – – – – – – .57 (.27)* .33–.96×Positive care – – – – – – – – 1.05 (.07) .91–1.20×Social supportfrequency

– – – – – – – – 1.04 (.06) .92–1.17

×Social supportdependability

– – – – – – – – .99 (.05) .90–1.08

Mean −2LL (range) 381.86 (328.14–384.47) 259.90 (188.45–263.19)Mean Wald p-value

(range)2.53 (.00–12.27) 1.73 (.00–11.27)

�Mean −2LL – 121.96ˆ

df 9 17�df – 8ˆ

Note. Nagelkerke R2 for Model 5 (average) = .14; *p < .05; **p < .01; ˆ Compared to Model 1 (control variables only).

Logistic regression analysis predicting infant neglect

Results of logistic regression analyses predicting infant neglect when mothers had a childhood history of neglect arepresented in Table 1. Frequency of social support significantly predicted infant neglect (OR = .94, p = .033) (Model 4). Wheninteraction effects were included (Model 5), social support (OR = .92, p = .038) maintained significance. Increased frequencyof contact between mothers and members of their social support network was associated with lower likelihood of infant

neglect. For each point increase in social support frequency, infants had 6% less likelihood of being neglected. As shown inFig. 1, we found a significant interaction between maternal childhood neglect and maternal age (OR = .57, p = .033). Whencontrolling for other variables, the probability of having a substantiated case of infant neglect increased slightly with ageamong mothers with no history of childhood maltreatment; there was no effect of age on infant neglect among mothers

-0.01

0

0.01

0.02

0.03

0.04

0.05

0.06

22212019181716

Pro

bab

ilit

y o

f In

fan

t N

egle

ct

Maternal Age at Birth (Years)

Childhoo d

neglect

No child hood

malt reatment

Fig. 1. Interaction plot of infant neglect by maternal history of neglect across different maternal ages at first birth (n = 447).

J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34 29

Table 2Regression models describing the relation between a maternal history of childhood multiple maltreatment and infant neglect (n = 447).

Predictor variable Model 1 Model 2 Model 3 Model 4

OR (SE) 95% CI OR (SE) 95% CI OR (SE) 95% CI OR (SE) 95% CI

Intercept .18 (.57)** .06–.54 .08 (.75)** .02–.36 .17 (.58)** .05–.51 .08 (.76)*** .02–.37Maternal age .96 (.12) .78–1.19 1.14 (.14) .87–1.50 .95 (.11) .76–1.17 1.12 (.14) .85–1.46Hispanic .52 (.33)* .27–.98 .57 (.41) .26–1.26 .56 (.34) .29–1.08 .65 (.41) .29–1.12Black .44 (.40)* .20–.98 .35 (.53)* .12–.99 .48 (.41) .22–1.07 .38 (.54) .21–1.47Multiracial .43 (.52) .16–1.18 .54 (.69) .14–1.45 .45 (.53) .16–1.25 .55 (.70) .14–1.10Other .92 (.61) .28–3.03 1.38 (.78) .30–6.32 .97 (.62) .29–3.27 1.34 (.79) .29–6.27Infant age 1.05 (.02) 1.00–1.10 1.07 (.03)* 1.01–1.13 1.04 (.02) .99–1.09 1.06 (.03) 1.00–1.13Grandmother co-residence 1.00 (.27) .58–1.69 1.29 (.36) .64–2.59 1.00 (.28) .58–1.75 1.19 (.63) .58–2.45Family resources .99 (.01) .98–1.01 .99 (.01) .97–1.01 1.00 (.01) .98–1.02 .99 (01) .97–1.01Program participation

.98 (.28) .58–1.71 .94 (.34) .48–1.81 .99 (.27) .58–1.67 .93 (.34) .48–1.80Childhood multiple

maltreatment– – 2.77 (.37)** 1.35–5.68 – – 2.68 (.37)** 1.30–5.54

Childhood positive care – – .99 (.03) .93–1.05 – – .99 (.03) .93–1.05Social support frequency – – – – .94 (.03)* .89–.99 .94 (.03) .89–1.00Social support

dependability– – – – 1.01 (.02) .97–1.04 1.02 (.03) .97–1.07

Mean −2LL (Range) 381.86 (328.14–384.47) 239.66 (173.44–242.23)Mean Wald p-value

(Range)2.53 (.00–12.27) 2.48 (.00–14.76)

�Mean −2LL – 142.20ˆ

df 9 17

N

wn

ymfc

M

t

TR

N

�df – 8ˆ

ote. Nagelkerke R2 for Model 5 (average) = .14; *p < .05; **p < .01; ***p < .001; ˆ Compared to Model 1 (control variables only).

ho had a history of neglect. Across differences in maternal age at birth, the odds of infant neglect were slightly higher foronmaltreated mothers than for neglected mothers. The effect size was small (Mean Negelkerke R2 = .14).

The logistic regression analysis predicting infant neglect by maternal history of childhood multiple maltreatment alsoielded significant results (Table 2, Model 4). Controlling for all other variables in the model, a mother’s history of multiplealtreatment was significantly related to infant neglect (OR = 2.68, p = .008). Infants whose mothers experienced multiple

orms of maltreatment in childhood were more likely to be neglected compared to infants of nonmaltreated mothers. Aomparable analysis with a maternal childhood history of physical abuse was nonsignificant.

ultiple regression analysis predicting maternal empathy

We used multiple regression to explore the relation between a maternal history of childhood neglect and maternal empa-hy, including possible moderators (Table 3, Model 5). Social support frequency moderated the relation between maternal

able 3egression models describing the relation between a maternal history of childhood neglect and maternal empathy (n = 447).

Variable Model 1 B (SE) Model 2 B (SE) Model 3 B (SE) Model 4 B (SE) Model 5 B (SE)

Intercept .73 (.50) .79 (.50) 1.07 (.42) .80 (.50) .73 (.50)Maternal age −.17 (.11) −.15 (.09)* −.18 (.08)* −.14 (.09) −.17 (.11)Hispanic −.76 (.28)** −.78 (.28)** −.88 (.24)** −.84 (.28)** −.76 (.28)**

Black −.60 (.31) −.66 (.30)* −.65 (.27)* −.71 (.30)* −.60 (.31)Multiracial/ethnic −.36 (.55) −.29 (.39) −.32 (.33) −.35 (.39) −.36 (.55)Other −.96 (.49) −.87 (.55) −.98 (.50)* −.94 (.55) −.96 (.55)Infant age −.02(.02) −.03 (.02) −.04 (.02) −.02(.02) −.02(.02)Grandmother co-residence −.14 (.23) −.12 (.22) −.04 (.19) −.11 (.23) −.14 (.23)Family resources .01(.01) .01 (.01) .01 (.01) .01 (.01) .01(.01)Program participation −.04 (.22) −.09 (.19) −.05 (.22)Childhood neglect – .29 (.24) – .31 (.24) .34 (.24)Childhood positive care – −.01 (.02) – −.01 (.02) .00 (.03)Social support frequency – – .03 (.02) .03 (.02) .00 (.02)Social support dependability – – −.02 (.01) −.01 (.01) .01 (.02)Childhood neglect

×Positive care – – – – −.06 (.05)×Maternal age – – – – .04 (.18)×Social support frequency – – – – .08 (.04)*

×Social support dependability – – – – −.06 (.03)

ote. Model 5 adjusted R2 (average) = .06; * p < .05. ** p < .01.

30 J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34

-3

-2

-1

0

1

2

3

4

5

6

7

8

9

150100500

Mat

ernal

em

pat

hy

Social support (frequency)

No childhood

maltreatment

Childhood

neglect

Fig. 2. Interaction plot of maternal empathy by a maternal history of neglect across different levels of social support frequency (n = 447).

childhood history of neglect and maternal empathy (B = .08, p = .037). As hypothesized, for mothers who were neglected,frequent social support was associated with higher levels of empathy, whereas for mothers without a history of maltreat-ment, the effect of social support had no detectable impact on empathy. Empathy was higher for neglected mothers than fornonmaltreated mothers across levels of social support frequency (Fig. 2). Similar analyses for a maternal history of physicalabuse and multiple maltreatment were not significant.

Discussion

The central aim of the investigation was to add to a scant empirical literature on the etiology of infant neglect (Mersky,Berger, Reynolds, & Gromoske, 2009). In doing so, we found Relational Developmental Systems (Lerner et al., 2013) andresilience approaches (Masten & Powell, 2003) to be useful in highlighting the contributions of risk and protective factorsto observed patterns of continuity and discontinuity in intergenerational cycles of maltreatment.

A young mother’s childhood history of abuse and neglect was a salient risk factor for infant neglect. We found a maineffect for a maternal childhood history of multiple maltreatment on the likelihood of infant neglect and a moderationeffect (maternal age) for a maternal childhood history of neglect on the odds of infant neglect. Nevertheless, the majorityof adolescent mothers who were maltreated had not continued a pattern of maltreatment with their children. Our studyresults thus support the notion of “cycles of maltreatment” (Kaufman & Zigler, 1987) while affirming our hypothesis thatmost young mothers would not perpetuate the cycle (Borkowski et al., 2007). The pervasiveness of childhood histories ofabuse and neglect among mothers in the study sample (46%) and their infants (20%) is in line with prior research showingthat teen mothers, and their children, commonly have childhood histories of maltreatment (Hildyard & Wolfe, 2002; Krpan,Coombs, Zinga, Steiner, & Fleming, 2005). These rates are alarming given that most infants have a limited number of primarycaregivers from whom they receive the care they need. Further, as children grow older, the proportion who are maltreated islikely to increase. These early legacies can have a toxic influence on children’s lifelong physical and mental health (Shonkoffet al., 2009).

Correlates of intergenerational cycles of child maltreatment

Our study documents several areas of linkage between mothers’ immediate and distal contexts and the neglect of theirchildren; specifically, their childhood histories of maltreatment, social support in their current networks, and their empathicattitudes about parenting. Approximately three-quarters of neglected infants had a mother who was a victim of maltreatmentin childhood, yet the rate of discontinuity in the sample was 77%, demonstrating resilience to transmission of maltreatmentin these young families comparable to Kaufman and Zigler’s (1987) estimate of 70%. The proportion of discontinuity at thisstage of development (<30 months) is noteworthy because most child neglect occurs during the infant and toddler years(U.S. Deparment of Health, Administration for Children & Families, Children’s Bureau, 2013; Sedlak et al., 2010).

Mothers who were childhood victims of more than one type of maltreatment had infants who were at heightened riskfor neglect. Their children had 2.5–3 times the likelihood of being neglected compared to the children of nonmaltreated

mothers. According to social learning, and attachment, theoretical perspectives, young mothers who were maltreated inmultiple ways may not have observed healthy parenting (Pears & Capaldi, 2001), forming dysfunctional working modelsof relationships that fail to support positive parenting behavior (Bowlby, 1958). Although multiple maltreatment exposureis predictive of psychological distress, adjustment problems, and psychiatric impairment (Arata, Langhinrichsen-Rohling,

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J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34 31

owers, & O’Brien, 2007; Finkelhor, Ormrod, & Turner, 2007), to our knowledge no other studies have examined multipleype victimization in one generation and neglect in the next.

The relation between social support and parenting quality was a key finding in this study, offering further evidence ofhe impact of relationships on neglect risk (Dixon et al., 2009; Thompson, 1995; Zolotor & Runyan, 2006). Social supporterved as a buffer against infant neglect, promoting resilience, i.e., breaking the intergenerational cycle of maltreatmentArmstrong et al., 2005). Because the effects of social support tend to be population specific, depend upon the type anduality of support, and vary by developmental timing, a nuanced understanding of what forms of social support work best,or whom, and under what conditions is essential to protecting children. We examined two different dimensions of socialupport (frequency and dependability); interestingly, frequent access to social support was more important to parentinghan was the dependability of support. Perhaps frequency is salient to young mothers’ parenting because it represents theegree to which their immediate practical and emotional needs are met. Further, young mothers are not passive recipientsf support, and the dimension of frequency may be a measure of their success in procuring help (Thompson, 1995).

Mothers with more empathetic attitudes reported more adequate family resources, echoing findings that access toesources enhances parenting quality (Sedlak et al., 2010; Slack et al., 2004). Surprisingly, older mothers reported lessarental empathy than did younger mothers in our sample (age range of 16 to 20 years at first birth), which was unex-ected given evidence that young parents display less empathy in interactions with their children than do adult parentsBaranowski, Schilmoeller, & Higgins, 1990). We speculate that a negative relation between older age and co-residence withrandmothers may explain this finding, as very young mothers may have more support from immediate family (Moore &rooks-Gunn, 2002). However, this hypothesis requires further exploration and warrants future study.

oderators of intergenerational cycles of maltreatment linked to infant neglect

The main objective of the current study was to identify modifiable factors that protect adolescent mothers against con-inuing cycles of child maltreatment. Maternal age and social support moderated the relation between maternal historiesf childhood maltreatment and parenting, whereas positive relationships in childhood did not. In light of considerablempirical support for the promotive effect of positive childhood relationships on parenting quality (Belsky et al., 2009), theon-significant finding for positive care during childhood was puzzling. It may be that adolescents felt that their mothersid the best they could under difficult circumstances (i.e., they were “caring” albeit maltreating). An attachment theoreticalerspective might suggest that such cognitive reappraisals might be crucial to interrupting cycles of insensitive parentingEgeland et al., 1988). Investigations in a recent special issue on safe, stable, and nurturing relationships as moderatorsf intergenerational cycles of maltreatment found mixed results, including three studies “with a significant associationetween protective constructs and attenuation in the continuity of maltreatment” but one study that failed to find an effectMerrick, Leeb, & Lee, 2013, p. S2). Herrenkohl, Bart Klika, Brown, Herrenkohl, and Leeb (2013) speculated that particularndicators of positive relationships in childhood may be more salient than others, including specific aspects of attachmentnd support, stability of relationships over time, overall levels of warmth and support provided, and child characteristicse.g., temperament, emotion regulation, social acuity).

Findings on the impact of maternal age on cycles of maltreatment suggested that, even within a restricted range, aarent’s age at birth has relevance to an infant’s risk of neglect. Contrary to our prediction, however, older age did not buffergainst the risk of infant neglect among mothers who themselves had been neglected, and the odds that a mother had aubstantiated report of infant neglect were slightly higher for nonmaltreated mothers who were older at the time of a firstirth. The latter finding represents a small effect, but it is difficult to explain in light of research demonstrating elevatedisk for child maltreatment among younger mothers (Sidebotham & Golding, 2001; Stier et al., 1993) and among maltreatedarents (Ertem et al., 2000; Kaufman & Zigler, 1987). One explanation may be that mothers who were victims of neglectay be better able to transform their experiences into a conscious resolve not to repeat the cycle (Egeland, 1988) thanothers who endured multiple types of maltreatment, whose capacity to overcome the legacy of abuse and neglect may be

ompromised by the extent of their trauma.The effects of social support on continuity and discontinuity in cycles of child maltreatment also varied under different

onditions. Social support moderated the relation between past experiences of neglect and maternal empathy. Neglectedothers who reported frequent access to social support held more empathetic attitudes toward their children than did

eglected mothers with less support, consistent with Egeland et al.’s investigation (1988). This finding highlights theundamental contribution of supportive relationships to healthy parenting following adversity (Lieberman et al., 2005;

erner, 2000) and affirms the study’s premise that social support enhances resilience in parenting subsequent to childhoodaltreatment.

mplications for the prevention of child neglect

The extent of discontinuity in intergenerational cycles of child maltreatment, even in this high risk sample of young

others, raises an important question: Why is our understanding of discontinuity so limited when it is the most usual and

esired outcome? When working with victims of child maltreatment, Lieberman et al. (2005) recommend a therapeutictance in which “experiences of joy, intimacy, pleasure, and love are considered to be as worthy of therapeutic attention asegative experiences” (p. 517).

32 J.D. Bartlett, M.A. Easterbrooks / Child Abuse & Neglect 45 (2015) 21–34

In the present study, frequent access to social support protected infants from neglect, suggesting that prevention policyand programs consider strategies to help teen parents establish regular social contact with others (e.g., home visiting, parentgroups, community opportunities for socialization). While social support is a cornerstone of many prevention programs,general strategies to increase social support, even when based on strong empirical and theoretical grounds, are unlikely toreduce neglect unless they address the specific needs of particular families (Daro & Dodge, 2009). Further research mightexpand our understanding of which forms of social support (e.g., tangible, informational, emotional), from whom (e.g.,professionals, paraprofessionals, family, friends), are most likely to protect against neglect for which families.

The results of this study also suggest that prevention policy and practice consider the contextual specificity of protectiveprocesses (Wright & Masten, 2006). The fact that social support and older maternal age operated differently for parents withand without a childhood history of maltreatment implies that “one-size-fits-all” approaches to prevention may fall short oftheir goals. Refining knowledge on how protective processes operate in different settings will enhance targeted preventionstrategies (Stagner & Lansing, 2009; Wulczyn, 2009).

Study limitations and conclusions

Certain limitations merit particular consideration when interpreting the results of this investigation. Our categorizationof situations as “neglect” or “nonmaltreatment” does not account for dimensions such as chronicity and severity. Also, weused a conservative standard for both infant neglect and maternal history of childhood maltreatment (i.e., substantiatedreports), likely leading to an underestimate of maltreatment. Still, we addressed a serious limitation of prior studies byanalyzing different forms of maltreatment in each generation. Another limitation was that we were not able to incorporatesome correlates of neglect that may help to explain continuity (e.g., substance abuse, intimate partner violence, limitedcommunity resources) and discontinuity (e.g., a supportive non-parental adult, psychotherapy) and play a causal role inneglect (Erickson & Egeland, 2002). In addition, our measures of mothers’ childhood maltreatment and positive care werelimited to retrospective self-report, as we were not able to follow mothers prospectively during childhood, and we assessedmaternal empathy via self-report rather than observing empathy directly. Despite these limitations, this study contributesto the field of child maltreatment prevention in several ways. First, it addresses the “neglect of neglect” (Dubowitz, 2007)by adding to a scant empirical literature on intergenerational cycles of neglect. Second, in contrast to most studies onintergenerational transmission, this investigation highlighted discontinuity and its applications to prevention of neglect.Lastly, the finding that social support and maternal age moderated intergenerational transmission of parenting suggestsavenues for intervention.

There is unrealized potential for researchers to assist infant neglect prevention efforts by identifying protective factorsthat prevent infant neglect from occurring and by pinpointing optimal foci for interventions aimed at strengthening fam-ilies. The inextricable link between children’s adjustment and parents’ psychological well-being (Easterbrooks, Driscoll, &Bartlett, 2008) suggests that children’s ability to achieve safety, security, love, and belonging (Maslow, 1943) depends onhow well society fulfills the social-emotional needs of parents, beginning during the prenatal and early postnatal period.Most importantly, preventing neglect will necessitate cross-disciplinary collaboration among researchers, scientists, poli-cymakers, practitioners, and other stakeholders to translate empirical findings into policy and practice that improves thelives of young children and their families.

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