measuring child neglect in community and clinical samples

1

Measuring Child Neglect in Community

and Clinical Samples

Glenda Kaufman Kantor, Ph.D.

Funded by N.I.C.H.D. Grant # RO1MD39144-01

Grant No. 2002-JW-BX-0002 (OJJDP)

[email protected]

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Why Study Neglect?

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Child Fatalities By Type Of Maltreatment, 2001 (NCANDS)

35.6%

26.3%

21.9%

5.9%

4.9%

3.3%

2.2%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Any Type Except PhysicalAbuse or Neglect

Neglect & Any MaltreatmentType

Unkown or Missing

Physical Abuse & AnyMaltreatment Type

Physical Abuse & Neglect

Physical Abuse Only

Neglect Only

U.S. Dept. of HHS, Admin. On Children, Youth, & Families, Child Maltreatment 2001 (Washington, DC: U.S. Government Printing Office, 2003).

1 Does not include neglect.

2 Does not include physical abuse.

1

2

Percentage

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Prior Child Report Measures of Neglect

• Few child measures

• Young children rarely source of data in instruments measuring neglect

• Some measure just one or two components of neglect

• Varying definitions

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Definition of Neglect

• “Neglectful behavior is behavior by a caregiver that constitutes a failure to act in ways that are presumed by the culture of a society to be necessary to meet the developmental needs of a child and which are the responsibility of a caregiver to provide.”– Straus & Kaufman Kantor, 2004

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Challenges in Measuring Neglect

• Omission

• Chronicity

• Causal factors separate from acts

• Acts vs. Injury

• Cultural Boundaries

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Challenges in Measurement• Children’s terminology• Language development, grammar• Cultural aspects of language• Reliability• Age of child• Distractibility• Cognitive ability• Response sets• Recall bias• Desire to please

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Central Aims of the Study

• Develop a standardized instrument to measure neglect based on Child Self-Report

• Describe the relationship of neglect to child behavior problems & family characteristics

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Assessment of Child Neglect in Community and Clinical Samples:

Development of the Multidimensional Neglect Scale for Child Self-Report

Glenda Kaufman Kantor &

Murray Straus, Family Research Lab; Carolyn Mebert, UNH, Wendy Brown, FRL, Crystal Macallum & Todd Flannery,

Westat

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Methods

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Clinical Sample

• Spurwink Child Abuse Program

• Maine DHS

• NH DCYF

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Eligibility

• Clinical Sample Inclusionary Criteria- 6-15 yrs old• Lived in foster care < 6 months (age 6-9)• Lived in foster care < 1 year (age 10-15)

• Exclusionary Criteria• Visually impaired • Hearing impaired• No spoken language ability• Non-English speaking • Formal diagnosis of mental retardation• Deemed “not interviewable” by clinician

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Sample Characteristics

• Clinical Sample• N = 287• 46% 6-9 years of age• 54% 10-15 yrs. of age• 50% female• 50% male• 8% non-white

• Community Sample• N = 207• 63% 6-9 years of age• 37% 10-15 yrs. of age• 52% female• 48% male• 18% non-white

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Maltreatment Types in Clinical SampleNumber & % in

Group

(Total N = 277)

Overall Types

Neglect

Physical abuse

Sexual abuse

Emotional/Psychological abuse

187 (67.5%)

79 (28.5%)

155 (55.9%)

91 (32.9%)

“Pure” Categories (Participants with only one designated abuse type)

Neglect

Physical abuse

Sexual abuse

Emotional/Psychological abuse

140 (50.5%)

61 (22.0%)

4 (1.4%)

75 (27.0%)

0 (0%)

Multiple Abuse Types 137 (49.4%)

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Child & Parent Characteristics

• Children– 42% in clinical sample had some emotional

disorder or behavioral disorder (depression, anxiety, ADHD conduct disorder)

• Parents– 50% Mental illness – 19% Developmental Disability– 45% Substance Abuse Problem– 70% Domestic Violence

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Peabody Picture Vocabulary Test (PPVT) Scores by Age and Sample

92

94

96

98

100

102

104

106

108

6-9 Yrs 10-15 Yrs

Community

Clinical

p <.001

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PPVT Standard Scores by Presenting Maltreatment Type

PPVT Standard Score

Age 6-9 (n=124) Age 10-15 (n=141)

Neglect Concerns

Yes 95.19* 97.07

No 100.63 99.50

Physical Abuse Concerns

Yes 94.16 95.66

No 98.45 98.47

Sexual Abuse Concerns

Yes 98.50 96.85

No 95.07 98.28

Psych. Abuse Concerns

Yes 96.32 97.53

No 97.68 97.62* p < .05

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Measures

ObservationalObservational

Child ReportChild ReportClinicianClinicianCaretakerCaretaker

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Parent-Child Interactions Within Neglectful Families

• Study by Burgess & Conger (1978) highlighted that:– Neglectful parents’ behaviors were marked by

extreme negativity. – Neglectful parents had fewer positive

interactions with their children, gave more commands, and complied less with their children’s commands than controls.

– Findings were particularly strong for mothers.– Interactions of abusive parents were different

from those observed in neglectful families.

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Parent-Child Interactions

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[Video Clip 1]

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[Video Clip 2]

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Parent-Child Interaction Scale

• Developed by Farran & colleagues (1986)• 11 aspects of parenting are rated for:

– Amount (frequency during time sample)

– Quality (harsh vs. gentle)– Appropriateness (related to timing,

age, & situation)

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PCIS Behaviors Rated

• Physical involvement

• Verbal involvement• Responsiveness• Play interaction• Control over

child’s activities• Directives

• Teaching• Positive

statements• Negative

statements• Relationship

among activities• Goal setting

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Caregiver Participants

Majority female (78%) Ages ranged from 27- 54 (M = 34.7) Risk factors included:

mental illness (64%) developmental disabilities (13%) substance abuse (42%) domestic violence (81%)

Neglect substantiated in 70% cases

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Results of Observational Analysis

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Quantitative Findings: Types of Neglect

• Among younger children, parents who had neglected their children in emotional & supervisory capacities interacted less, were less appropriate, & had lower quality interactions

• For older children, these same interaction patterns were seen among parents who had emotionally or physically neglected their children

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Quantitative Findings: Parent Characteristics

• Less frequent, less appropriate, & lower quality interactions were observed among families in which domestic violence was present

• Less frequent and less appropriate interactions were observed among parents with mental illnesses who had young children

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Summary of Research

• Observing interactions provides a better understanding of specific areas that could be targeted for interventions

• Parent-Child Interaction Scale is one option for coding dyadic interactions

• Important to note that the presence of risk factors does not always mean that parents are not capable of parenting their children effectively

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Supports Other Neglect Research

• Evidence for pervasive lack of involvement– Neglectful mothers of infants were

withdrawn, uninvolved, initiated few activities, provided little stimulation (Crittenden & Bonvillian, 1984).

– After controlling for education level, neglectful mothers were less responsive & less developmentally appropriate compared to controls (Fagan & Dore, 1993).

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Child Self-Reports

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ACASI

• Audio enhanced version of the Computer Assisted Self-Administered Interview

• Uses an audio system and touch screen to interview child

• Tutorial• Scale version adapted by Age and Gender of the

Child and Gender of the Primary Caretaker • Interactive program• Older Children can take Independently• Computer Game Break

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Child Self Report Measures

• Measures cognitive, emotional, supervision, and physical neglect

• Includes subscales on potential areas of child endangerment: • Exposure to parental conflict & violence• Abandonment• Parental alcohol abuse

• Includes subscale on child’s general feelings or Appraisals of each domain

• Includes Child Self-Report Measure of Depression• Includes Social Desirability Scale

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This girl’s father doesn’t make her feel better when

she is sad or scared

This girl’s father makes her feel better when she is sad

or scared

Which girl is most like you?

Emotional Neglect Sample Item

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Is this…

Emotional Neglect Sample Item Cont.

A little Sort of A lot Really a lot like you like you like you like you

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This girl’s mother does not talk to her about what she is

learning in school

This girl’s mother talks to her about what she is

learning in school


Cognitive Neglect Sample Item

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Which boy is most like you?

This boy’s mother doesn’t know where he’s playing

outdoors

This boy’s mother knows where he’s playing

outdoors

Supervision Neglect Sample Item(age 6-9)

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This boy’s father does not find out where he is going after

school

This boy’s father finds out where he is going after

school

Supervision Neglect Sample Item(age 10-15)

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This boy’s mother makes sure he takes a bath

This boy’s mother does not make sure he takes a bath

Physical Neglect Sample Item

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This girl’s father hasn’t left her alone for a couple of days

without grown-ups

This girl’s father has left her alone for a couple of days

without grown-ups

Abandonment Sample Item

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This boy sees the grown-ups in the house

hitting each other

This boy does not see the grown-ups in the house

hitting each other

Exposure to Violence Item

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This girl hears grown-ups in the house

fighting

This girl does not hear grown-ups in the house

fighting


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This boy’s mother does not let other people

in the house hurt him

This boy’s mother lets other people

in the house hurt him


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This boy does not see grownups in the house

throwing things

This boy sees grownups in the house

throwing things


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Some girls are unhappy a lot of the time

Other girls are pretty happy a lot of the time

Depression Sample Item

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Is this…

Depression Sample Item Cont.

A little Sort of A lot Really a lot like you like you like you like you

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Appraisal ScaleItem

• Child Feels Like Someone Takes Care of Him

• Child Has to Take Care of Parent

• Child Feels Like Someone Loves Him

• Child Feels like Someone Helps with schoolwork

• Child Feels Hungry a lot

Picture

• Child Happy Face with Adult

• Child Pulls Covers over Parent in bed

• Happy Child

• Happy Child with Book

• Sad Child with Stomach Hurting

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Social Desirability Scale• I always say please and thank you to grown-ups.

• Sometimes I don’t feel like doing what my teachers want me to do.

• Sometimes I feel like throwing things or breaking them.

• I never talk back to my parents.

• When I do something wrong, I always say I am sorry.

• I sometimes feel like making fun of someone.

• I always wash my hands before eating.

• I sometimes feel angry when I don’t get my way.

• Sometimes I argue with my parent to do something she doesn’t want me to do.

• I always do what my parent tells me to do.

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Results on Psychometric Properties of MNBS-CR

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Reliability and Validity

• Full Scale Alpha Older Children =.94• Full Scale Alpha Young Children =.76• Emotional Subscale - highest alphas for

both young and older children

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Total MNBS-CR Scores by Child Neglect Sample: Age 6-9

3.47

8.19

0

2

4

6

8

10

Community Sample Clinical Sample

Neglect Total

p < .001

N = 130 N = 132

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Total MNBS-CR Scores by Child Neglect Sample: Age 10-15

4.94

11.52

0

2

4

6

8

10

12

Community Sample Clinical Sample

Neglect Total

N = 24 N = 114

p=.004

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% Neglect Reported by Total Child and Community & Clinical Samples

6-9 years 10-15 years

Subscale Clinical

n = 132

Cmty.

n = 130

Clinical

n = 155

Cmty.

n = 77

% Emotional 39.1 35.0 59.3 59.1

% Cognitive 47.8 36.3 51.3 52.9

% Supervision 49.2 27.7*** 55.5 54.5

% Physical 54.5 32.3*** 41.3 22.1**

% Abandonment 6.8 2.3 6.5 5.3

% Violence Exp. 38.3 26.3* 29.4 20.5

% Alcohol Exp. 8.4 .9** 10.6 2.1***

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Prevalence of Child Reports and Clinician Reports of Domestic Violence in Clinical Sample

6-9 Years 10-15 Years

% Clinician Reports 67% 73%

% Child Reports (total) 38% 31%

% Hearing Fights

(DV identified)23% 23%

% Seeing Fights

(DV identified) 15% 17%

% Sees Grown-ups throwing things

(DV identified)--.-- 10%

% Lets others hurt child

(DV identified)4% 7%

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Key Findings Across Sources & Samples

• Children in Clinical Sample report more neglect than those in Cmty. Sample

• Children’s reporting of Neglectful behavior not always concordant with Clinicians

• Children report more Neglectful behavior than Parents

• Supervisory Neglect predominates across all groups

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Neglect Profile

6-9 yr. oldsSevere Neglect • Abandonment• Alcohol-related Parental

Neglect• Physical Neglect-Not

enough food in the house

• Inadequate Supervision

Minor Neglect

10-15 yr. OldsSevere Neglect• Failure to Protect - lets

other people in the house hurt him

• Abandonment• Alcohol-related parental

neglect• Physical Neglect

Minor Neglect - separate factor

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Results on Validity of MNBS-CR

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% Child Behavioral Problems by MNBS-CR Median Split Scores

35%

45%

27%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

6-9 year olds 10-15 year olds

Below Median

Above Median

N = 98N = 102

P<.00110-15 yr. olds

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DV, Victimization and Child Outcomes

• Among young and older children, self-reported depression is significantly associated with their reports of exposure to conflict/violence, and neglect

• No Significant multivariate effects on CBCL scores of children’s reports of exposure or neglect

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Effects of Parental Characteristics on Child

Reports of Neglect

• Series of Analyses– Severity weighted score MNBS-CR =

dependent variable– Clinical Record Data on:

• Parent Mental Illness (No effects found)• Domestic Violence• Parent Substance Abuse*

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Relation between MNBS-CR Scores & Parent/Child Characteristics: 6-9

• Higher Neglect total & Appraisal scores related to > child self-reported Depression

• Child reports of Supervisory neglect significantly correlated with Clinical reports of Parental drug abuse

• Child reports of Emotional neglect significantly correlated with their reports of Conflict/violence exposure

• Higher Neglect Appraisal scores were associated with lower Parent IQ scores

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Relation between MNBS-CR Scores & Parent/Child Characteristics: 10-15

• Higher neglect total & appraisal scores related to > child self-reported depression & more severe child behavioral problems

• Greater perceptions of neglect associated with > CBCL social, thought, attention problems & aggressive behavior

• Higher alcohol exposure scores were related to more CBCL reported delinquency, thought problems, & aggressive behaviors

• Greater perceptions of neglect were associated with lower parent IQ and more parental substance abuse

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Sibling Concordance

• Tested 83 pairs of siblings– 61 pairs in clinical sample– 22 pairs in community

• Results of Analysis– If one sibling reported neglect, other sibs had

78% chance of also reporting neglect– Children in Clinical sample reported greater

similarity in neglect than those in community– Gender significant predictor of concordance

(girls more concordant than boys)

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Conclusions

• Children, particularly older children report patterns of severe neglect that are consistent with typical CPS cases

• Neglect multidimensional phenomenon• Parental Substance major component of Child

Neglect• Parental inability to protect the child from being

hurt, or to keep the child safe is associated with a severe dimension of neglect

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Conclusions

• MNBS-CR is promising measure– Strong Discriminant Validity– Substantial Evidence of Construct Validity– High Reliability for Older Children– Moderate Reliability for Younger Children– Important tool for screening, assessment,

target interventions. – Pose sensitive questions with low risk of

distress– Multiple measures best

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Conclusions

• Findings suggest that Neglect is significantly associated with child depression and behavioral disturbances

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Preliminary Conclusions: Observational Study

• Less frequent, less appropriate, & lower quality interactions were observed among families in which domestic violence was present

• Less frequent and less appropriate interactions were observed among parents with mental illnesses who had young children

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Preliminary Conclusions: Observational Study

• Among younger children, parents who had neglected their children in emotional & supervisory capacities interacted less, were less appropriate, & had lower quality interactions

• For older children, these same interaction patterns were seen among parents who had emotionally or physically neglected their children

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Conclusions:Benefits of Observing Parent-

Child Interactions

• Observing parent-child interactions can provide a less biased perspective on family dynamics

• Understanding patterns will lead to more effective interventions

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Next Steps

• Follow-up Study

• Further Study Needed on Cognitive Effects of Neglect

• Further Study of Different Etiological Pathways to Neglect

• Validate in different populations

measuring child neglect in community and clinical samples

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