Stith Et Al. (2009) - Risk Factors in Child Maltreatment Munchausen Excluded. Aggression & Violent Behavior, 14, 13-29 PDF

Aggression and Violent Behavior 14 (2009) 13–29
Contents lists available at ScienceDirect
Aggression and Violent Behavior
Risk factors in child maltreatment: A meta-analytic review of the literature☆

Sandra M. Stith ⁎, Ting Liu, L. Christopher Davies, Esther L. Boykin, Meagan C. Alder,
Jennifer M. Harris, Anurag Som, Mary McPherson, J.E.M.E.G. Dees
Kansas State University, Manhattan, Kansas, United States
Virginia Polytechnic Institute and State University, Falls Church, Virginia, United States
a r t i c l e i n f o a b s t r a c t
Article history: This review presents the results of a series of meta-analyses identifying the relative strength of various risk
Received 21 September 2005 factors for child physical abuse and neglect. Data from 155 studies examining 39 different risk factors were
Accepted 21 March 2006 included in the review. Large effect sizes were found between child physical abuse and three risk factors
Available online 9 August 2008
(parent anger/hyper-reactivity, family conflict and family cohesion). Large effect sizes were also found
between child neglect and five risk factors (parent–child relationship, parent perceives child as problem,
Keywords:
parent's level of stress, parent anger/hyper-reactivity, and parent self-esteem).
Child maltreatment
Child physical abuse
© 2008 Elsevier Ltd. All rights reserved.
Child neglect
Risk factors
Meta-analysis
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2. Review of literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3. Theoretical perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.1. Parent–child interaction or parental report of child behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.2. Parent characteristics independent of the child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.3. Child characteristics, excluding parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.4. Family factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.5. Hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4.1. Literature search. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4.2. Inclusion criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4.3. Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4.4. Study quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4.5. Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
5. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
5.1. Meta-analysis results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
6. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
6.1. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
6.2. Suggestions for future research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
6.3. Clinical implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
6.4. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
☆ This material is based upon work supported by the Cooperative State Research, Education, and Extension Service, U.S. Department of Agriculture, and the U.S. Air Force, under
Agreement No. 98-EXCA-3-0654. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the
views of the U.S. Department of Agriculture or the U.S. Air Force. We thank Dr. Joel Milner, Lt. Col. Dari Tritt, Col Rene' Robichaux, Ms. Marciann Day, for their assistance in this project.
In addition, we want to thank Dr. David Sugarman for his comments on earlier versions of this manuscript.
⁎ Corresponding author. Family Studies and Human Services, Kansas State University, 101 Campus Creek Complex, Manhattan, KS 66506, United States. Tel.: +1 785 532 4377.
E-mail address: [email protected] (S.M. Stith).
1359-1789/$ – see front matter © 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.avb.2006.03.006
14 S.M. Stith et al. / Aggression and Violent Behavior 14 (2009) 13–29
1. Introduction Studies were inconsistent in the finding of a relationship between

abuse and parents' ability to read child emotional cues. Finally, Hazler
Maltreatment of children is a prevalent social problem. The and Denham (2002) supported the findings of Milner and Chilamkurti
National Clearinghouse on Child Abuse and Neglect reported that in (1991) and Milner and Dopke (1997) by reviewing several studies on
2002 an estimated 896,000 children were the victims of child abuse or social isolation and child abuse and neglect, all of which found a
neglect. Child physical abuse is defined as non-accidental injury significant positive relationship to exist.
(including bruises, welts, cuts, burns, broken bones, or other tissue None of the empirical literature reviews to date have cited
damage) to the child inflicted by a parent or a caregiver in a parenting demographic factors as particularly important in relation to child
role. Child neglect is defined as failure of a parent or a caregiver in a physical abuse or neglect. Moreover, Buchholtz and Korn-Bursztyn
parenting role to provide adequate supervision, safety, medical care, (1993) reviewed the literature on teen parenting and child maltreatment
education, or other necessities to the child. Although a large number and concluded that the high levels of abuse reported in the applicable
of studies have examined risk factors for child maltreatment, the studies seemed to reflect constructs other than age of the parent,
findings of these studies are inconclusive. In addition, although child including depression and life stress. Furthermore, Giles-Sims (1997)
neglect has been consistently shown to be the most frequently reviewed the literature on non-biological parents and found mixed
substantiated type of child maltreatment, research on child neglect is support for a higher prevalence of physical abuse in stepfamilies.
limited (Schumacher, Slep & Heyman, 2001). However, the research Some reviews have focused solely on child-related factors. Veltman
that has been conducted (e.g., McDonald & Marks, 1991) indicates that and Browne (2001) reviewed 65 studies examining the relationship
while there is some overlap in factors related to abuse and neglect, the between child maltreatment and school performance and language
best prediction of re-abuse is attained when abuse and neglect are development. Most, but not all, of these studies found delayed
analyzed separately. Therefore, the present study summarizes the development and poor school performance among maltreated chil-
literature on child physical abuse and neglect and uses a meta-analytic dren. A review of the literature on child disability and maltreatment
design to determine the strength of the relationship between each risk showed what little research exists on the subject to be inconsistent
factor and abuse or neglect across the literature as a whole. While other (Westcott, 1991). Furthermore, Dubowitz (1999) found no consistent
types of child maltreatment have been examined in the literature, i.e., relationship across studies between child neglect and child age,
child sexual abuse, emotional abuse and undifferentiated child gender, or developmental problems. Dubowitz also reviewed studies
maltreatment, the focus of this review is limited to two types of examining parent factors in neglect. His findings supported those of
child maltreatment, i.e., child physical abuse and child neglect. Milner and Chilamkurti (1991), Milner and Dopke (1997), and Hazler
and Denham (2002), with parent stress, non-responsivity/negativity
2. Review of literature toward the child, social isolation, depression, unrealistic expectations,
poor parenting skills, substance abuse, and history of childhood abuse
Empirical literature on child abuse has shifted in focus over the being consistently shown to be positively related to neglect.
past several decades. Earlier studies tended to focus more on Belsky (1993) also reviewed the research on risk factors in child
psychological and personality characteristics of the offender, espe- physical abuse and neglect examining multiple levels of factors, including
cially those of the mother. Later studies have examined a variety of those pertaining to individual family members, the family system,
factors pertaining to family members, the family system, and the interaction with the community, and societal factors. His findings
environmental milieu. Previous reviews of demonstrate this trend. supported those of Milner and Chilamkurti (1991), Milner and Dopke
Baumrind (1995) reviewed literature on parent psychological factors (1997), Dubowitz (1999), and Hazler and Denham (2002) regarding the
and child abuse. She notes that although in the 1950s and 1960s child risk factors of childhood history of abuse, that is, depression, psycho-
abuse was seen as a product of parent psychopathology, studies in the pathology, self-esteem, psychophysiological reactivity, coercive disci-
1970s found psychopathology to be rare in abusive parents. Studies pline, social isolation, non-responsivity/negativity toward the child, and
also failed to identify a specific psychological or personality pattern in belief that the child has a behavior problem or acts to intentionally annoy.
abusive parents. Nevertheless, recent research has not abandoned the Like Buchholtz and Korn-Bursztyn (1993), Belsky found no consistent
study of parent psychological risk factors. Parent depression and relationship between child disability and maltreatment. Belsky also
impulse control problems in particular are consistently shown to be supported Dubowitz in finding inconsistency across studies on child age.
positively related to both child abuse and neglect. The inconsistency of the findings across studies warrants the use of
The literature on parent biological, cognitive, affective, and meta-analytic methods to interpret the research. To date, only two
behavioral factors in child physical abuse is summarized by Milner reviews have calculated effect sizes. One study examined risk factors
and Chilamkurti (1991) and by Milner and Dopke (1997). These for physical abuse (Black, Heyman & Slep, 2001) and one examined
reviews indicated that parental low self-esteem, depression, psycho- risk factors for neglect (Schumacher et al., 2001). Black et al. (2001)
pathology, history of childhood abuse, and social isolation, among reviewed 46 studies examining parent and child cognitive, psycholo-
other factors, are at least somewhat consistently positively related to gical, demographic, intelligence, and historical factors, as well as social
child physical abuse. Studies are also somewhat consistent in finding isolation, family factors, and parent–child interaction factors and child
abusive parents to be more psychophysiologically reactive to aversive physical abuse. The results of reviewed studies were summarized and
child stimuli, to have unrealistic expectations of the child (either too an effect size was computed for each study. No composite effect sizes
high or too low), to use more coercive discipline than inductive were computed for the purposes of summarizing all studies on a given
reasoning, to have less interaction with the child, to be more negative factor and no general conclusions were offered regarding relative
than positive in interactions with the child, and to see the child as a strength of the various risk factors examined. However, most
problem child or as acting to intentionally annoy (Milner & demographic variables did not appear to be important risk factors
Chilamkurti, 1991; Milner & Dopke, 1997). McCanne and Milner for child physical abuse. Moderate to strong positive effect sizes were
(1991) investigated psychophysiological reactivity in detail, summar- found for mother's tendency toward loneliness and isolation, fear of
izing six studies. They determined that although there appears to be a being controlled and impulsivity. Most adjustment variables (social
positive relationship between reactivity and abuse, not all physiolo- support, interpersonal problems, etc.) were moderately strongly
gical measures consistently indicate such a pattern. associated with child abuse. Several cognitive risk factors had
Milner and Chilamkurti (1991) also found that the few studies on moderate to strong positive associates with child abuse. Abusive
parent substance abuse and child physical abuse suggest a positive mothers were more likely to make internal and stable attributions
relationship between the two, particularly in the case of alcohol abuse. about their children's negative behavior and more negative and higher
S.M. Stith et al. / Aggression and Violent Behavior 14 (2009) 13–29 15
than normal expectations of their children, as well as less under- abuse and for child neglect. The factors examined here included par-
standing of appropriate developmental norms. Also, negative affect and ent–child relationship (the studies in this category primarily involved
autonomic nervous system arousal by parents' were positively related coding of parent–child interaction and/or child attachment to parent
to child abuse. Finally, abusive mothers were more likely to use harsh behaviors), parenting behaviors [the studies in this category included
discipline strategies and verbal aggression and less likely to use positive studies of parenting styles using measures such as, the Child-rearing
strategies than non-abusive mothers. Schumacher et al. reviewed 10 Practices Q-Sort (Block, Block, & Morrison, 1981); surveys measuring
studies examining the relationship between some of these factors and the parent's ability to plan or carry out to completion effective
child neglect. Parent psychological and behavioral characteristics had interactions with their children, such as the Parent Problem Solving
the largest effect sizes, although effect sizes could not be computed for Instrument (Wasik, Day, & Wasik, 1980); studies which examined
most factors due to a small body of literature on neglect. parent's unrealistic expectations of their child with measures such as
The purpose of the present study is to summarize the literature on the Developmental Expectation Questionnaire derived from the
a variety of risk factors for child physical abuse and neglect. This study Vineland Social Maturity Index (Doll and McKnight, 1965); and studies
adds to the existing literature by providing composite effect sizes which examined parental level of empathy toward the child with
indicating the strength of the relationship between each respective measures such as the Empathy Scales (Scotland, 1969)]. We also
factor and child physical abuse or neglect. These composite effect sizes looked at the parent's perception of the child as a problem. Studies
provide some indication of the importance of each risk factor relative included in this factor included studies where the parent completed
to other risk factors. assessments of the child using measures such as the Child Behavior
Checklist (Achenbach & Edelbrock, 1983). We also looked at whether
3. Theoretical perspective the pregnancy with the abused child was unwanted or unplanned,
parent's use of corporal punishment, and parent stress regarding
Much of the research on child maltreatment to date is guided by the parenting [this variable included studies that used measures such as
theory that maltreatment stems from individual pathology. This focus the Parenting Stress Index (Abidin, 1995) to measure the parent's level
on individual pathology is evident from the large number of studies of stress specifically regarding parenting].
examining risk factors pertaining to the offending parent (Buchholtz &
Korn-Bursztyn, 1993; Giles-Sims, 1997; Hazler & Denham, 2002; 3.2. Parent characteristics independent of the child
McCanne & Milner, 1991; Milner & Chilamkurti, 1991; Milner &
Dopke, 1997) and to the child victim (Veltman & Browne, 2001; The next more distal microsystemic level included 19 factors related
Westcott, 1991). However, because child maltreatment occurs in a to parent characteristics independent of the child. These factors included
family context, family-level factors should also be considered. In this the age, gender, and employment status of the offending parent and
study, ecological theory guided the choice of risk factors to be examined. whether or not the offending parent is a single parent. This level also
This theory originated with Bronfenbrenner (1979), who explains child included measures of the parent's drug abuse, alcohol abuse (not
development based on multiple levels of embedded systems. These including other drugs), health problems, anxiety, depression, personal
levels range from the proximal child environment (i.e., school, home, stress, self-esteem, and psychopathology (this variable included any
and peer group) to more distal social structures to the larger culture. measure of mental illness besides depression or anxiety including
Ecological theory considers each level as relevant to child development. schizophrenia, bipolar disorder, etc.). In this level we also included poor
For the purposes of this study, we examine various microsystems relationship with own parents (either as an adult or as a child), past
of the ecological model for child physical abuse and neglect. We criminal behavior (including violent outside the home) and level of anger/
recognize that important work has examined more distal social hyper-reactivity [this factor assesses the parent's agitation, physiological
structures and community factors but have chosen to focus on the arousal, and negative affect in response to a given stimulus (measured in
factors most closely related to the individual child for this review. We laboratory studies) and global measures of hostility measured by
instruments such as the Buss-Durkee Hostility Inventory (Buss & Durkee,
predicted that variables most proximal to the experience of child
maltreatment would have the strongest effect sizes and variables 1957) and the Mood Adjective Checklist (Frodi, A. M., & Lamb, M. E.,
1978.)]. We also looked at parent's experience of childhood abuse,
most distal from the experience of child maltreatment would have
the smallest effect sizes. Since child abuse involves both child and parent's level of social support, parent's coping or problem-solving skills
[measured by scales such as the Problem Solving Inventory (Heppner &
parent, we considered parent–child interaction and/or parent's
report of the child's behavior to be most proximal to the issue of Peterson, 1982)] and parent's approval of corporal punishment.
child abuse. For the next microsystem level, we considered parent
3.3. Child characteristics, excluding parents
characteristics the next most proximal level since parents are the
perpetrators of abuse. We then looked at child characteristics Within the microsystem that contained child characteristics, exclud-
(excluding parent) and finally, we examined the microsystemic factors ing parents, we attempted to calculate effect sizes for seven factors for
we considered most distal, family characteristics. This project was child physical abuse and the same factors for child neglect. For the studies
commissioned by the U.S. Department of Defense Military Family to fit in this microsystem level, the assessment of child behavior or
Advocacy Program to guide the development of a child abuse risk problem needed to come from an external source, not the parent. We
assessment instrument. The Family Advocacy Program works to calculated effect sizes for child gender, age, and disability (professionally
prevent and intervene with all types of family maltreatment diagnosed physical, mental or learning disability). We also looked at
experienced by military families. Risk factors were identified through studies examining child social competence (child's ability to interact well
initial perusal of the literature reviews on child abuse and neglect cited with peers assessed by individuals other than parents), child externalizing
above and iteratively throughout the study coding process. In addition, behaviors (disruptive behavior, aggression, delinquency, non-compliant
a panel of military clinicians and researchers was convened to suggest behavior, etc.), child internalizing behavior (withdrawn behavior, depres-
additional factors they thought would be important to examine. sion, sadness, etc.), and prenatal/neonatal problems of the child (problems
or complications in child during pregnancy, delivery, or infancy).
3.1. Parent–child interaction or parental report of child behavior
3.4. Family factors
In the microsystem level determined to be most proximal to the
abuse, parent–child interaction or parental report of child behavior, The most distal microsystemic level included seven family-related
we attempted to calculate effect sizes for six factors for child physical factors. We looked at family conflict, family cohesion, spousal violence,
socio-economic status of the family, marital satisfaction, family size, and syndrome by proxy or failure to thrive in our definition. Because risk
whether or not there was a non-biological parent in home. factors for these types of abuse were likely to be different from risk
factors for other forms of child physical abuse or neglect, studies
3.5. Hypotheses examining these types of abuse were also not included in these analyses.
Although factors from each of these microsystemic levels influence 4.1. Literature search
the occurrence of child abuse and neglect, since child abuse is an
interactional phenomena, we hypothesized that the microsystem Computer database searches were the primary method of identify-
level which includes “parent–child interaction or parental report of ing articles for inclusion in this study. The Psychological Abstracts
child behavior” would have stronger effect sizes than would factors International (PsychINFO) computer database was searched for all
that from microsystemic levels representing more individual level studies conducted to present including the keywords: “child abuse,”
factors (“child characteristics” or “parent characteristics”) or “family “child maltreatment,” “child physical abuse,” and “child neglect.” In
factors” which might be more distant from the parent–child addition to using the computer database, the reference list for each
interaction. Although the offender, as an individual, enacts the study was examined for additional potential studies to be included in
behaviors defined as abusive or neglectful, these incidents occur, by the review. The literature search identified 867 relevant studies, which
definition, at a dyadic level and not solely within the individual. were obtained for possible inclusion in this meta-analysis.
4. Methods 4.2. Inclusion criteria
Definitions or criteria for physical abuse and neglect vary from study The inclusion of studies in this meta-analysis was based on several
to study. We did not include child sexual abuse, infanticide, Munchausen's criteria (Johnson, 1989; Stith et al., 2000; Wampler & Serovick, 1996).
Table 1
Overall effect sizes for child physical abuse risk factors
d CI r Qw k N
Microsystem: parent–child interaction/parental report of child behavior
Parent perceives child as problem .62 .53/.71 .30*** 57.68*** 25 3317
Unplanned pregnancy .58 .28/.89 .28*** .31 2 1490
Parent–child relationships −.55 −.66/− .45 −.27*** 117.68*** 32 1624
Parent use of corporal punishment .55 .38/.72 .26*** 4.65 7 703
Parenting behaviors .34 .24/.44 .17*** 130.85*** 25 2956
Stress over parenting .15 .00/.30 .07*** 51.14*** 11 2075
Microsystem: parent characteristics independent of the child

Anger/hyper-reactivity .72 .47/.97 .34*** 14.25* 9 345
Anxiety .60 .41/.79 .29*** 4.39 8 563
Psychopathology .59 .48/.69 .28*** 62.21*** 13 8630
Depression .55 .45/.67 .27*** 46.18*** 14 8258
Self-esteem −.50 −.64/− .36 −.24*** 32.92*** 11 2485
Poor relationship with own parents .44 .34/.54 .22*** 20.38* 11 2997
Parent experienced childhood abuse .44 .34/.54 .21*** 78.55*** 15 3722
Criminal behaviors .42 .24/.60 .21*** .66 4 1963
Personal stress .39 .29/.49 .19*** 50.74*** 22 3114
Social support −.36 −.45/− .28 −.18*** 65.32*** 20 10,315
Alcohol abuse .34 .19/.50 .17*** 8.06* 3 654
Unemployment .30 .19/.42 .15*** 29.57*** 8 1263
Parent coping and problem-solving skills −.27 −.52/− .02 −.14* 7.54* 4 303
Single parenthood .24 .19/.30 .12*** 108.23*** 22 14,223
Parent age −.20 −.26/− .14 −.10*** 234.05*** 31 12,136
Drug abuse .16 .01/.32 .08* 2.18 3 654
Health problems .22 −.01/.45 .11 3.17 3 286
Parent gender .13 −.03/.30 .07*** .10 2 7309
Approval of corporal punishment .09 −.11/.30 .05 5.65 5 1674
Microsystem: child characteristics, excluding parents

Child social competence −.53 −.64/− .42 −.26*** 27.46* 14 1527
Child externalizing behaviors .47 1.39/.54 .23*** 135.69*** 31 2874
Child internalizing behaviors .31 .22/.40 .15*** 50.62*** 23 2282
Child gender .08 −.04/.19 .04 6.10 13 1702
Prenatal or neonatal problems .08 −.03/.19 .04 15.34 10 1432
Child disability .02 −.20/.24 .01 .8 4 325
Child age −.05 −.14/.04 −.02 12.63 14 3332
Microsystem: family characteristics

Family conflict .54 .54/1.15 .39*** 16.02* 5 170
Family cohesion −.68 −.98/− .38 −.32*** 3.02 5 183
Spousal violence .46 .31/.61 .22*** 3.82 5 773
Marital satisfaction −.32 −.47/−.90 −.16*** 14.45* 8 840
Family size .31 .24/.38 .15*** 65.53*** 23 11,224
Socio-economic status −.28 −.36/− .20 −.14*** 41.45*** 16 10,321
Non-biological parent in home −.05 −.28/.17 −.03 3.25 3 302
*p b .05; **p b .01; ***p b .001.

Note. d = d-value (numerical representation of the relationship between two risk factors corrected for sample size expressed in standard deviation units); CI = Confidence Interval;
r = effect size expressed as correlation; Qw = homogeneity within; k = number of effect sizes; N = sample size.
First, the study must empirically examine the relationship between population. Thirteen studies were excluded because they contained
the identified risk factor and either child physical abuse or child duplicate samples. Twenty-nine studies were excluded because they
neglect. Second, as mentioned earlier, the maltreatment sample may did not contain relevant data that could be converted to an effect size,
not include perpetrators or victims of child sexual abuse, failure to given the statistics reported. When sufficient data were not provided
thrive, Munchausen's syndrome by proxy, or infanticide. The rationale and the study was not published before 1985, we made an attempt to
behind excluding these studies is that the profile and patterns contact the authors for these data. However, no additional data were
associated with these acts is different from those associated with received as a result of this effort. The remaining 155 studies (published
other forms of child maltreatment. Third, in order to be included, each between the years of 1969 and 2003) were retained for coding.
study must use a non-abusive comparison group. Fourth, the
perpetrators of child maltreatment in the study must be parents or 4.3. Coding
in a parenting role. Fifth, included studies must not draw their entire
sample from a special population (such as mentally handicapped A codebook was designed for use in this study to capture
parents). Sixth, each study must include the quantitative data information about individual studies including bibliographical infor-
necessary for the calculation of at least one effect size. Finally, each mation, sample information, study quality, and data for the calculation
study must use an original sample. Results from separate studies using of effect sizes. In order to resolve problems with the codebook and
the same sample were included only if they reported data that could establish consistent guidelines for coding studies, the entire research
be used to calculate effect sizes for different variables or for different team coded the first several studies. After team consensus in coding
samples. Therefore, only one study using a particular sample was became typical, two team members independently coded each of the
included in the meta-analytic review for each variable. remaining studies. Each study was then cross-coded jointly by both
The literature search yielded a large number of studies for possible coders in order to compare codes and achieve congruence. In all cases,
inclusion in the meta-analysis. This was due, in part, to the decision to the occurrence of a disagreement in coding was recorded. Overall,
use a broadly defined search. Of the 867 studies obtained, 712 were coders agreed on 82% of codebook items. The rate of disagreement
excluded from the study because they did not meet the above criteria. ranged from a low of 68% on subjective rating of study quality to 100%
Two hundred and twelve studies were excluded because they on a number of variables including type of publication outlet. When
contained no empirical data. Two hundred and sixty-eight studies discrepancies occurred, the coding pair was encouraged to discuss the
were excluded because the sample of abusers or abused children did issue and make a joint decision as to how the particular item should be
not differentiate between types of abuse (neglect or physical) or the coded. Any discrepancies or questions that could not be resolved by the
sample included emotional abuse or the study did not examine a risk coding pair were brought to the remaining research team members.
factor for child maltreatment that was on our list. Sixty-four studies
were excluded because the sample included sexual abusers or sexual 4.4. Study quality
abuse victims. One hundred and four studies were excluded for lack of a
comparison group, and eight were excluded because the comparison The quality of a meta-analysis is dependent on the quality of each
group was not non-abusive. One study was excluded because the of the studies included in the meta-analysis. If the individual studies
perpetrator of the abuse was not a parent or in a parenting role. Thirteen are of poor quality, then the results of the meta-analysis might be
studies were excluded because the entire sample represented a special questionable. In order to address this concern, the codebook included
Table 2
Overall effect sizes for child neglect risk factors
d CI r Qw k N
Microsystem: parent–child interaction/parental report of child behavior
Parent–child relationships −1.09 −1.31/−.86 −.48*** 58.16*** 11 400
Parent perceives child as problem .91 .46/1.36 .41*** 4.91 4 87
Parenting behaviors .37 .24/.50 .18*** 32.54*** 8 1016
Stress over parenting .29 .05/.53 .14** 40.82*** 4 307
Microsystem: parent characteristics independent of the child

Personal stress .81 .60/1.02 .38*** 24.84*** 3 386
Anger/hyper-reactivity .74 .42/1.06 .35*** 1.98 3 211
Self-esteem −.69 − .99/−.38 −.33*** 1.98 4 184
Psychopathology .52 .39/.66 .25*** 14.45* 8 7652
Unemployment .51 .35/.67 .25*** 8.69* 4 719
Depression .42 .32/.53 .21*** 15.93* 8 8207
Poor relationship with own parents .39 .25/.54 .19*** 15.40* 7 855
Social support −.33 − .43/−.24 −.16*** 55.11*** 13 8582
Parent experienced childhood abuse .31 .17/.45 .15*** 25.21*** 6 1417
Parent age −.25 − .36/−.13 −.12*** 19.94* 9 8120
Single parenthood .16 .03/.28 .08*** 13.41 9 7751
Microsystem: child characteristics, excluding parents

Child social competence −.62 − .81/−.43 −.30*** 10.03 7 584
Child externalizing behaviors .45 .31/.58 .22*** 35.37** 17 956
Child internalizing behaviors .22 .08/.36 .11*** 48.22*** 11 922
Child gender .03 − .17/.22 .01 .28 5 961
Child age −.02 − .23/.19 −.01 13.49 8 369
Microsystem: family factors

Family size .54 .45/.64 .26*** 75.19*** 12 8546
Socio-economic status −.39 − .51/−.28 −.19*** 36.29*** 10 7986
*p b .05; **p b .01; ***p b .001.

Note. d = d-value (numerical representation of the relationship between two risk factors corrected for sample size expressed in standard deviation units); CI = Confidence Interval;
r = effect size expressed as correlation; Qw = homogeneity within; k = number of effect sizes; N = sample size.
a scale that rated the quality of the study on eight dimensions. Study Table 3
quality scores ranged from zero (poor) to four (excellent). Only six Study, measure, sample size and effect sizes for each study used to calculate composite
effect sizes for child physical abuse
studies received a quality rating of zero (poor). Thirty-nine studies
received a quality rating of one (below average). The remaining 166 Microsystem: parent-child interaction/parent report of child behavior
studies received a rating of two (average) or three (above average). The Study Measure N Effect (r)
mean study quality score was 1.83, with a standard deviation of .60. Risk factor: parent perceives child as problem
The median/mode study quality score was 2. Removal of the poor Whipple and Webster- Child Behavior Checklist; 86 .17
studies from the analysis did not alter any effect sizes by more than Stratton (1991; fathers) Eyberg child behavior inventory
.02; therefore, no studies were excluded on the basis of quality. Bradley and Peters (1991) Eyberg child behavior inventory 16 .50⁎
Kinard (1995a,b) Child Behavior Checklist 164 .31⁎⁎⁎
Mash, Johnston and Kovitz (1983) Child Behavior Checklist 36 .56⁎⁎⁎
4.5. Data analysis Graham, Weiner, Cobb Questionnaire (this study) 47 .45⁎⁎
and Henderson (2001)
We conducted 61 meta-analyses, one for each of the risk factors Perry, Doran and Wells (1983) Washington symptom checklist 42 .36⁎
Rohrbeck and Twentyman (1986) Revised Conners parent rating 24 .24
and child physical abuse and for the same ones (when data was
scale
available) and child neglect. Because the studies included in the Salzinger, Feldman, Child Behavior Checklist 174 .30⁎⁎⁎
meta-analyses used reported various statistics, we used D-Stat: Hammer and Rosario (1993)
Software for the Meta-Analytic Review of Research Literatures Whipple and Webster- Child Behavior Checklist; 121 .31⁎⁎⁎
(Johnson, 1989) to transform all results into d-values, g-values, Stratton (1991; mothers) Eyberg child behavior inventory
Webster-Stratton (1985) Child Behavior Checklist interview 40 .13
and r-values. g-Values are a numerical representation of the Starr (1982) Questionnaire (this study) 174 .05
relationship between two variables expressed in standard deviation Smith and Hanson (1975) Interview 187 .07
units, that is, they represent the standardized mean difference Timmer, Borrego and Urquiza (2002) Child Behavior Checklist 30 .12
between the two groups (abusive and non-abusive) on the risk Williamson, Bourduin Revised behavior problem 23 .71⁎⁎⁎
and Howe (1991) checklist
factor. The value may be positive or negative, with the sign
Hamilton, Stiles, Melowsky Questionnaire (this study) 54 .45⁎⁎⁎
indicating the direction of the relationship. A value of .00 indicates and Beal (1987)
no relationship. D-values are g-values that have been corrected for Hansen, Pallotta, Tishelman, Eyberg child behavior inventory 20 .65⁎⁎
sample size. r-Values represent the relationship between two Conaway and MacMillan (1989)
variables expressed as point-biserial correlations or Pearson's r. In Salzinger, Feldman, Hammer Child Behavior Checklist 191 .27⁎⁎⁎
and Rosario (1992)
some studies, the authors reported findings as significant or non- Feldman et al. (1995) Child Behavior Checklist 166 .36⁎⁎⁎
significant but did not report specific statistics. In such cases, a Smith and Alder (1991) Interview 90 .26⁎
significance level of .05 was entered in D-Stat for findings reported Trickett, Aber, Carlson and Child Behavior Checklist 42 .58⁎⁎⁎
as significant, and a significance level of .5 was entered for findings Cicchetti (1991)
Reid, Kavanagh and Baldwin (1987) Becker bi-polar adjective 42 .40⁎⁎
reported as non-significant (Amato & Keith, 1991).
checklist; Child Behavior
Because the risk factors used in this study were not all Checklist
mutually exclusive, it was necessary to generate a single effect size Trickett (1993) Child Behavior Checklist 58 .47⁎⁎⁎
for each risk factor within each study. For example, a number of Wolfe and Mosk (1983) Child behavior profile 70 .55⁎⁎⁎
studies included data from multiple measures or scales reflecting Altemeier, O'Connor, Vietze, Interview 1400 .27⁎⁎⁎
Sandler and Sherrod (1982)
the same risk factor (as defined by this meta-analysis). To prevent
Larrance and Twentyman (1983) Coded observation 20 .39
studies producing multiple effect sizes from being over repre-
sented in the analysis, z-transformations were used to average Risk factor: unplanned pregnancy
effect sizes within a single study and produce a single effect size. Altemeier et al. (1982) 1400 .24⁎⁎⁎
Green (1976) 90 .32⁎⁎⁎
The average r-value and the total sample size were entered into
D-Stat, and a single effect size was calculated for each risk factor Risk factor: parent–child relationship
within each study. These effect sizes were used to calculate the Browne and Saqi (1988) Observation using: strange 46 −.44⁎⁎
composite effect size for the risk factor (Durlack, 1995; Johnson, situation
1989; Wampler & Serovick, 1996). Crittenden (1988b) Observation using: strange 51 −.56⁎⁎⁎
situation
Crittenden (1985a,b) Observation using: strange 20 −.90⁎⁎⁎
5. Results situation
Shipman and Zeman (2001) Emotion management 50 −.43⁎⁎
5.1. Meta-analysis results interview — child version
(this study)
Burgess and Conger (1978; fathers) Coded observation using: 36 −.11
The coded studies produced 656 distinct effect sizes reflecting the behavioral observation scoring
relationship between one of the 39 risk factors and either child system
physical abuse or child neglect. These effect sizes were used to Coohey (2000) Questionnaire (this study) 70 −.30⁎
calculate composite effect sizes for each risk factor by each form of Whipple and Webster-Stratton Coded observation 85 −.19
(1991; fathers)
maltreatment. Composite effect sizes were calculated for 39 risk
Reid, Taplin and Lorber Coded observation 35 −.23
factors and child physical abuse (see Table 1) and for 22 risk factors (1981; fathers)
and child neglect (see Table 2). No studies were found for 17 factors Burgess and Conger Observation using: behavioral 36 −.30
with child neglect. A list of each study's effect size, measures used and (1978; mothers) observation scoring system
Dietrich, Starr and Kaplan (1980) Observation using: measure of 28 −.31
sample size for physical abuse is found in Table 3 and for neglect is
maternal stimulation
found in Table 4. Cerezo and D'Ocon (1995) Coded observation using: 30 .12
Hanson (2000) has suggested one way of interpreting the Standardized Observation Codes
magnitude of effect sizes (absolute values), stating that effect sizes 3rd revision
may be considered large if they exceed r = .30, medium if they range Christopoulos, Bonvillian Coded observation 20 −.06
and Crittenden (1988)
from r = .20 to .30, and small if they range from r = .10 to .20. The
Crittenden and Bonvillian Observation: maternal coding 20 −.92⁎⁎⁎
magnitude of composite effect sizes reported in this study range (in (1984) device
absolute value) from very large (r = .48) to very small (r = .01). The
Table 3 (continued) Table 3 (continued)

Microsystem: parent-child interaction/parent report of child behavior Microsystem: parent-child interaction/parent report of child behavior
Study Measure N Effect (r) Study Measure N Effect (r)

Risk factor: parent–child relationship Risk factor: parenting behaviors
Lahey, Conger, Atkeson and Behavior observation 24 − .27 Kropp and Haynes (1987) Questionnaire (this study) 40 − .41⁎⁎
Treiber (1984) Shipman and Zeman (2001) Emotion management interview — 50 − .61⁎⁎⁎
Mash et al. (1983) Behavior observation 36 .11 mother version (this study)
Bousha and Twentyman (1984) Observation using: interactional 24 − .70⁎⁎⁎ Rosenstein (1995) Adult–adolescent parent 29 − .27
language inventory
Schindler and Arkowitz (1986) Observation using: Patterson 23 − .35 Disbrow et al. (1977a,b) Empathy scales 59 − .38⁎⁎
system
Whipple and Webster- Coded observation 120 − .21⁎ Risk factor: stress over parenting
Stratton (1991; mothers) Altemeier et al. (1982) Interview 1400 .24⁎⁎⁎
Wasserman, Green and Allen (1983) Observation using: maternal style 24 − .17 Graham et al. (2001) Parenting Stress Index 47 .43⁎⁎
scale Starr (1982) Questionnaire (this study) 174 .06
Webster-Stratton (1985) Observation using: dyadic parent– 40 − .13 Timmer et al. (2002) Parenting Stress Index 30 .47⁎⁎
child interaction coding system Chan (1994) Parenting Stress Index 72 .32⁎⁎
Reid et al. (1981; mothers) Coded observation 54 − .43⁎⁎⁎ Trickett and Susman (1988) Interview 56 .34⁎
Shipman and Zeman (1999) Mother–child interaction task 44 − .44⁎⁎ Caselles and Milner (2000) Questionnaire (this study) 60 − .22
Susman, Trickett, Iannotti, Q-sort: block child rearing practices 33 − .39⁎ Mash et al. (1983) Parenting sense of competence 36 − .51⁎⁎
Hollenbeck and Zahn-Waxler (1985) scale
Starr (1982) Caldwell's home observation 174 − .13 Rosenberg and Reppucci (1983) Interview 24 − .31
Timmer et al. (2002) Coded observation 30 − .21 Disbrow et al. (1977b) Interview 117 − .20⁎
Smith and Hanson (1975) Interview 187 − .13 Disbrow et al. (1977a,b) Questionnaire (this study) 59 .09
Hyman, Parr and Browne (1979) Coded observation 24 − .27
Kavanagh, Youngblade, Reid and Observation: interactive behavior 45 − .29 Microsystem: parent characteristics independent of child
Fagot (1988) code
Study Measure N Effect (r)
Trickett et al. (1991) Child-Rearing Practices Q-Sort 42 − .52⁎⁎⁎
Trickett and Susman (1988) Interview 56 − .14 Risk factor: anger/hyper-reactivity
Toth and Cicchetti (1996) Relatedness scales 58 .20 Shorkey and Armendariz (1985) Buss-Durkee Hostility Inventory 36 .15
Disbrow, Doerr and Caulfield Coded observation using: Barnard 59 − .71⁎⁎⁎ Spinetta (1978) Michigan screening profile of 63 .74⁎⁎⁎
(1977a,1977b) scales parenting
Robyn and Fremouw (1996) State-trait anger expression 18 .10⁎
Risk factor: parent use of corporal punishment inventory
Whipple and Webster-Stratton Parent daily report 89 .42⁎⁎⁎ Bauer and Twentyman (1985) Questionnaire (this study) 24 .48⁎
(1991; fathers) Bradley and Peters (1991) Eyberg child behavior inventory 16 .16
Smith and Hanson (1975; fathers) Interview 187 .20⁎⁎ Frodi and Lamb (1980) Mood Adjective Checklist 28 .38⁎
Whipple and Webster-Stratton Parent daily report 114 .28⁎⁎ Friedrich, Tyler and Clark (1985) Laboratory test 29 .24
(1991; mothers) Disbrow et al. (1977b) Laboratory test 117 .31⁎⁎⁎
Smith and Hanson Interview 187 .33⁎⁎⁎ Wolfe and Mosk (1983) Laboratory test 14 .16
(1975; mothers)
Trickett and Kuczynski (1986) Parent daily report 40 .17 Risk factor: parent anxiety
Trickett and Susman (1988) Interview 46 .20 NSPCC Battered Child Cattell's sixteen personality 16 .12
Webster-Stratton (1985) Interview 40 .16 Research Team (1976; fathers) factor questionnaire
Whipple and Webster- State-trait anxiety inventory 86 .17
Risk factor: parenting behaviors Stratton (1991; fathers)
Lorber, Felton and Reid (1984) Coded observation 18 − .28 NSPCC Battered Child Cattell's sixteen personality 24 .24
Shipman and Zeman (2001) Emotion management interview 50 − .37⁎⁎ Research Team (1976; mothers) factor questionnaire
Hansen et al. (1989) Parental problem-solving 20 − .47⁎ Friedrich et al. (1985) Multiple affect adjective 29 .23
measure checklist
Altemeier et al. (1982) Interview 1400 .02 Whipple and Webster- State-trait anxiety inventory 119 .21⁎
Azar, Robinson, Hekimian and Parent opinion questionnaire 20 .50⁎ Stratton (1991; mothers)
Twentyman (1984) Webster-Stratton (1985) State-trait anxiety inventory 40 .30
Caselles and Milner (2000) Questionnaire (this study) 60 .41⁎⁎ Smith, Hanson and Noble (1973) International classification of 176 .39⁎⁎⁎
Spinetta (1978) Michigan screening profile of 63 .50⁎⁎⁎ disease
parenting Robertson and Juritz (1979) DSM-II diagnosis 73 .34⁎⁎
Smith and Hanson (1975) Interview 187 .10
Hawkins and Duncan (1985b) Survey 276 .41⁎⁎⁎ Risk factor: psychopathology
Kravitz and Driscoll (1983) Vineland Social Maturity Index 60 .35⁎⁎ Smith et al. (1973; fathers) DSM-I diagnosis 113 .49⁎⁎⁎
Twentyman and Plotkin (1982) Developmental Expectation 26 .49⁎ Christensen, Brayden, Tennessee self-concept scale 33 .17
Questionnaire from: Vineland Dietrich, McLaughlin and
Social Maturity Index Sherrod (1994)
Corse, Schmid and Trickett (1990) Child-Rearing Practices Q-Sort 52 .24 Estroff et al. (1984) Brief symptom inventory 56 .27⁎
Melnick and Hurley (1969) Manifest rejection scale 20 − .48⁎ Lahey et al. (1984) State-trait anxiety inventory; 24 .59⁎
Wasserman et al. (1983) Observation using: maternal style 24 .14 Cornell medical index
scale Friedrich et al. (1985) Mini-Mult 29 .20
Susman et al. (1985) Q-sort: block child rearing practices 33 .09 Williamson et al. (1991) Symptom checklist-90-revised 23 .26
report Green, Liang, Gaines and Current and past psychopathology 40 .11
Starr (1982) Questionnaire (this study) 174 .05 Sultan (1980) scales
Webster-Stratton (1985) Interview 40 .08 Smith et al. (1973; mothers) DSM-I diagnosis 176 .61⁎⁎⁎
Letourneau (1981) Observation using: a role-play 60 .59⁎⁎⁎ Anderson and Lauderdale Tennessee self-concept scale 737 .36⁎⁎⁎
inventory (1982)
Disbrow et al. (1977b) Questionnaire (this study) 117 .38⁎⁎⁎ Hansen et al. (1989) Symptom checklist-90-revised 20 .40
Trickett and Kuczynski (1986) Parent daily report 40 .34⁎ Kelleher, Chaffin, Hollenberg Diagnostic interview schedule 338 .22⁎⁎⁎
Trickett et al. (1991) Child-Rearing Practices Q-Sort 42 .14 and Fischer (1994)
Trickett and Susman (1988) Child-rearing Practices Q-Sort 46 .15 Chaffin, Kelleher and Diagnostic interview schedule 7015 .01
Letourneau (1981) Hogan empathy test; measure 60 − .51⁎⁎⁎ Hollenberg (1996)
of empathetic responsiveness Wright (1976) Rorschach 26 .02
(continued on next page)


parent-child interaction/parent
Microsystem: parent-characteristic report
independent of child behavior
of child parent-child interaction/parent
of child

Risk factor: depression Risk factor: criminal behavior
Whipple and Webster-Stratton Beck depression inventory 86 .03 Starr (1982) Questionnaire (this study) 174 .17⁎
(1991; fathers) Altemeier et al. (1982) Interview 1400 .26⁎⁎⁎
Culp, Culp, Soulis and Letts (1989) Center for epidemiologic studies 55 .65⁎⁎⁎
depression scale Risk factor: personal stress
Chan (1994) Parenting Stress Index 72 .17 Coohey (2000) Questionnaire (this study) 70 .17
Evans (1980) Measure adapted from MMPI 40 .43⁎⁎ Whipple and Webster-Stratton Life experience survey 84 .20
Lahey et al. (1984) Beck depression inventory 24 .68⁎⁎ (1991; fathers)
Kinard (1996) CES-depression scale 232 .26⁎⁎⁎ Chan (1994) Parenting Stress Index 72 .28⁎
Mash et al. (1983) Parenting Stress Index 36 .72⁎⁎⁎ Coohey and Braun (1997) Items from: social readjustment 229 .13⁎
Friedrich et al. (1985) Multiple affect adjective checklist 29 .15 rating scale
Whipple and Webster-Stratton Beck depression inventory 119 .36⁎⁎⁎ Gaines et al. (1978) Schedule of recent experience; 160 −.09
(1991; mothers) family life form
Webster-Stratton (1985) Beck depression inventory 40 .49⁎⁎ Letourneau (1981) Social readjustment rating scale 60 .06
Zuravin and Starr (1991) Beck depression inventory 142 .16 Mash et al. (1983) Parenting Stress Index 36 .51⁎⁎
Timmer et al. (2002) Parenting Stress Index 30 .47⁎⁎ Newberger, Reed, Daniel, Interview 154 .21⁎⁎
Kelleher et al. (1994) Diagnostic interview schedule 338 .16⁎⁎ Hyde and Kotelchuck (1977)
Chaffin et al. (1996) Diagnostic interview schedule 7015 .29⁎⁎⁎ Whipple and Webster-Stratton Life experience survey 120 .44⁎⁎⁎
(1991; mothers)
Risk factor: self-esteem Webster-Stratton (1985) Life experience survey 40 .33⁎
Bradley and Peters (1991) Parental attribution test 32 .35⁎ Rosenberg and Reppucci (1983) Social readjustment rating scale 23 .57⁎⁎
Culp et al. (1989) Index of self-esteem 55 − .42⁎⁎ Williamson et al. (1991) Hassles scale 23 .49⁎
Christensen et al. (1994) Tennessee self-concept scale 33 − .21 Conger et al. (1979) Social readjustment rating scale 40 .35⁎
Altemeier et al. (1982) Interview 1400 − .28⁎⁎⁎ Hamilton et al. (1987) Social readjustment rating scale 64 .28⁎
Melnick and Hurley (1969) California test of personality 20 − .48⁎ Justice, Calvert and Justice (1985) Recent life changes questionnaire 46 .25
Shorkey and Armendariz (1985) Rosenberg self-esteem scale 36 − .02 Lawson and Hays (1989) Recent life changes questionnaire 46 .31⁎
Anderson and Lauderdale (1982) Tennessee self-concept scale 737 − .23⁎⁎⁎ Justice and Duncan (1976) Social readjustment rating scale 70 .46⁎⁎⁎
Hamilton et al. (1987) Tennessee self-concept scale 44 − .51⁎⁎⁎ Smith and Alder (1991) Interview 90 .28⁎⁎
Lawson and Hays (1989) Items from: parent child relations 46 .25 Starr (1982) Questionnaire (this study) 174 .05
questionnaire; self-description and NSPCC Battered Child Health visitor questionnaire 40 .34⁎
mate description form Research Team (1976) (this study)
Williamson et al. (1991) Interpersonal support evaluation 23 − .54⁎⁎ Smith and Alder (1991) Interview 90 .12
list Starr (1982) Questionnaire (this study) 174 .15
Disbrow et al. (1977a,b) Questionnaire (this study) 59 − .40⁎⁎ Robertson and Juritz (1979) Interview 73 .12
Altemeier et al. (1982) Interview 1400 .05⁎
Risk factor: poor relationship with own parents
Altemeier et al. (1982) Interview 1400 .22⁎⁎⁎ Risk factor: social support
Caliso and Milner (1994) Childhood social network 52 .01 Coohey (2000) Questionnaire (this study) 70 −.23
questionnaire Altemeier et al. (1982) Interview 1400 .02
Gaines, Sandgrund, Green and Michigan screening profile of 160 .05 Chan (1994) Maternal social support index 72 −.31⁎⁎
Power (1978) parenting Coohey and Braun (1997) Questionnaire (this study) 229 −.15⁎
Green (1976) Interview 90 .30⁎⁎ Corse et al. (1975) Community relationships index; 52 −.17
Whipple and Webster-Stratton (1991) Interview 122 .29⁎⁎ interview; family relationship index
Spinetta (1978) Michigan screening profile of 63 .57⁎⁎⁎ Coohey (1996) Questionnaire (this study) 195 .07
parenting Gaudin and Pollane (1983) Index of social network 98 −.39⁎⁎⁎
Zuravin and Starr (1991) Michigan screening profile of 142 .27⁎⁎ strength
parenting Mash et al. (1983) Parenting Stress Index 36 −.60⁎⁎⁎
Starr (1982) Questionnaire (this study) 174 .07 Lau and Donnan (1987) Interview 58 −.03
Smith and Hanson (1975) Interview 187 .34⁎⁎⁎ Newberger et al. (1977) Interview 154 −.21⁎⁎
Disbrow et al. (1977b) Interview 117 .22⁎ Mitchell (1990) Attachment and support systems 60 −.36⁎⁎
Wiehe (1992) Block child rearing practices report 490 .23⁎⁎⁎ questionnaire
Risk factor: parent experienced childhood abuse Zuravin and Starr (1991) Interview 142 −.23⁎⁎
Coohey (2000) Adapted from: conflict tactics scales 70 .14 Williamson et al. (1991) Interpersonal support 23 −.56⁎⁎
Smith and Alder (1991; fathers) Interview 90 .24⁎ evaluation list
Altemeier et al. (1982) Interview 1400 .14⁎⁎⁎ Newberger et al. Interview 96 −.19
Coohey and Braun (1997) Items from: conflict tactics scales 229 .23⁎⁎⁎ (1986; mothers)
Altemeier, O'Connor, Sherrod and Interview 927 .02 Smith, Hanson and Noble (1974) Interview 175 −.25⁎⁎⁎
Tucker (1986) Chaffin et al. (1996) Diagnostic interview 7015 .01
Whipple and Webster-Stratton (1991) Interview 123 .36⁎⁎⁎ schedule
Webster-Stratton (1985) Interview 40 .47⁎⁎ Disbrow et al. (1977b) Interview 117 −.44⁎⁎⁎
Smith and Alder (1991; mothers) Interview 90 .34⁎⁎ Starr (1982) Questionnaire (this study) 174 −.08
Zuravin and Starr (1991) Interview 142 .09 Smith and Alder (1991) Interview 90 −.14
Disbrow et al. (1977a,b) Questionnaire (this study) 59 .59⁎⁎⁎ Disbrow et al. (1977a,b) Questionnaire (this study) 59 −.54⁎⁎
Newberger, Hampton, Marx Interview 96 .32⁎⁎
and White (1986) Risk factor: alcohol abuse
Starr (1982) Questionnaire (this study) 174 .13 Zuravin and Starr (1991) Interview 142 .16
Mitchell (1990) Attachment and support systems 60 .80⁎⁎⁎ Starr (1982) Questionnaire (this study) 174 .00
questionnaire Kelleher et al. (1994) Diagnostic interview schedule 338 .26⁎⁎⁎
Smith and Hanson (1975) Interview 187 .19⁎
Conger, Burgess and Barrett (1979) Item from: survey on bringing up 35 .47⁎⁎ Risk factor: unemployment
children Coohey (2000) 70 −.06
Starr (1982; fathers) 174 .22⁎⁎
Risk factor: criminal behavior Crittenden (1988a,b) 51 −.10
Smith et al. (1973; fathers) Criminal records 213 .24⁎ Kinard (1995b) 231 .44⁎⁎⁎
Smith et al. (1973; mothers) Criminal records 176 .21⁎⁎ Salzinger et al. (1993) 174 .05

parent-child interaction/parent
of child parent-child interaction/parent
of child
Risk factor: unemployment Risk factor: age
Starr (1982; mothers) 174 .08 Hansen et al. (1989) 20 .25
Zuravin (1988) 399 .13⁎⁎ Wiehe (1992) 294 −.07
Shipman and Zeman (2001) 50 .07 Robyn and Fremouw (1996) 18 .80⁎⁎⁎
Risk factor: coping and problem-solving skills Risk factor: drug abuse
Cantos, Neale, O'Leary Problem solving inventory 33 − .50⁎⁎ Zuravin and Starr (1991) Interview 142 .02
and Gaines (1997) Starr (1982) Questionnaire (this study) 174 .02
Gaines et al. (1978) Michigan screening profile of 160 − .14 Kelleher et al. (1994) Diagnostic interview schedule 338 .14⁎
parenting
Justice et al. (1985) Family environment scale; social 46 .12 Risk factor: health problems
support system inventory; social Chan (1994) Parenting Stress Index 72 .12
information form Starr (1982) Questionnaire (this study) 174 .05
Robyn and Fremouw (1996) Social problem solving 18 − .78 Conger et al. (1979) Cornell medical index 40 .35⁎
inventory — rev
Risk factor: parent gender
Risk factor: single parent Chaffin et al. (1996) 7015 .08⁎⁎⁎
Coohey (2000) 70 − .16 Wiehe (1992) 294 .05⁎
Gelles (1989; fathers) 1582 .29⁎⁎⁎
Connelly and Straus (1992) 1997 − .02 Risk factor: approval of corporal punishment
Coohey (1996) 195 .17⁎ Coohey (2000) Item from: general social science 70 .11
Crittenden and DiLalla (1988) 43 .06 survey
Gelles (1989; mothers) 1582 .06⁎ Altemeier et al. (1982) Interview 1400 .21⁎⁎⁎
Gaines et al. (1978) 160 .05 Newberger et al. (1986) Interview 96 −.11
Lau and Donnan (1987) 58 .31⁎ Kelley, Grace and Elliott (1990) Treatment evaluation inventory 62 .03
Graham et al. (2001) 47 .16 Trickett and Susman (1988) Interview 46 −.05
Salzinger et al. (1993) 174 .05
Webster-Stratton (1985) 40 .37⁎ Microsystem: child characteristics, excluding parents
Starr (1982) 174 .10
Finzi, Har-Even and Weizman (2003) 76 .05
Smith et al. (1974) 175 .27⁎⁎⁎ Risk factor: child social competence
Timmer et al. (2002) 30 .18 Kinard (1995a,b) Child Behavior Checklist; teacher's 164 −.13
Shipman and Zeman (2001) 50 − .12 report form of the child behavior
Chaffin et al. (1996) 7015 .01 profile
Corey, Miller and Widlak (1975) 98 − .07 Perry et al. (1983) Developmental profile 42 −.51⁎⁎⁎
Hoffman-Plotkin and Twentyman 28 − .29 Daniel, Hampton and Newberger Vineland Social Maturity Index 32 −.35⁎
(1984) (1983)
Sack, Mason and Higgins (1985) 436 .11⁎ Hoffman-Plotkin and Twentyman Child behavior form 28 −.53⁎⁎
Whipple and Webster-Stratton (1991) 123 .22⁎ (1984)
Wolfe and Mosk (1983) 70 .25⁎ Haskett and Kistner (1991) Coded observation 28 −.37⁎
Howes and Espinosa (1985) Coded observation 52 −.58⁎⁎⁎
Risk factor: age Klimes-Dougan and Kistner (1990) Coded observation 22 −.19
NSPCC Battered Child Research Team 16 − .47 Frodi and Smetana (1984) Rothenberg social sensitivity test 48 −.10
(1976; fathers) Salzinger et al. (1993) Peer ratings 174 −.25⁎⁎
Lauer, Tenbroeck and Grossman 243 − .13⁎ Rogosch and Cicchetti (1994) California child Q-set; teacher's 86 −.33⁎⁎
(1974; fathers) report; teacher's rating scale of
Whipple and Webster-Stratton 109 .00 child's actual behavior
(1991; fathers) Flisher, Kramer, Hoven and Instrumental and social 665 −.19⁎⁎⁎
Smith and Alder (1991; fathers) 90 − .23⁎ Greenwald (1997) competence scale
Fundudis, Kaplan and Dickinson 48 − .94⁎⁎⁎ Trickett (1993) Child Behavior Checklist 58 −.23
(2003; fathers) Toth and Cicchetti (1996) Self-perception profile for 58 −.28⁎
Connelly and Straus (1992) 1997 − .07⁎⁎ children
NSPCC Battered Child Research Team 24 − .59⁎⁎ Wolfe and Mosk (1983) Child behavior profile 70 −.50⁎⁎⁎
(1976; mothers)
DiLalla and Crittenden (1990) 79 − .19⁎ Risk factor: child externalizing behavior
Gaines et al. (1978) 160 − .06 Bousha and Twentyman (1984) Observation using: interactional 24 .64⁎⁎⁎
Kinard (1995b) 231 .04 language
Letourneau (1981) 60 .07 George and Main (1979) Coded observation 20 .42
Lau and Donnan (1987) 58 − .03 Kinard (1995a,b) Teacher's report form of the child 164 .09
Friedrich et al. (1985) 29 .30 behavior profile
Graham et al. (2001) 47 .07 Williamson et al. (1991) Revised behavior problem checklist 23 .64⁎⁎⁎
Lauer et al. (1974; mothers) 243 − .21⁎⁎⁎ Green (1976) Interview 90 .51⁎⁎⁎
Salzinger et al. (1993) 174 .05 de Paul and Arruabarrena (1995) Teacher's report form of child 41 .29
Whipple and Webster-Stratton 121 − .37⁎⁎⁎ behavior profile
(1991; mothers) Jacobson and Straker (1982) Coded observation 57 .18
Webster-Stratton (1985) 40 − .18 Hoffman-Plotkin and Twentyman Coded observation; child behavior 28 .39⁎
Smith and Alder (1991; mothers) 90 − .24⁎ (1984) form
Shipman and Zeman (1999) 44 − .02 Haskett and Kistner (1991) Coded observation 28 .42⁎
Zuravin and Starr (1991) 152 .02 Reidy, Anderegg, Tracy and Colter Behavior problem checklist 40 .48⁎⁎
Williamson et al. (1991) 23 − .37 (1980)
Starr (1982) 174 .05 Salzinger et al. (1993) Self and peer ratings: teachers 174 .20⁎⁎
Timmer et al. (2002) 30 .12 report form of child behavior profile
Fundudis et al. (2003; mothers) 58 − .95⁎⁎⁎ Prino and Peyrot (1994) Pittsburgh adjustment survey scale 42 .69⁎⁎⁎
Zuravin (1988) 399 − .19⁎⁎⁎ Toth, Manly and Cicchetti (1992) Child Behavior Checklist 118 .12
Shipman and Zeman (2001) 50 − .05 Howes and Eldredge (1985) Coded observation 18 .72⁎⁎
Chaffin et al. (1996) 7015 − .11⁎⁎⁎
(continued

parent-child
Microsystem: child interaction/parent
characteristics, report of child behavior
excluding parents Microsystem: parent-child interaction/parent
child characteristics, report of child behavior
excluding parents

Risk factor: child externalizing behavior Risk factor: child gender
Rohrbeck and Twentyman (1986) Conners teacher rating scale 24 .15 Bolger and Patterson (2001) 214 .01
Milner and Robertson (1990) Child abuse potential inventory 60 .42⁎⁎⁎ Lauer et al. (1974) 243 − .01
Lynch and Cicchetti (1998) Child Behavior Checklist; checklist 206 .12 Whipple and Webster-Stratton (1991) 123 .10
of child distress symptoms Webster-Stratton (1985) 40 .14
Salzinger et al. (1992) Teacher's report form of the child 191 .16⁎ Ten Bensel and Baxon (1973) 20 − .20
behavior profile
Feldman et al. (1995) Teacher's report form of the child 166 .27⁎⁎⁎ Risk factor: child pre- or neonatal problems
behavior profile Crittenden (1988a,b) Interview 51 − .17
Rogosch and Cicchetti (1994) California child Q-set; teacher's 86 .38⁎⁎⁎ Lynch (1975) Hospital records 60 .45⁎⁎⁎
report form of child behavior Lau and Donnan (1987) Interview 58 .09
profile; teacher's rating scale of Perry et al. (1983) Questionnaire (this study) 42 .09
child's actual behavior Starr (1982) Questionnaire (this study) 174 − .03
Waldinger et al. (2001) Coded observation using: core 49 .89⁎⁎⁎ Corey et al. (1975) Hospital records 98 .01
conflictual relationship theme Smith and Alder (1991) Interview 90 .00
method Flisher et al. (1997) Diagnostic interview schedule for 665 .06
Flisher et al. (1997) Diagnostic interview schedule for 665 .14⁎⁎⁎ children
children Ten Bensel and Baxton (1973) Hospital records 20 .00
Toth and Cicchetti (1996) Self-perception profile for children 58 .21 Starr (1988) Hospital records 174 − .02
Reid et al. (1987) Coded observation 42 .10
Crittenden (1988b) Coded observation 51 .13 Risk factor: child disability
Mash et al. (1983) Parenting Stress Index 36 .50⁎⁎ Crittenden (1988a,b) Interview 51 .09
Newberger et al. (1986) Infant scales 96 .22⁎ Lau and Donnan (1987) Interview 58 .00
Schindler and Arkowitz (1986) Observation using: Patterson 23 .45⁎ Perry et al. (1983) Questionnaire (this study) 42 .08
system Starr (1982) Questionnaire (this study) 174 − .03
Webster-Stratton (1985) Observation using: dyadic 40 .28
parent–child interaction Risk factor: child age
coding system Connelly and Straus (1992) 1997 − .03
Trickett and Kuczynski (1986) Parent daily report 40 .53⁎⁎⁎ Crittenden (1988a,b) 51 − .30⁎
Starr (1982) Questionnaire (this study) 174 − .04 During and McMahon (1991) 46 − .14
Crittenden and DiLalla (1988) 43 .02
Risk factor: child internalizing behavior DiLalla and Crittenden (1990) 79 .08
Kinard (1995a,b) Teacher's report form of the child 164 .15 Friedrich et al. (1985) 29 .27
behavior profile Williamson et al. (1991) 23 − .20
Chan (1994) Parenting Stress Index 72 .26⁎ Hansen et al. (1989) 20 .23
Mash et al. (1983) Child Behavior Checklist 36 .60⁎⁎⁎ Hoffman-Plotkin and Twentyman 28 − .08
Rohrbeck and Twentyman (1986) Conners teacher rating scale; 24 .14 (1984)
revised Conners parent rating scale Whipple and Webster-Stratton (1991) 123 .00
Webster-Stratton (1985) Child Behavior Checklist 40 .19 Webster-Stratton (1985) 40 − .08
Williamson et al. (1991) Revised behavior problem checklist 23 .20 Flisher et al. (1997) 665 .00
Timmer et al. (2002) Child Behavior Checklist 30 .12 Wolfe and Mosk (1983) 70 − .20
de Paul and Arruabarrena (1995) Teacher's report form of the child 41 .21 Toth et al. (1992) 118 .01
behavior profile
Jacobson and Straker (1982) Coded observation 57 .45⁎⁎⁎ Microsystem: family factors
Haskett and Kistner (1991) Preschool behavior questionnaire 28 .31
Lynch and Cicchetti (1998) Child Behavior Checklist; checklist 206 .09
of child distress symptoms Risk factor: family conflict
Reidy et al. (1980) California child Q-set; behavior 40 .26 Evans (1980) Family concept inventory 40 .52⁎⁎⁎
problem checklist Davis and Graybill (1983) Moos family environment scale 30 .28
Feldman et al. (1995) Teacher's report form of the child 166 .22⁎⁎ Howes, Cicchetti, Toth and Rogosch Coded observation 42 .05
behavior profile (2000)
Salzinger et al. (1993) Self and peer ratings 174 − .02 Trickett et al. (1991) Family environment scale 42 .52⁎⁎⁎
Rogosch and Cicchetti (1994) California child Q-set; teacher's 86 .07 Silber, Bermann, Henderson and Coded observation 16 .82⁎⁎⁎
report form of child behavior Lehmen (1993)
profile; teacher's rating scale of
child's actual behavior Risk factor: family cohesion
Trickett et al. (1991) Child Behavior Checklist 42 .48⁎⁎ Williamson et al. (1991) Family adaptability and cohesion 23 − .36
Prino and Peyrot (1994) Pittsburgh adjustment survey scale 42 − .12 evaluation scales-II
Flisher et al. (1997) Diagnostic interview schedule for 665 .10⁎⁎ Davis and Graybill (1983) Moos family environment scale 30 − .24
children Justice and Calvert (1990) Family environment scale 46 − .44⁎⁎
Wolfe and Mosk (1983) Child behavior profile 70 .34⁎⁎ Howes et al. (2000) Coded observation 42 − .15
Toth et al. (1992) Children's depression inventory 118 .02 Trickett et al. (1991) Family environment scale 42 − .42⁎⁎
Trickett (1993) Child Behavior Checklist 58 .52⁎⁎⁎
Toth and Cicchetti (1996) Children's depression inventory 58 − .01 Risk factor: spousal violence
Reid et al. (1987) Child Behavior Checklist 42 .10 Coohey and Braun (1997) Items from: conflict tactics scales 229 .13⁎
Green (1976) Interview 90 .23⁎
Risk factor: child gender Starr (1982) Questionnaire (this study) 174 .20⁎⁎
Crittenden (1988a,b) 51 .20 Smith and Alder (1991) Interview 90 .22⁎
DiLalla and Crittenden (1990) 79 − .08 Cox, Kotch and Everson (2003) Questionnaire (this study) 190 .39⁎⁎⁎
Lau and Donnan (1987) 58 .14
Williamson et al. (1991) 24 .08 Risk factor: marital satisfaction
Timmer et al. (2002) 30 .07 Whipple and Webster-Stratton Marital adjustment test 82 − .06
Corey et al. (1975) 95 .02 (1991; fathers)
Cohen, Brown and Smailes (2001) 607 .13⁎⁎ Chan (1994) Parenting Stress Index 72 − .20
Dubowitz, Hampton, Bithoney and 115 .06 Lau and Donnan (1987) Interview 58 − .17
Newberger (1987) Robertson and Juritz (1979) Interview 73 − .44⁎⁎⁎
Table 3 (continued) Table 4

parent-child
Microsystem: family factorsinteraction/parent report of child behavior Study, measure, sample size and effect sizes for each study used to calculate composite
effect sizes for child neglect
Microsystem: parent-child interaction/parent report of child behavior
Risk factor: marital satisfaction
Whipple and Webster-Stratton Marital adjustment test 91 − .26⁎ Study Measure N Effect (r)
(1991; mothers)
Risk factor: parent–child relationship
Green (1976) Interview 90 − .14 Burgess and Conger Observation using: behavioral 36 −.43⁎⁎
Starr (1982) Questionnaire (this study) 174 .03 (1978; fathers) observation scoring system
Smith et al. (1974) Interview 290 − .21⁎⁎⁎ Burgess and Conger Observation using: behavioral 36 −.22
(1978; mothers) observation scoring system
Risk factor: family size
Christopoulos et al. (1988) Coded observation 20 −.35
Coohey (2000) 70 .23⁎ Crittenden and Bonvillian Observation using: maternal coding 20 −.97⁎⁎⁎
Connelly and Straus (1992) 1997 .12⁎⁎⁎ (1984) device
Chan (1994) 72 .29⁎ Fagan and Dore (1993) Parent/caregiver involvement scale 27 −.30
Crittenden (1988a,b) 51 .21 Lacharite et al. (1996) Parenting Stress Index/short form 48 −.54⁎⁎⁎
Coohey (1996) 195 .05 Bousha and Twentyman Observation using: interactional 24 −.74⁎⁎⁎
DilLalla and Crittenden (1990) 79 .00 (1984) language
Letourneau (1981) 60 − .03
Toth and Cicchetti (1996) Relatedness scales 59 −.21
Friedrich et al. (1985) 29 .43⁎
Disbrow et al. (1977a,b) Coded observation using: Barnard scales 61 −.61⁎⁎⁎
Graham et al. (2001) 47 .38⁎⁎ Crittenden (1988b) Coded observation 49 −.50⁎⁎⁎
Salzinger et al. (1993) 174 .05 Crittenden (1985a,b) Coded observation 20 −.90⁎⁎⁎
Webster-Stratton (1985) 40 .00
Shipman and Zeman (1999) 44 .10 Risk factor: parent perceives child as problem
Zuravin and Starr (1991) 142 .31⁎⁎⁎ Rohrbeck and Twentyman Revised Conners parent rating scale 24 .42⁎
Williamson et al. (1991) 23 .31 (1986)
Smith et al. (1974) 187 .21⁎⁎
Hansen et al. (1989) Eyberg child behavior inventory 20 .29
Chaffin et al. (1996) 7015 .13⁎⁎⁎
Williamson et al. (1991) Revised behavior problem checklist 23 .69⁎⁎⁎
Hansen et al. (1989) 20 − .13 Larrance and Twentyman Interview 20 .24
Manly, Cicchetti and Barnett (1994) 162 .34⁎⁎⁎ (1983)
Wolfe and Mosk (1983) 70 − .08
Toth et al. (1992) 118 .04 Risk factor: parenting behaviors
Trickett and Susman (1988) 56 .09 Azar et al. (1984) Parent Problem Solving Instrument 20 −.49⁎
Starr (1982) 174 .05 Hansen et al. (1989) Parental problem-solving measure 20 −.46⁎
Zuravin (1988) 399 .39⁎⁎⁎
Azar et al. (1984) Parent opinion questionnaire 20 .70⁎⁎⁎
Jones and McNeely (1980) Questionnaire (this study) 58 .24
Risk factor: socio-economic status Spinetta (1978) Michigan screening profile of parenting 65 .35⁎⁎
Webster-Stratton (1985) 40 − .27 Hawkins and Duncan Survey 647 .14⁎⁎⁎
Chaffin et al. (1996) 7015 .01 (1985b)
Whipple and Webster-Stratton (1991) 123 − .49⁎⁎⁎ Twentyman and Plotkin Developmental Expectation 27 .54⁎⁎
Smith et al. (1973) 170 − .25⁎⁎⁎ (1982) Questionnaire from: Vineland Social
Price and Glad (2003) 75 − .26⁎
Maturity Index
Smith et al. (1974) 91 − .31⁎⁎
Disbrow et al. (1977a,b) Questionnaire (this study) 61 .27⁎
Connelly and Straus (1992) 1997 − .04⁎ Disbrow et al. (1977b) Interview, coded observation using 118 .44⁎⁎⁎
Crittenden (1988a,b) 51 − .19 Barnard scales; questionnaire
Coohey (1996) 195 − .13
Kinard (1995b) 231 − .29⁎⁎⁎ Risk factor: stress over parenting
Graham et al. (2001) 47 − .37⁎⁎ Ethier, Lacharite and Parental stress index 80 .47⁎⁎⁎
Webster-Stratton (1985) 40 − .45⁎⁎ Couture (1995)
Letourneau (1981) 60 − .21
Lacharite et al. (1996) Parental stress index short form 48 .54⁎⁎⁎
Hansen et al. (1989) 20 − .32
Disbrow et al. (1977a,b) Questionnaire (this study) 61 .09
Hoffman-Plotkin and Twentyman 28 − .08 Disbrow et al. (1977b) Interview, coded observation using 118 −.31⁎⁎⁎
(1984) Barnard scales, questionnaire
Gaines et al. (1978) 160 − .15
Howes and Eldredge (1985) 18 − .18 Microsystem: parent characteristics independent of child
Risk factor: non-biological parent Study Measure N Effect (r)

Coohey (2000) 70 − .19
Risk factor: personal stress
Starr (1982) 174 − .02
Gaudin, Polansky, Checklist of stressful life events 203 .52⁎⁎⁎
Lau and Donnan (1987) 58 .13
Kilpatrick and Shilton
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.005. (1993)
Gaines et al. (1978) Schedule of recent experience family life 160 .13
form (this study)
Williamson et al. (1991) Hassles scale 23 .73⁎⁎⁎
Risk factor: anger/hyper-reactivity

mean effect size is r = .22. Large effect sizes were found between child
⁎Friedrich et al. (1985) Multiple affect adjective checklist 28 .42⁎
physical abuse and three risk factors (parent anger/hyper-reactivity, Spinetta (1978) Michigan screening profile on 65 .67⁎⁎⁎
family conflict and family cohesion). Fifteen moderate effect sizes and parenting
fifteen small, but significant effect sizes were also calculated between Disbrow (1977b) Interview, coded observation using 118 .20⁎
child physical abuse and risk factors. Seven effect sizes were found to Barnard scale, questionnaire
be insignificant (i.e., parent health problems, approval of corporal

Risk factor: self-esteem
punishment, child gender, prenatal or neonatal problems, disability Christensen et al. (1994) Tennessee self-concept scale 44 −.34⁎
and age, and non-biological parent in home). Culp et al. (1989) Index of self-esteem 56 −.27⁎
Large effect sizes were found between child neglect and five risk Disbrow et al. (1977a,b) Questionnaire (this study) 61 −.29⁎
Williamson et al. (1991) Interpersonal support 23 −.55⁎⁎
factors (parent–child relationship, parent perceives child as problem,
evaluation list
parent level of stress, parent anger/hyper-reactivity, and parent self-
(continued
esteem). Six moderate effect sizes and nine small but significant effect

parent-child
Microsystem: parent interaction/parent
characteristics report
of child Microsystem: parent characteristics
parent-child independent
interaction/parent of child
report of child behavior

Risk factor: psychopathology Risk factor: single parent
Christensen et al. (1994) Tennessee self-concept scale 44 .27 Coohey (1996) 219 −.03
Estroff et al. (1984) Brief symptom inventory 43 − .01 Crittenden and DiLalla 45 .37⁎
Friedrich et al. (1985) Mini-Mult 28 .32 (1988)
Williamson et al. (1991) Symptom checklist-90-revised 23 .31 Fagan and Dore (1993) 27 .11
Green et al. (1980) Current and past psychopathology scales 40 .05 Gaines et al. (1978) 160 .05
Hansen et al. (1989) Symptom checklist-90-revised 20 .21 Sherrod et al. (1984) 38 .42⁎⁎
Kelleher et al. (1994) Diagnostic interview schedule 418 .36⁎⁎⁎ Finzi et al. (2003) 73 .19
Chaffin et al. (1996) Diagnostic interview schedule 7036 .15⁎⁎⁎ Chaffin et al. (1996) 7036 .03⁎
Hoffman-Plotkin and 28 .08
Risk factor: unemployment Twentyman (1984)
Crittenden (1988a,b) 49 .10 Polansky et al. (1979) 125 .16
Kinard (1995b) 232 .40⁎⁎⁎
Sherrod, O'Connor, Vietze 38 .24 Microsystem: child characteristics, excluding parents
and Altemeier (1984)
Zuravin (1988) 400 .18⁎⁎⁎
Risk factor: child social competence
Risk factor: depression Newberger et al. (1986) Vineland Social Maturity Index 82 −.29⁎⁎
Culp et al. (1989) Center for epidemiologic studies 56 .51⁎⁎⁎ Kinard (1999) Child Behavior Checklist 232 −.31⁎⁎⁎
depression scale Hoffman-Plotkin and Child behavior form 28 −.53⁎⁎
Ethier et al. (1995) Beck depression inventory 80 .22⁎ Twentyman (1984)
Gaudin et al. (1993) Hudson's generalized contentment scale 205 .30⁎⁎⁎ Howes and Espinosa (1985) Coded observation 52 −.79⁎⁎⁎
Kinard (1996) CES-depression scale 232 .26⁎⁎⁎ Frodi and Smetana (1984) Rothenberg social sensitivity test 52 −.09
Friedrich et al. (1985) Multiple affect adjective checklist 28 .36 Rogosch and Cicchetti CA child Q-set; teacher's form of child 79 −.25⁎
Zuravin and Starr (1991) Beck depression inventory 152 .27⁎⁎⁎ (1994) behavior profile
Kelleher et al. (1994) Diagnostic interview schedule 418 .10⁎ Toth and Cicchetti (1996) Self-perception profile for children 59 −.22
Chaffin et al. (1996) Diagnostic interview schedule 7036 .16⁎⁎⁎
Risk factor: child externalizing behaviors
Risk factor: poor relationship with own parents Bousha and Twentyman Observation using: interactional 24 .53⁎⁎
Polansky, Chalmers, Interview 125 .35⁎⁎⁎ (1984) language
Buttenwieser and Williamson et al. (1991) Revised behavior problem checklist 23 .67⁎⁎⁎
Williiams (1981) Green (1976) Interview 60 .42⁎⁎⁎
Coohey (1995) Questionnaire (this study) 175 .15⁎ de Paul and Arruabarrena Teacher's report form of the child 49 .33⁎
Gaines et al. (1978) Michigan screening profile of parenting 160 .04 (1995) behavior profile
Green (1976) Interview 60 .15 Hoffman-Plotkin and Coded observation; child behavior form 28 .21
Spinetta (1978) Michigan screening profile of parenting 65 .46⁎⁎⁎ Twentyman (1984)
Zuravin and Starr (1991) Interview 152 .12 Reidy et al. (1980) Behavior problem checklist 36 .43⁎⁎
Disbrow et al. (1977b) Interview 118 .37⁎⁎⁎ Prino and Peyrot (1994) Pittsburgh adjustment survey scale 47 −.17
Toth et al. (1992) Child Behavior Checklist 107 .18
Risk factor: social support Rohrbeck and Twentyman Conners teacher rating scale 24 .30
Polansky et al. Interview 72 − .30⁎⁎ (1986)
(1981; fathers) de Paul and Arruabarrena Teacher's report form of the child 49 .46⁎⁎⁎
Coohey (1996) Questionnaire (this study) 219 − .21⁎⁎ (1995) behavior profile
Gaudin et al. (1993) Social network map 205 − .18⁎ Milner and Robertson (1990) Child abuse potential inventory 60 .28⁎
Jones and McNeely (1980) Questionnaire (this study) 58 − .17 Lynch and Cicchetti (1998) Child Behavior Checklist; checklist of 200 .07
Polansky et al. (1981) Interview 306 − .10 child distress; Levonn measure
Zuravin and Starr (1991) Interview 152 − .16⁎ Reyome (1993) Child Behavior Checklist 63 .15
Williamson et al. (1991) Interpersonal support evaluation list 23 − .76⁎⁎⁎ Rogosch and Cicchetti California child Q-set; teacher's report 79 .09
Polansky et al. Interview 125 − .29⁎⁎⁎ (1994) form of child behavior profile; teacher's
(1981; mothers) rating scale of child's actual behavior
Newberger et al. (1986) Interview 82 .19 Toth and Cicchetti (1996) Self-perception profile for children 59 .12
Chaffin et al. (1996) Diagnostic interview schedule 7036 .01 Crittenden (1988b) Coded observation 49 .17
Disbrow et al. (1977b) Interview 118 − .47⁎⁎⁎ Lacharite et al. (1996) Parenting Stress Index/short form 48 .55⁎⁎⁎
Polansky et al. (1981) Interview 125 − .29⁎⁎⁎
Disbrow et al. (1977a,b) Questionnaire (this study) 61 − .37⁎⁎ Risk factor: child internalizing behavior
Kinard (1995b) Harter dimensions of depression profile 232 −.04
Risk factor: parent experienced childhood abuse for children
Polansky et al. Interview 72 − .06 Rohrbeck and Twentyman Conners teacher rating scale; revised 24 .36
(1981; fathers) (1986) Conners parent rating scale
Polansky et al. Interview 125 .45⁎⁎⁎ Williamson et al. (1991) Revised behavior problem checklist 23 .18
(1981; mothers) de Paul and Arruabarrena Teacher's report form of the child 49 .15
Altemeier et al. (1986) Interview 927 .02 (1995) behavior profile
Ethier et al. (1995) Psychosocial interview 80 .23⁎ Lynch and Cicchetti (1998) Child Behavior Checklist; checklist of 200 .08
Zuravin and Starr (1991) Interview 152 .16⁎ child distress symptoms
Disbrow et al. (1977a,b) Questionnaire (this study) 61 .37⁎⁎ Reyome (1993) Child Behavior Checklist 66 .29⁎
Reidy et al. (1980) California child Q-set; behavior problem 36 .11
Risk factor: age checklist
DiLalla and Crittenden (1990) 69 − .15 Rogosch and Cicchetti California child Q-set; teacher's report 79 .08
Gaines et al. (1978) 160 − .03 (1994) form of child behavior profile; teacher's
Kinard (1995b) 232 .04 rating scale of child's actual behavior
Friedrich et al. (1985) 28 .21 Prino and Peyrot (1994) Pittsburgh adjustment survey scale 47 .81⁎⁎⁎
Zuravin and Starr (1991) 152 − .04 Toth et al. (1992) Children's depression inventory 107 −.05
Williamson et al. (1991) 23 − .03 Toth and Cicchetti (1996) Children's depression inventory 59 .10
Zuravin (1988) 400 − .26⁎⁎⁎
Chaffin et al. (1996) 7036 − .17⁎⁎⁎ Risk factor: child gender
Hansen et al. (1989) 20 .23 Crittenden (1988a,b) 49 .06
Table 4 (continued) Clearly, studying or intervening to prevent or treat child maltreatment

Microsystem: child characteristics,
parent-child excluding parents
interaction/parent report of child behavior must include risk factors at each level of the macrosystem.
Study Measure N Effect (r) Furthermore, we found that many of the same risk factors were
Risk factor: child gender
associated with child physical abuse as with neglect. Parent perception
DiLalla and Crittenden 69 .03 of the child as a problem and parent anger/hyper-reactivity were
(1990) important risk factors for physical abuse and for neglect. The quality of
Williamson et al. (1991) 23 − .02 the parent–child relationship was a strongly related factor in neglect
n = 23
and a moderately related factor in physical abuse. Child social
Cohen et al. (2001) n = 606 606 − .03
Bolger and Patterson 214 .02 competence was moderately related to child neglect and to child
(2001) n = 214 physical abuse. Child age and gender were not found to be significantly
related to either form of maltreatment, and parent age was also found
Risk factor: child age
to have a small relationship to each form of maltreatment.
Crittenden (1988a,b) 49 − .38⁎⁎
Crittenden and DiLalla 45 − .18
However, there were differences in which factors were most strongly
(1988) related to neglect and child physical abuse. For example, risk factors
DiLalla and Crittenden 69 − .05 strongly related to neglect but not strongly related to physical abuse
(1990) included factors pertaining perhaps to personal adequacy, competency,
Friedrich et al. (1985) 28 .08
or resilience (i.e., parent self-esteem and stress). In the same vein, parent
Williamson et al. (1991) 23 .04
Hansen et al. (1989) 20 .30 unemployment and family size were both moderately related to neglect
Hoffman-Plotkin and 28 .00 and only minimally related to child physical abuse. Thus, it appears that
Twentyman (1984) the phenomena of child neglect may be different from child physical
Toth et al. (1992) 107 .17 abuse and deserves its own investigation into cause and treatment.
Microsystem: family factors
Currently, considerably more research has gone into understanding
child physical abuse than in understanding child neglect.
Risk factor Measure N Effect (r)
The results of this meta-analysis also illustrate which variables are
Family size most strongly related to child physical abuse and neglect throughout the
Crittenden (1988a,b) 49 .00
literature as a whole. It is interesting to note that the most frequently
Coohey (1996) 219 .05
DilLalla and Crittenden 69 .17 studied parent-related risk factors in child physical abuse pertain to
(1990) factors such as parent stress, parent social support, and single
Friedrich et al. (1985) 28 .41⁎ parenthood. This meta-analysis, however, showed some less frequently
Polansky et al. (1985) 306 .26⁎⁎⁎ studied factors (e.g., parent anger/hyper-reactivity, anxiety, and psy-
Zuravin and Starr (1991) 152 .45⁎⁎⁎
chopathology) to be more strongly related than these to physical abuse.
Williamson et al. (1991) 23 .18
Chaffin et al. (1996) 7036 .13⁎⁎⁎ An exception to this is that parent perception of the child as a problem is
Hansen et al. (1989) 20 − .04 frequently studied as well as important risk factor for both physical
Manly et al. (1994) 137 .11 abuse and neglect. Although child misbehavior (i.e., externalizing
Toth et al. (1992) 107 .22⁎
behaviors) is a popular topic of study relating to both child physical
Zuravin (1988) 400 .55⁎⁎⁎
abuse and child neglect, maltreatment is more strongly related to the
Socio-economic status perceptions of the parent regarding the child's behavior than to other
Crittenden (1988a,b) 49 − .39⁎⁎ indicators of child behavior. Furthermore, only three child factors were
Polansky et al. (1985) 153 − .10 significantly related to abuse or neglect (i.e., child social competence,
Coohey (1996) 219 − .04
child externalizing behavior, and child internalizing behavior). However,
Kinard (1995b) 232 − .48⁎⁎⁎
Gaines et al. (1978) 160 − .06 it is important to note that the direction of causality is uncertain.
Hansen et al. (1989) 20 − .18
Hoffman-Plotkin and 28 .00 6.1. Limitations
Twentyman (1984)
Howes and Eldredge (1985) 8 − .13
Chaffin et al. (1996) 7036 − .16⁎⁎⁎ This meta-analysis is subject to a number of limitations that should
Price and Glad (2003) 81 − .42⁎⁎⁎ be considered when interpreting the results. First, it is impossible to
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.005.
include every source of relevant data on each of the risk factors
considered. As a result, studies that would have dramatically influenced
the results may have been overlooked. Because of the volume of
sizes were also calculated. Two effect sizes were found to be insignificant literature on the subject of child maltreatment and the infeasibility of
in relationship to child neglect (i.e., child gender and child age). searching multiple databases and sources, only the foremost database
on the subject was searched (PsychINFO). This search was also
6. Discussion supplemented by searches of the references of several large literature
reviews on the subject and of the references of the studies reviewed in
This study was guided by Bronfenbrenner's (1979) ecological this meta-analysis. However, some studies were likely excluded because
theory. We predicted that variables within the parent–child interac- they were cited in other databases or sources that were not searched.
tion and/or parent's report of child behavior level of the microsystem Some potentially relevant studies that were found through the database
would be most proximal to the issue of child maltreatment and would search were published in obscure sources or were otherwise unable to
have the strongest effect sizes. In fact, the two strongest risk factors for be obtained. In addition, we did not include unpublished dissertations in
neglect (parent child relationships and parent perception of child as our data set. Some relevant studies were omitted because the results
problem) were from this level. However, the strongest effect sizes for could not be converted to effect sizes. Furthermore, a number of the
child physical abuse were parent factors independent of child (parent largest effect sizes were obtained with relatively few studies. For
anger/hyper-reactivity) and family factors (high family conflict and example, only two effect sizes were used to calculate unplanned
low family cohesion) which we had predicted would be most distal pregnancy which had a strong effect size. Effect sizes based on smaller
from the abuse. These results provide support for the importance of samples or smaller numbers of studies are at greater risk for bias due to
examining child maltreatment from a multi-factoral perspective. omission. Furthermore, there exists the possibility of “file drawer bias”
that suggests studies that do not find significant results are less likely to abuse (unplanned pregnancy, parent use of corporal punishment,
be submitted for publication (Hunter & Schmidt, 1990). parent anxiety, past criminal behavior, family conflict, family cohe-
A second limitation of this study pertains to the construction and sion, and spousal violence) were not found in the literature review for
definition of risk factors examined in the study. It is likely that the study child neglect. A clear implication for future research involves the need
variables actually encompass one or more mediating variables or overlap for more research on child neglect.
with one another. A measure of homogeneity, Qw, was calculated for each In addition, future research needs to be conducted with subsets of
of the study variables. For many of the variables, the measure indicates these meta-analyses in order to conduct moderator analyses. To
significantly more variability in results across studies than would be understand how moderator factors such as age of child, type of sample
expected to occur by chance. In addition, some of the variables are likely (community versus clinical), etc. influence the strength of the effect
to be correlated (such as depression, anxiety and psychopathology). Some sizes future work is needed. Since D-Stat (Johnson, 1989), the software
overlap exists in the definitions of the constructs examined in the used in these analyses to calculate effect sizes, uses a fixed effects
literature, and this is reflected in overlap in the definitions of the factors model it is especially important that future work results in well-fitting
examined in this study. It is also likely that the significant Qw is a result of models. Models with random effects components reduce to fixed
varying research methodologies and sample populations. The lack of effect models when they are well fitting (Kinney & Dunson, 2006).
homogeneity within most of the data sets further illustrates the Our review also indicates the need for more research on abusive
complexity of child maltreatment. In addition, in some of the studies fathers and more research comparing mothers and fathers in abusive
included in this review, the factors examined were considered and neglectful families. We were able to calculate effect sizes for only
outcomes of maltreatment by the original authors. For example, it is two studies of parental gender for child physical abuse and no studies
possible that child externalizing and internalizing behaviors are for child neglect. It is imaginable that a different pattern of predictive
outcomes of child abuse, rather than risk factors for abuse. Of course, factors of abuse and neglect exists for fathers than for mothers.
one cannot determine causation in a non-experimental review of the However, the present study was forced to combine mothers and
literature. It is important to recognize that this review was only able to fathers due to an insufficient number of studies on fathers to compute
examine the relationship between the various factors and child abuse an effect size for most factors. Future research should also make the
or neglect, but was not able to determine the direction of causality. distinction between offending and non-offending parents in the
Third, there is considerable variability among studies in how child methodology of studies and in the reporting of results.
physical abuse and neglect are defined and measured. For example, This study identifies factors that are associated with child
some studies rely upon self-report questionnaires or interviews, while maltreatment. The nature of this association remains to be deter-
other studies rely upon clinical or Child Protective Services assessment mined. For example, it is not yet known which factors are the best
and classification. Also, some studies report categorical data and others predictors of future maltreatment, only which factors are related to
continuous data. While it is generally considered more appropriate to maltreatment. Further research into the use of the risk factors
calculate an odds ratio rather than a d or r when using categorical data, identified by the present study to predict recidivism in known cases
we chose to use a common metric to be able to calculate composite effect of child maltreatment would be valuable in improving the accuracy of
sizes and compare effect sizes. This variability in data is a limitation in child maltreatment risk assessment procedures.
meta-analyses. There is also a difference between physical abuse and Furthermore, a number of studies were excluded from this meta-
neglect in what risk factors are most commonly studied. This is analysis because they did not include the basic statistics needed to
manifested, for example, in that most of the strongest effect sizes for calculate effect sizes. As meta-analysis is increasingly utilized in the
physical abuse could not be computed for neglect because of an social sciences, it becomes increasingly important for authors to
insufficient number of studies examining that risk factor. Since a meta- include data necessary to calculate effect sizes in the published results.
analysis can only compare the importance of factors that have been For example, means, standard deviations, zero-order correlation
studied in the empirical research, caution should be taken when matrix, and sample sizes should be included for all groups.
interpreting the strengths of these relationships relative to one another.
Finally, the vast majority of research in child maltreatment fails to 6.3. Clinical implications
distinguish actual abusers from non-offending caregivers. The bulk of
the literature is biased toward viewing mothers as the abusers. All but Knowledge of the risk factors associated with child maltreatment is
a very small proportion of studies include only mothers in their important in assessing the level of risk for future child maltreatment,
samples. Research on abusive and neglectful fathers is rare. Further- and for preventing and treating child maltreatment. The relative effect
more, most studies do not make the distinction between parents of sizes presented in Tables 1 and 2 should be of considerable interest to
abused children and abusive parents, even when the sample contains clinicians responsible for assessing and intervening with abusive
both. In fact, many studies assume the mother to be the abuser when families. The risk factors with large effect sizes in either analysis i.e.,
child abuse is present in the family. In many cases of child neglect, parent perception of child as problem, parent–child relationships,
both parents may reasonably be considered offenders for failing to parent anger/hyper-reactivity, parent stress, parent self-esteem, family
provide for the needs and safety of the child. However, in most cases conflict, family cohesion, and child social competence are clearly factors
only the mother is classified as the abuser. Furthermore, some studies that should be addressed in child maltreatment assessment and
classify mothers of physically abused children as abusers merely on treatment. The results of this meta-analysis also point to the importance
the grounds that the mother did not prevent the father from physically of addressing the mental health needs of abusive and neglectful parents.
harming the child. As a result of this bias in the literature, the results of Anxiety, depression and other forms of psychopathology appear to be
this meta-analysis may be limited in their applicability to fathers. important risk factors for child maltreatment. Finally, the importance of
family conflict and family cohesion as risk factors for child physical abuse
6.2. Suggestions for future research suggest that systemic interventions with the entire family may be
necessary to reduce the likelihood that abuse may recur.
Meta-analyses often highlight areas in which more research is
needed. As indicated earlier, meta-analysis can only compare the 6.4. Summary
importance of factors that have been studied in the empirical research.
If there are unstudied factors they cannot show up as important in the This meta-analytic literature review contributes to the understand-
meta-analysis. We were unable to identify studies for 17 risk factors ing of the risk factors related to child physical abuse and neglect. It is the
for child neglect. Some of the important risk factors for child physical first meta-analysis examining a variety of risk factors. The results of this
study provide some indication of the strength of various risk factors in ⁎Coohey, C. (1996). Child maltreatment: Testing the social isolation hypothesis. Child
Abuse and Neglect, 20(3), 241−254.
child maltreatment and the importance of a multi-factorial approach to ⁎Coohey, C. (2000). The role of friends, in-laws, and other kin in father–perpetrated
assessment and intervention in child maltreatment. This study also child physical abuse. Child Welfare, 79(4), 373−402.
highlights gaps in the literature on child neglect and on abusive and ⁎Coohey, C., & Braun, N. (1997). Toward an integrated framework for understanding
child physical abuse. Child Abuse and Neglect, 21, 1081−1094.
neglectful fathers. Future research is needed to correct these gaps. ⁎Corey, E. J. B., Miller, C. L., & Widlak, F. W. (1975). Factors contributing to child abuse.
Nursing Research, 24, 293−295.
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Aggression and Violent Behavior 14 (2009) 13–29

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Aggression and Violent Behavior

Risk factors in child maltreatment: A meta-analytic review of the literature☆

1. Introduction Studies were inconsistent in the ﬁnding of a relationship between

4. Methods 4.2. Inclusion criteria

Microsystem: parent characteristics independent of the child

Microsystem: child characteristics, excluding parents

Microsystem: family characteristics

*p b .05; **p b .01; ***p b .001.

Microsystem: parent characteristics independent of the child

Microsystem: child characteristics, excluding parents

Microsystem: family factors

*p b .05; **p b .01; ***p b .001.

Table 3 (continued) Table 3 (continued)

Study Measure N Effect (r) Study Measure N Effect (r)

(continued on next page)

Table 3 (continued) Table 3 (continued)

Study Measure N Effect (r) Study Measure N Effect (r)

Table 3 (continued) Table 3 (continued)

Table 3 (continued) Table 3 (continued)

Study Measure N Effect (r) Study Measure N Effect (r)

Table 3 (continued) Table 4

Risk factor: non-biological parent Study Measure N Effect (r)

Risk factor: anger/hyper-reactivity

be insigniﬁcant (i.e., parent health problems, approval of corporal

Table 4 (continued) Table 4 (continued)

Study Measure N Effect (r) Study Measure N Effect (r)

Table 4 (continued) Clearly, studying or intervening to prevent or treat child maltreatment

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p b .05; p b .01; p b .001.

p b .05; p b .01; p b .001.