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Theories of child abuse

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 Theories of Child Abuse

Tamara Del Vecchio

St. John’s University

Ann C. Eckardt Erlanger and Amy M. Smith Slep

New York University

Del Vecchio, T., Erlanger, A. C.E., & Slep, A. M. S. (2012). Theories of child abuse. In
M. A. Fine & F. D. Fincham (Eds.), Handbook of Family Theories: A Content-
based Approach (pp.) New York: Taylor and Francis/Routledge.
 2

Lore in the field of child maltreatment suggests that the start of child protection from abuse

began in the 1870s with the case of Mary Ellen. A child who was abused by her caregivers, Mary

Ellen was removed from the home through work with the Society for the Prevention of Cruelty

to Animals. The New York Society for the Prevention of Cruelty to Children was created as a

consequence of the public outrage and negative media coverage (Pfohl, 1977). Almost 100 years

later, prompted by the seminal book The Battered Child (Helfer & Kempe, 1968), the field began

progressing at a rapid rate with the establishment of mandated reporting (1960s; Besharov, 1983)

and the child welfare system (1970s; Child Abuse Prevention and Treatment Act, CAPTA,

Public Law 93-247).

Our knowledge of the impact of child maltreatment has expanded tremendously, as has

our understanding of the factors that place parents at risk for perpetration. Although rates of child

maltreatment in the United States are high, at approximately 1 million per year, prevalence rates

do appear to be decreasing (Sedlak et al., 2010). Furthermore, our repertoire of efficacious

interventions for the prevention (e.g., Olds, Henderson, Chamberlin, & Tatelbaum, 1986) and

treatment (e.g., Kolko, 1996; Lutzker, 1984) of child maltreatment perpetration has grown

substantially over the last several years. However, several critical gaps remain.

Perhaps the most fundamental is a lack of consensus regarding definitions of child

maltreatment. Without such definitions, scholars, researchers, and clinicians are all placed at a

disadvantage and left unsure as to how to best consider data from various sources and

methodologies. Additionally, theoretical development has slowed. Some deceleration is an

outcome of the natural progression and maturing of a field. However, the slowing also reflects

shifts in research focus, driven, in part, by a change in priorities among funding agencies to

emphasize intervention and impact on victims. Despite the current state of research, the
 3

foundations to move forward, address gaps, and significantly advance theory in the next decade

are strong.

In this chapter, we will present the key findings and results in child abuse and neglect and

review theoretical frameworks for conceptualizing child maltreatment. This review will include

limitations of these theories and possible future theoretical directions for understanding child

maltreatment.

Key Findings

Child maltreatment is a broad term and typically includes both abuse (i.e., acts of

commission) and neglect (i.e., acts of omission). Furthermore, abuse is often categorized as

physical, emotional or psychological, or sexual. Neglect ranges from extreme deprivation to

failures to ensure adequate education and medical care. Throughout this chapter, we will use

child maltreatment as the umbrella term that includes all forms of maltreatment, and will specify

neglect or specific types of abuse as relevant for describing specific theories or research findings.

In less than 50 years, the issue of child maltreatment in the United States has undergone

remarkable shifts. The last 10 years has seen a tremendous maturing of our societal perspective

on, as well as our empirical understanding of the treatment of maltreatment. In this section, we

briefly review several recent key findings that are shaping the future of child maltreatment

research.

Defining and Measuring Child Maltreatment

Defining child maltreatment in a manner that allows consistent decisions in fieldwork and

research settings has been largely elusive. Although the rate of research on child maltreatment

has slowed, the last 10 years has seen considerable progress on this front. Heyman and Slep

(2006, 2009; Slep & Heyman, 2006) developed and tested operationalized definitions of child
 4

maltreatment for the United States Air Force Family Advocacy Program. Criteria were

developed for types of abuse (physical, emotional, sexual) and neglect of children. Each set of

criteria includes acts committed by the offender and the impact (actual or potential) on the

victim. In a series of field trials and a dissemination trial, when implemented by decision-making

boards in the military, percent agreement with master reviewers (experienced clinicians trained

in the criteria serving as the “gold standard”) improved from 50% to over 90%. In addition to the

criteria, clinical assessment interviews and self-report questionnaires were developed to support

consistent operationalizations of maltreatment in both clinical and research settings.

Interestingly, the implementation of these definitions, which were perceived by stakeholders in

the community (e.g., committee members, clinicians, leaders) as unbiased and fair to the alleged

perpetrators and victims (Slep & Heyman, 2006), was associated with a significant reduction in

recidivism among alleged and substantiated perpetrators as compared with recidivism under the

prior definitions (Snarr, Heyman, Slep, Malik, & USAF Family Advocacy Program, in press)

This work is now being extended in an effort to establish systems for reliably classifying the

severity of maltreatment and the application of these definitions in civilian child protective

systems. If consistent definitions of maltreatment were reliably applied in both community and

research based efforts, this would result in more reliable decision making processes for families,

more accurate data, and better generalizability of research findings to community and clinical

systems.

Rates of Child Maltreatment

One of the most provocative recent findings has been the apparent declining rate of child

maltreatment, the first decline since it began being rigorously tracked. Even though rates of child

maltreatment are decreasing, large numbers of children are still maltreated. An estimated
 5

1,256,600 children were maltreated during 2005-2006 (17.1 per 1,000 children), according to the

Fourth National Incidence Study of Child Abuse and Neglect (NIS–4; Sedlak et al., 2010). In a

representative sample of youth in the United States, as many as 60.6% reported being victimized

or witnessing victimization; 10% of these children had been maltreated (Finkelhor, Turner,

Ormrod, & Hamby, 2009).

Still, there is converging evidence child maltreatment is on the decline. NIS–4 results

indicated a statistically significant decline in the frequency of child sexual abuse, with a marginal

decrease in child physical abuse and child emotional abuse (Sedlak et al., 2010). During the

1990s, substantiated cases of child sexual abuse by child protective agencies decreased by 39%

(Jones, Finkelhor, & Kopiec, 2001). Between 1993 and 2004, child maltreatment and child

victimization as assessed in the National Victimization Survey (a nationally representative

survey of children and adolescents) declined by 40-70%, after a peak in 1993 (Finkelhor &

Jones, 2006). The evidence suggests that the frequency of physical and sexual maltreatment has

declined, with a possible decline in child neglect masked due to changes in reporting (Jones,

Finkelhor, & Halter, 2006).

There are several possible influences on this decline in child maltreatment. During the

1980s and 1990s, substantial funding and attention were devoted to child sexual abuse

prevention and intervention (both community and criminal justice based). Perhaps these

activities were effective public health measures (Jones & Finkelhor, 2003). Additional economic

changes and increased use of psychiatric medication by would-be perpetrators might also

contribute to the decline in physical and sexual maltreatment. Moreover, the decline could be

reflective of a change in awareness of and decreasing tolerance of physical and sexual abuse of

children.
 6

Outcomes

Over the last several years, two important and disparate conclusions have emerged from

research on the impact of maltreatment. First, the effects of maltreatment can be substantially

broader than the emotional, behavioral, and social effects that were initially the focus of

research. The Adverse Childhood Experiences (ACEs) study from 1995 through 1997 by the

Centers for Disease Control and Prevention (CDC) utilized a sample of 17,000 participants to

examine the physical outcomes of a negative childhood (Felitti, Vincent, Anda, Robert, &

Nordenberg, 1998). ACEs, which include child maltreatment, along with family dysfunction,

have been found to influence physical health. For example, ACEs increase the risk of liver

disease; this relation is strongly mediated by substance abuse and dangerous sexual activities

(Dong, Dube, Felitti, Giles, & Anda, 2003).

Physical differences in the brain are associated with child maltreatment victimization.

Parental verbal abuse (a behavior that can be considered child emotional maltreatment) is related

to a change in neurological functioning, specifically white matter tracts. In a sample of young

adults, it was found that those exposed to parental verbal abuse had altered neural pathways

related to language and psychopathology (e.g., anxiety, depression); (Choi, Jeong, Rohan,

Polcari, & Teicher, 2009). The corpus callosum is also affected by child maltreatment.

Psychiatric patients who were maltreated (abused or neglected) had a smaller corpus callosum

when compared to healthy controls (by 17%) and other psychiatric patients who were not

maltreated (11%). Furthermore, it appeared that neglect, as compared to other forms of

maltreatment, played the biggest role in reduced corpus callosum area (15-18% difference;

Teicher et al., 2004). In an interesting series of studies examining the impact of emotional

neglect, operationalized as children who spent time in orphanages and then were adopted into
 7

nurturing homes, the children with a history of institutionalization had deficits in inhibition,

visual memory, attention, and visually mediated learning. Yet, these children scored at

appropriate developmental thresholds on comparative tasks with auditory and executive

processes (Pollak et al, 2010). In other work, severe neglect history in institutionalized children

appeared to increase levels of stress hormones (cortisol) with extended elevations after mother-

child interactions (Fries, Shirtcliff, & Pollak, 2008) even after years in responsive environments.

These results indicate that even within the context of a close relationship, these children can

experience prolonged problematic hormone regulation and neurological impacts of maltreatment

(DeBellis, Chrousos, et al., 1994; DeBellis, Lefter, Trickett, & Putnam, 1994; Ito, et al., 1993).

Although, the majority of child maltreatment research focuses on negative results and

excludes resilient outcomes, there is also evidence to show that children can experience

maltreatment with no apparent negative effects, and perhaps fair better than might be expected.

In categorizing abused and neglected individuals, McGloin and Widom (2001) defined resiliency

through the following areas: employment, education, socialization, psychiatric health, and

absence of homelessness, substance abuse, and criminality. Using these categories, 22% of

victims of child maltreatment were classified as resilient. Looking at gender difference, females

were labeled as more resilient than males (i.e., females met more resiliency criteria as outlined in

the above categorizes); (McGloin & Widom, 2001).

Even in maltreatment traditionally thought of as more severe (child sexual abuse), there

appear to be a significant number of resilient outcomes. Meta-analytic evidence pertaining to

college students that were sexually abused as children shows that they, on average, are slightly

less well adjusted in terms of psychological functioning and social adjustment when compared to

college students without a sexual abuse history. However child sexual abuse explained less than
 8

1% of the variance; poor family environment was a much better predictor of adjustment than

sexual abuse itself (Rind, Tromovitch, & Bauserman, 1998). Parental support and level of stress

resulting from abuse predict better outcomes among sexually abused females (Spaccarelli &

Kim, 1995).

So, what role does the onset of maltreatment play in later challenges? Although child

maltreatment has been linked with an array of problematic outcomes, much of this literature

suffers from significant methodological limitations. Often, comparison groups of children differ

from maltreated groups in a number of ways other than merely maltreatment. Types of child

maltreatment covary (Edwards, Holden, Felitti, & Anda, 2003) and child maltreatment covaries

with a wide variety of other problematic parenting behaviors (Brown, Cohen, Johnson, &

Salzinger, 1998), as well as a myriad of other family (e.g., intimate partner violence, Appel &

Holden, 1998; Slep & O’Leary, 2005) and more macro-level factors (e.g., poverty, Coulton,

Korbin, Su, & Chow, 1995) that relate to problematic child outcomes. As research on the impact

of maltreatment moves forward, it will be important to continue to try to tease apart the role of

maltreatment as part of this stew of adverse contexts and experiences for children.

Theoretical Conceptualizations of Child Maltreatment

Behavioral Theories

Behavioral theories have had a strong influence on conceptualizations of child

maltreatment, serving as the basis for several more specific theoretical arguments. Behavioral

theories emphasize reinforcement, positive or negative, in the development of aggressive

behavior. Positive reinforcement involves the introduction of a reward contingent upon

aggressive behavior serving to increase the likelihood of future aggression. Negative

 9

reinforcement increases the likelihood that aggression will occur in the future by a removal of an

aversive stimulus contingent upon aggression.

Coercion theory (Patterson 1982; Reid, Patterson, & Snyder, 2002) suggests positive and

negative reinforcement that occur in dyadic conflict result in a learned pattern of aggressive

escalation. A parent and child in a conflict escalate with increasingly noxious behaviors, until

one person capitulates. The person who “wins” is negatively reinforced for escalating through

the removal of the aversive conflict behavior and often positively reinforced through the

attainment of a reward such as earning privileges or gaining compliance. The person who “loses”

is negatively reinforced via the other’s cessation of aversive behavior. Physically abusive

behavior patterns can occur as a result of the escalation process that crests with aggressive

discipline and is reinforced due to its variable effectiveness at “winning”. Moreover, consistent

with coercion theory, abusive mothers are also more inconsistent and likely to provide positive

consequences for their child’s aversive behavior than non-abusive mothers (Oldershaw, Walters,

& Hall, 1986). Patterson (1976) established that the most likely antecedent for aversive behavior

is the aversive behavior displayed by another family member. As such, the “victim” in these

conflictual interactions is also the ”architect” of the aggressive exchanges by supplying

reinforcement to the aggressor. Through this process, abusive parents and their children may

develop dysfunctional patterns for parent-child interactions that encourage conflict and

aggression and the escalation of that aggression to injurious forms of discipline. Moreover,

children learn maladaptive behavior patterns that contribute to externalizing behavior problems

(Snyder, 2002) and may develop a proclivity to aggression resulting in an intergenerational cycle

of child maltreatment (Swick & Williams, 2006).

 10

Social learning theory (e.g., Bandura, 1977; 1986), an extension of behavioral theory,

posits that behavioral change occurs through vicarious, or observed, reinforcement. In their oft-

cited study on imitative learning of aggressive behavior, Bandura, Ross, and Ross (1961)

demonstrated that aggressive behavior could be learned through the observation of aggressive

actors without the need for direct reinforcement. Thus, observational learning of aggressive

behaviors bypasses the need for learning of aggression through directly experienced

consequences. Modeling as a mechanism for learning of aggressive behavior is well established

(see Huesmann, 1997; Mineka & Hamida, 1998 for reviews).

The intergenerational transmission hypothesis asserts that children grow up to repeat

what they experienced and saw as children with their own children. Social learning is most often

presumed as a primary mechanism for the intergenerational transmission of child maltreatment.

Social learning theory, as applied to the intergenerational transmission hypothesis, postulates that

abusive behavior is learned through the witnessing of abusive parenting and subsequent

modeling of an abusive parent. Parents who used severe physically aggressive techniques were

more likely to report witnessing partner aggression in childhood (Straus, 1994; Straus & Smith,

1990). Moreover, numerous studies have found relations between parent abuse history and the

occurrence and severity of child abuse perpetration (Ethier, Couture, & Lacharite, 2004; Gelles

& Straus, 1987; Gil, 1971; Heyman & Slep, 2002; Kaufman & Zigler, 1993; Stith, et al, 2009).

Heyman and Ezzell (2005) estimate that intergenerational transmission of child physical abuse

occurs in one-third of the cases. Although fewer than 1% of parents without a child physical

abuse history maltreat their own children within the first few years of life, only about 7% of

parents with abuse history maltreat (Browne 1995; Dixon, Brown, & Hamilton-Giachritsis,
 11

2009). Thus, even though abuse history remains a significant risk factor, it does not follow that

abused children will necessarily be abusive parents (Heyman & Ezzell, 2005)

Child sexual abuse perpetrators are also more likely to be abused as children, physically

(d =.49) and sexually (d =.70; Whitaker et al, 2008). On average, 28% of sex offenders have a

child sexual abuse history, with higher rates among male victims of male offenders (Starzyk &

Marshall, 2003). Koyabashi, Sales, Becker, Figueredo, and Kaplan (1995) suggest that male

offending has a greater impact on victims and may result in sexual confusion for male victims.

Although not directly evaluated, modeling of inappropriate sexual behavior may be the

mechanism through which child sexual abuse is transmitted to new perpetrators. As with

physical abuse, however, although a history of victimization is more often found among sexual

abuse perpetrators than people who do not perpetrate sexual abuse, the vast majority of sexual

abuse victims will not go on to become perpetrators.

Cognitive models

Social information processing models of abusive behavior emphasize the role of

cognitive processes, such as schemas, executive functioning deficits, and attributions and

appraisals as predictors of abusive parenting (Azar, Reitz, & Goslin, 2008). Parenting schemas,

or mental scripts, develop from past experiences, influenced by family experiences and cultural

norms. Schemas represent people’s views of themselves as parents, the parenting role in general,

and expectations for children; and are proposed to mediate the relation between child behavior

and abusive parental responses. New information, such as a specific instance of child behavior, is

then filtered through these schemas. This results in selective attention to schema-consistent cues

in parent-child interactions. Once activated, schemas can influence simultaneous cognitive,

affective, and behavioral responses.

 12

Adaptive schemas are flexible and can be modified through trial-and-error learning

(Azar, Nix, & Makin-Byrd, 2005). Contingent, responsive parenting requires the ability to

modify responding based on the needs of the particular situation (Azar &Weinzierl, 2005). In

contrast, abusive parents rely on schemas that are rigid and negative affect laden (Azar, Nix, &

Makin-Byrd, 2005; Milner, 2000; Nayak & Milner, 1998). These rigid cognitive schemas may

reflect deficits in executive functioning; that is, cognitive flexibility. Consistent with this model,

several studies have indicated that abusive parents are more likely to underestimate task demands

and overestimate their children’s developmental abilities, resulting in unrealistic expectations

(Azar & Rohrbeck, 1986; Spinetta, 1978; Twentyman & Plotkin, 1982). When the child naturally

disconfirms expectations, parents are angered and respond in an overly harsh manner.

Within the social information processing framework, parents’ negative perceptions and

evaluations of child behavior and positive outcome expectancies for abusive behavior are

thought to contribute to abusive responding (Milner 1993; Milner, 2000). Abusive parents are

more likely to endorse negative attributions for child behavior, appraise child behavior more

negatively, and have unrealistic expectations for child behavior. For example, Bauer and

Twentyman (1985) asked mothers to respond to hypothetical vignettes and found that abusing

mothers were the most likely to view their child as acting intentionally to annoy them. Moreover,

Larrance and Twentyman (1983) report that physically abusive parents make more internal and

stable attributions for negative child behavior and external, unstable attributions for positive

child behavior. Chilamkurti and Milner (1993) found that mothers at high-risk for child abuse

evaluated minor child transgressions as more wrong and endorsed more power assertive

disciplinary techniques than low-risk mothers. In one of the few studies to incorporate

observational measures of child behavior, Reid et al (2002) found that even though abusive
 13

parents reported significantly more aggression and hyperactivity than non-abusive parents,

independent observers did not identify differences in the mean rate of aversive behavior or

severity of conduct problems. Sexual abuse perpetrators overestimate children’s sexual

development and are more likely to misinterpret children’s behaviors as sexual advances (Ward

& Keenan, 1999).

Parents at-risk for abuse may evidence positive outcome expectancies for abusive

behavior; high-risk mothers perceive the use of power assertive discipline by others as more

appropriate than their counterparts (Chilamkurti & Milner, 1993). Results regarding attitudes

about physical discipline are mixed. Slep and O’Leary (2007) found it to uniquely contribute to

aggressive parenting in the context of a multivariate prediction model. In contrast, Stith and

colleagues (2009) found non-significant effect sizes for the association between approval of

corporal punishment and child physical abuse. Perhaps the inconsistent findings are due to

interactive effects. Crouch and Behl (2001) found that the association between stress and child

physical abuse risk was moderated by the parents’ level of belief in the value of corporal

punishment; the relation was stronger for those who value corporal punishment. In addition,

sexual abuse perpetrators are more likely to rationalize their behaviors and report that children

benefit from the sexual behavior or actively sought out sexual contact (Stermac & Segal, 1989).

Abuse as a Function of Stress and Anger

The roles of stress and anger in etiological models of child maltreatment have garnered

considerable attention in the literature (Dopke & Milner, 2000; Gaudin, Polansky, Kilpatrick, &

Shilton, 1993; Whipple & Webster-Stratton, 1991; Williamson, Bourduin, & Howe, 1991).

Abusive and high-risk parents report more stressful life events and more parenting stress than

non-abusive parents (Coohey & Braun, 1997; Crouch & Behl, 2001; Dopke & Milner, 2000;
 14

Mash, Johnston, & Kovitz, 1983; Rodriguez & Green, 1997; Rosenberg & Reppucci, 1983; Stith

et al, 2009). The number of stressful life events is also associated with child sexual abuse, as

mothers of sexually abused children report a greater number of stressful life events compared to

mothers of non-abused children (Pianta, Egeland, & Erikson, 1989). Clearly, not all parents who

encounter stress abuse their children. In a prospective study of low-income mothers, Egeland,

Breitenbucher, and Rosenberg (1980) examined differences between stressed mothers who

abused their children and stressed mothers who did not abuse their children. Although the

mothers did not differ in type of life stress event experienced, abusive mothers reported more

aggression and defensiveness, and less seeking of support in reaction to the stress. Moreover,

abusive mothers, compared to non-abusive mothers, are more likely to report loneliness (Milner

& Robertson, 1990; Spinetta, 1978). Although the availability of supportive resources does not

distinguish abusive from non-abusive parents (Chaffin, Kelleher, & Hollenberg, 1996), abusive

parents report receiving less social support (Corse, Schmid &Trickett, 1990; Pianta, Egeland, &

Erikson, 1989).

Thus, current theory suggests that stress is not a sufficient condition for child

maltreatment perpetration. Pianta (1984) argues that abusive parents have poor coping skills and

are more likely to cope in negative ways, such as drinking and hostility, resulting in an increased

risk for child-directed violence. When stress cannot be coped with effectively, parents are more

likely to develop negative perceptions of child behavior and engage in abusive or neglectful

behaviors (Belsky, 1993). Hillson and Kupier (1994) suggest that specific coping strategies are

associated with specific abuse types. Neglectful parents are more likely to engage in behavioral

or mental disengagement characterized by a withdrawal of caregiver behaviors or the use of

mental distractors to avoid the stressor. In contrast, physically abusive parents are more likely to
 15

engage in rumination and venting of negative emotions. The coping pattern may change over

time as automatic coping responses are developed. Moreover, physically abusive and neglecting

parents show deficits in problem-solving skills related to child-rearing and child-care (Azar,

Robinson, Hekimian, & Twentyman, 1984; Dawson, de Armas, McGrath, & Kelly, 1986).

Hansen, Pallotta, Tishelman, Conaway, and MacMillan (1986) compared physically abusive and

neglectful parents to clinic and community parents and found that although abusive parents were

deficient in problem-solving ability, problem-solving skill deficits were not significantly

associated with child behavior problems. In addition, even though clinic parents and abusive

parents reported similar levels of child behavior problems, clinic parents generated more

solutions and more effective solutions than did the abusive parents. Thus, abusive parenting may

reflect deficits in coping and the ability to determine and select effective solutions to child

rearing problems.

Anger is associated with child abuse risk and abusive status (Ammerman, 1990; Dopke &

Milner, 2000; Rodriguez & Green, 1997). Aversive child rearing events occur with great

frequency during early childhood (e.g., temper tantrums, defiance) and elicit anger, annoyance,

and frustration. Angry emotional responses to children may result in an overwhelming flood of

negative emotions and selection of over-learned, schema-consistent, dysfunctional parenting

techniques (Gottman, Katz, & Hooven, 1996). Moreover, abusive mothers evidence increased

sensitivity to child negative affect. Milner, Halsey, and Fultz (1995) found that high-risk,

compared to low-risk, mothers reported more negative affectivity (e.g., distress, hostility) to

infant cries. In addition, when presented with videotaped infant cries, abusive mothers evidence

increased physiological reactivity (e.g. heart rate, skin conductance, and diastolic blood pressure)

(Frodi & Lamb, 1980). Abusive parents also report feeling more angry or annoyed in response to
 16

children’s behavior in general, and specifically with regard to social or moral transgressions,

than non-abusive parents (Bauer & Twentyman 1985; Dopke & Milner, 2000; Spinetta, 1978;

Trickett & Kuczynski, 1986). A recent meta-analytic review by Stith et al. (2009) examining 155

studies found that parent anger consistently predicted both child physical abuse and neglect.

Psychopathology

The psychopathological model of child maltreatment focuses on the perpetrator’s mental

health as an etiological factor. Although several disorders have been implicated as predictors of

child physical abuse and neglect perpetration, two disorders have consistently evidenced

associations with perpetration: depression and substance abuse. A large body of research

documents the relation between depression and child physical abuse and neglect (Cummings &

Cicchetti, 1990; Downey & Coyne, 1990; Gil, 1971; Kinard, 1982; Scott, 1992; Stith et al,

2009). Using wave II data from National Institute for Mental Health's Epidemiologic Catchment

Area survey, Chaffin, Kelleher, and Hollenberg (1996) found that major depression was a

significant predictor of the onset of physical abuse, controlling for substance use and

demographic variables. Although depression was also found to significantly predict neglect

univariately, the strength of the relation decreased to nonsignificant levels when substance use

and demographic variables were included as predictors.

Data from the Epidemiologic Catchment Area survey also indicated that substance use

predicted the onset of child physical abuse and neglect (Chaffin, Kelleher, & Hollenberg, 1996).

In addition, Murphy, Jellinek, Quinn, Smith, Poitrast, and Goshko (1991) examined the

prevalence of substance abuse in a sample of cases of serious child abuse or neglect brought

before a juvenile court. The presence of parental substance abuse in at least one of the parents

was indicated in 43% of the cases. Among addicted parents, Black and Mayer (1980) found that
 17

41% of their children met criteria for serious neglect, abuse, or both, although all experienced

some degree of neglect. In a community sample of over 11,000 individuals, abusive parents were

more likely than their matched controls to report substance abuse; the association was

independent of levels of depression and social support (Kelleher, Chaffin, Hollenberg, & Fischer,

1994). However, depression and substance use are neither necessary nor specific to child abuse

perpetrators.

In a meta-analytic review examining characteristics associated with the perpetration of

child sexual abuse, Whitaker and colleagues (2008) identified several psychopathological

correlates of maltreatment. Consistent with the findings for child physical abuse and neglect,

substance abuse was a significant predictor of perpetration. However, the associations with

depression and maltreatment were less consistent; studies evidenced positive and negative

effects. In addition, Whitaker et al. identified a relation between anxiety symptoms and antisocial

personality disorder and child sexual abuse perpetration.

Family Environment

Indicators of “high-risk” family environments, such as early motherhood, poverty, and a

low level of education, influence the capacity to parent and have been implicated in the etiology

of child physical abuse and neglect. Parenting age is associated with a number of risk factors

including low level of education, higher levels of stress, less social support, and coercive

discipline practices (Brooks-Gunn & Chase-Lansdale, 1995; Ketterlinus, Lamb, & Nitz, 1991;

Stevens-Simon, Nelligan, & Kelly, 2001). Young mothers are at a slightly increased risk for

physical abuse behaviors and neglect (Dixon, Brown, & Hamilton-Giachritsis, 2009; Stith, et al,

2009; Wolfner & Gelles, 1993). Although several studies have found that age was negatively

related to the severity of physical abuse (Connelly & Straus, 1992; Gil, 1971), using
 18

Epidemiological Catchment Area data Chaffin, Kelleher, and Hollenberg (1996) failed to find a

significant association between parents' age and whether or not severe physical abuse was

perpetrated. The relation between parent age and child neglect is unclear with several studies

indicating no effect (Schumacher, Slep & Heyman, 2001; Stith et al., 2009). Moreover, Allen

and Pothast (1994) found no significant age difference between sexual abusers and non-abusers.

Income level has been consistently found to be negatively associated with child physical

abuse (Chaffin, Kelleher, & Hollenberg, 1996; Garbarino, 1976; Straus, Gelles, & Steinmetz,

1980; Gil, 1971; Sedlak, 1997; Wolfner & Gelles, 1993) and neglect (Brown, Cohen, Johanson,

& Salzinger, 1998; Pelton, 1994). In addition to occurrence, severity of abuse may be associated

with poverty; severe injuries have been found to be more likely among low-income families

(Gelles, 1992; Gil, 1971; Kruttschnitt, McLeod, & Dornfeld, 1994; Sedlak & Broadhurst, 1996).

However, both the Epidemiological Catchment Area and the National Family Violence Survey

failed to find an association between severity of perpetration and income level (Chaffin,

Kelleher, & Hollenberg, 1996; Ross, 1996). Perhaps the inconsistent findings may be due to type

of child maltreatment evaluated: neglect, physical abuse, or sexual abuse. For example, using

1990 Census data and Child Protective Services data, Drake and Pandey (1996) found that

neighborhood poverty was most strongly associated with neglect as compared with other forms

of abuse. In addition, in a meta-analytic review of 155 studies, Stith et al (2009) found that

unemployment was moderately related to child neglect, but only minimally related to child

physical abuse.

Demographic factors, such as age and socioeconomic status, are unlikely to be direct

determinants of abuse status. Instead, the association between poverty and abuse status is likely

to be indirect, mediated by stress associated with poverty (Pianta, 1984). Furthermore, poverty is
 19

correlated with educational level, single parent status, and psychopathology, and each is

associated with child maltreatment status (Allen & Pothast, 1994; Gil, 1971; Milner &

Chilamkurti, 1990). Poverty is associated with a low level of education, and although educational

level predicts child maltreatment risk when controlling for income level, the converse relation is

not supported (Rodriguez, 2008). Lower income families also tend to have more children and

having multiple children under 18 increases the risk for child physical abuse and neglect

perpetration (Gil, 1971). Single parent status is also associated with both the incidence and

chronicity of child maltreatment (Ethier, Couture, & Lacharite, 2004; Sedlak & Broadhurst,

1996), although severity of perpetration and single parent status are not significantly related

(Chaffin, Kelleher, & Hollenberg, 1996; Connelly & Straus, 1992). Mothers who work full-time

are less likely to report physical abuse perpetration (Gelles & Hargreaves, 1990). Black,

Heyman, and Slep (2001) suggest that perhaps time spent with children is a better predictor of

perpetration than employment status in itself. Although variables indexing social disadvantage,

such as poverty and a low level of education, are associated with abuse perpetration, child

maltreatment is not exclusively a lower SES condition. Lower income parents are more likely to

come in contact with Child Protective Services and, as a result, the association between poverty

and child maltreatment perpetration may also be an artifact of sampling biases (Gil, 1971). In

contrast to physical abuse and neglect, income and educational level are not related to child

sexual abuse (Finkelhor & Baron, 1986; Putnam, 2003).

Ecological model

Perhaps the most widely accepted etiological model of child maltreatment is a

multidimensional integration of diverse factors operating at more proximal and more distal levels

of influence. Parent characteristic models are greatly limited by the failure to identify variables
 20

that account for a large portion of the variance. Based on Bronfenbrenner’s perspective (1979),

the ecological model of child maltreatment suggests that the environment influences parents at

multiple levels of the ecological system (Belsky, 1980). The systems represent levels of

influence from the most proximal (i.e., ontogenic – psychopathology, family of origin

influences) to the most distal (i.e., cultural norms). Relations are not necessarily unidirectional

(e.g.,Cicchetti & Lynch, 1993; Wolfe, 1987). For example, abusive parenting contributes to child

behavior problems and likely is a source of parental stress, and these negative sequelae affect

other systems such as work and school performance (Swick & Williams, 2006).

Within an ecological framework, child maltreatment is thought to occur as a function of

the society, community and family ecology supporting or undermining the quality of parent-child

interactions. The empirical literature has identified risk and protective factors that exist at all

levels of the ecology (see Black, Heyman, & Slep, 2001; Stith et al., 2009, for reviews).

Ecological theories suggest that more proximal factors, such as parental psychopathology, have

the most direct effect on parent-child interaction and abuse, and that the effects of more distal

factors are often mediated through their impact on more proximal factors. In other words, the

presence of risk factors (e.g., neighborhood stressors) directly results in negative outcomes or

increases the likelihood of exposure to additional risk factors. Negative interactions that can

occur between person and environment may result in multiple challenges (e.g., Felitti, Vincent,

Anda, Robert, & Nordenberg, 1998) and poor outcomes (e.g., Choi, Jeong, Rohan, Polcari, &

Teicher, 2009). In contrast, protective factors buffer against the effects of the risk factors, and

can compensate for other, even proximal, risk factors, resulting in more successful outcomes

(Cicchetti, 2004). Thus, it is not only the number of risk factors at each level of the ecology that

determines the likelihood of child maltreatment, but also the balance among the factors; if risk
 21

factors outweigh protective factors, the risk for child maltreatment is increased. However, there

is little data to suggest which risk factors are most important or how risk factors interact to

increase overall risk.

Limitations

In this section, we briefly highlight some of the main limitations to how theory has been

developed and applied to the study of child maltreatment.

Lack of Operational Definitions

Perhaps one of the biggest limitations in the field of child maltreatment is the lack of

consistent, operational definitions. As a consequence of the absence of uniform criteria,

unreliable data collected by community-based systems poorly inform policy makers and can

contribute to erroneous conclusions about the etiology of child maltreatment. Ambiguous

thresholds for maltreatment can result in unfair decision-making at the family level. For

example, two hypothetical child neglect cases with virtually the same set of circumstance might

result in radically different outcomes---one case might be substantiated (i.e., officially

documented as an incident of child maltreatment or “founded”) and the other unsubstantiated

(i.e., officially dismissed as below threshold or lacking evidence or “unfounded”). This sends

profoundly inconsistent messages to both the perpetrator and the victim about society’s view of

their behaviors and experiences. Further, assessment approaches that are not designed to collect

information necessary to make reliable substantiation decisions make it challenging for

researchers to compare outcomes and progress the field in a targeted way. Application of

uniform definitions will greatly facilitate the integration of research across different samples and

with different methodologies, thereby speeding the rate at which theories can be refined.

Moreover, varying assessment methods could be considered strengths if better incorporated into
 22

the study outcomes. For example, Stockhammer’s (2001) examination of Child Protective

Services records and parent report suggests that agency records provide more reliable

information about proximal factors, like specific incidents of maltreatment, and parent reports

provide more accurate information about distal factors, such as family context.

Mixed Abuse Types

There are fundamental gaps in our understanding of the relations among different types

of abuse. Most child welfare contexts do not carefully assess for all forms of maltreatment, with

most systems preferring to pursue the most salient type in an incident or family. Researchers

typically categorize families either through often-limited child protective service records, or

based on the assessment of a single type of maltreatment intended to be the focus of the research.

In addition, measures of specific forms of abuse and neglect are lacking. Therefore, we have

little information about the distinctiveness of abuse types (i.e., how overlapping versus distinct

physical and emotional abuse are or how often neglect and abuse co-occur). In addition,

aggregating maltreatment types muddles our models of abuse perpetration. Differences in child

maltreatment are found at a fundamental level; namely, most physical and emotional abuse, as

well as neglect, occurs at the hands of a parent or caregiver, while much sexual abuse occurs at

the hands of other adults in the child’s circle (e.g., Finkelhor, 1984). Conflating abuse types also

makes it difficult to assess differential predictors. For example, theories of sexual abuse

emphasize general characteristic of families of sexual abuse victims in contrast to perpetrator-

specific variables. Low prevalence rates of child sexual abuse and the tendency for studies on

risk factors for child abuse to combine all forms of maltreatment make it difficult to identify

specific predictors of sexual abuse. These gaps in our knowledge contribute to limitations in our

theories and methodological issues in our research.

 23

Theories of child maltreatment will be able to better specify testable mechanisms when

they identify whether theories of maltreatment are specific to maltreatment type or generalize

across types, that is, physical abuse only, physical abuse and neglect, or all types of maltreatment

including sexual abuse. Theories specific to abuse type, or that allow for generalization across

types, would result in stronger etiological theories that can be refined through scientific

investigations. In addition, understanding under which circumstances variables indicate

significant risk or protection would inform theoretical advancements and interventions for

populations that often present with complex typologies.

Theory Testing

Several limitations exist in child maltreatment theory as it currently exists. First, despite

the fact that transactional, ecological conceptualizations of child maltreatment have been in the

literature for over 20 years, the field has not moved much beyond fairly broad, non-specific

conceptualizations. Understandably, examining ecological models of child maltreatment is

difficult; the necessary studies would be large, and likely be the product of interdisciplinary

research teams using a wide variety of methods to adequately capture different types of

variables. Although studies would be expensive and time consuming, they are necessary if we

are going to move beyond theoretical heuristic frameworks to testable ecological models that

identify specific predictors and interrelations among predictors. In contrast, much of the recent

risk factor research was not developed to test etiological theories directly. Thus, although such

efforts contribute to the knowledge base, results can only offer support for model components

rather than clarifying underlying mechanisms. It is no longer sufficient to explore constituent

parts of child maltreatment models.

 24

Second, development is often unaddressed by theories of child maltreatment. This is an

important gap. Risk of abuse varies by age for overall harm, physical abuse, sexual abuse,

emotional abuse, emotional neglect, and educational neglect (Sedlak et al., 2010). It is likely that

at least some of the processes that contribute to abuse play out differently with infants as

compared with adolescents. Specifying mechanisms that change over the course of children’s

development, as has been done with respect to the role of parenting in the etiology of conduct

disorder, for example (e.g., Forgatch & Patterson, 2010), would be an important advance.

Additionally, theories of intergenerational transmission could likely gain increased predictive

power if the role of development in determining the impact of exposure to family of origin

violence were included.

Third, existing theories are more developed with respect to risk mechanisms than

protective effects. Although broad conceptualizations of child maltreatment all acknowledge the

importance of protective factors, theories are silent with respect to where in the causal chain

specific protective factors are hypothesized to operate. Mistakenly, protective factors are often

conceptualized as a lack of risk factors instead of separate variables that influence child

maltreatment in the presence of vulnerabilities. Although specific protective factors are often

unidentified, resiliency studies and models (e.g., McGloin & Widom, 2001; Spaccarelli & Kim,

1995) suggest that internal and external protective factors can result in a synergistic effect,

bolstering a child’s functioning in the face of maltreatment. It is critical that theories of child

maltreatment explain not only the occurrence of maltreatment, but also non-occurrence in the

context of risk.

Fourth, there are few longitudinal studies of maltreating parenting, with only a few

notable exceptions (e.g., Chaffin, Kelleher, & Hollenberg, 1996; Erickson, Egeland, & Pianta,
 25

1989), studying families early enough that they can truly test theories of onset of maltreatment as

compared with the maintenance of maltreatment. No longitudinal studies speak to the onset of

sexual abuse perpetration. This limits the field’s ability to disentangle mechanisms that are truly

etiological from those that might contribute to the recurrence or severity of maltreatment. Thus,

most theories do not distinguish these two causal processes, yet important differences might exist

between them.

Finally, theories of child maltreatment, especially those that are informed by work with

families involved with child protective services, need to account for the disproportionate

detection of child maltreatment by systems (e.g., child welfare) in addition to the rates of child

maltreatment itself. For example, poverty is a risk factor for all forms of child maltreatment.

However, it is likely also a risk factor for being detected for child maltreatment and becoming

involved in the child welfare system. People with few financial resources often live in close

quarters, and neighbors are more likely to overhear episodes of abuse and notice neglect than

people who live in affluent neighborhoods. Low income families are also involved with many

more service providers, most of whom are mandated reporters, and see them more frequently

than high income families. These sorts of factors could contribute to easier detection of

maltreatment in low income as compared with high-income families resulting in higher apparent

rates of child maltreatment among lower income families as compared with families who are at

lower risk for detection. This conflation of maltreatment risk and detection risk could result in

the apparent inflation of the contribution of poverty to child maltreatment. It may be

inappropriate to generalize the risk factors derived from and theories developed on families

involved in the child welfare system to rest of the population. In fact, more representative
 26

samples find smaller effect sizes for the link between income and abuse (e.g., Slep & O’Leary,

2007). Disentangling these issues will enable greater precision and specificity in our theories.

Theoretical Advances

The child maltreatment literature has a substantial research base; however, progress in the

field has slowed considerably. As reviewed earlier, this change in progress can be attributed to

several factors. To move forward, we need to begin to do more integrative research that cuts

across focal theories and develops well-specified, but testable, integrative and comprehensive

theories.

Theories in other areas in negative emotion and aggression have informed theories of

child maltreatment to some degree, but there continues to be room for improvement. Theories of

anger, emotion regulation, coping, general aggression, as well as theories of other forms of

family violence all can be brought to bear on child maltreatment theory. The literature clearly

demonstrates that emotional and physical abuse of children is associated with emotional and

physical abuse of partners (O’Leary, Slep, & O’Leary, 2000). Theories that can account for

unique and shared predictors of the co-occurrence of aggression are overdue and will inform our

understanding of both child and partner abuse. In the first study to investigate whether different

risk profiles characterize different types of aggressors, Slep and O’Leary (2009) sampled males

and females, including those who were physically aggressive only with their children or their

partners, or aggressive toward both children and partners. Individuals who were aggressive

toward only their partners or only their children had distinct risk profiles, with highest levels of

risk on the role-specific variable sets. Role-specific variables were risk factors tied to the specific

relationship. They included factors such as jealousy and partner-blaming attributions in the

couple dyad and parenting style and child-blaming attributions in the parent-child dyad. With the
 27

exception of men who were physically aggressive only with their children, single role aggressive

individuals’ risk levels were significantly lower on role-independent (e.g., stress, depressive

symptoms, alcohol problems) and unrelated role-specific risk factors than they were on role-

related risk factors. Being the first work of this type, it is premature to say that profiles based on

whether people perpetrate both child and partner abuse or only one form of abuse might translate

not only into different risk profiles, but might also suggest different etiological theories and

different interventions. However, identifying distinct patterns of behaviors in aggressive parents

and partners would provide additional guidance for child care workers who address whether

there is risk for a child in a maritally violent household. Theories accounting for specific and

common risk factors for child maltreatment are in their infancy, but hold promise.

Ecological theory is attractive because it incorporates many risk factors to better

represent the complex nature of child maltreatment. Although ecological theory has been popular

for years, researchers have typically tested components of the theory separately rather than the

theory as a whole. This is a bit counter-intuitive, because the crux of ecological theory is the

entire environment, its systems, and the interactions among those systems. However, the study of

singular risk factors dominates the literature. Moreover, distal predictors of child maltreatment

have been evaluated with a broad stroke and as a result there is little understanding of the

mechanisms through which distant variables influence child maltreatment. Slep and O’Leary

(2007), using a representative sample, did test an ecological model of parental aggression,

finding support for an ecological approach. Risk factors from all ecological levels included in the

study were retained in the model, and more distal factors were mediated through more proximal,

parent-level variables. This study suggests that the field can begin to integrate disparate, focal
 28

theories of abuse and work toward an empirically supported, integrated, ecological model of

child maltreatment.

Recent efforts have been made to address the lack of operational definitions. Most

maltreatment definitions are not sufficiently operationalized to be reliably applied in clinical

settings. By incorporating the best of existing definitions and adding operationalizations when

necessary, Heyman and Slep (2006, 2009; Slep & Heyman, 2006) were able to develop

definitions that could be reliably applied in both field and research settings. These definitions

include both the act committed/omitted and the impact (actual or potential) on the victim. For

example, child physical abuse includes two criteria, as well as a few exclusions.

Criterion A is, “The non-accidental use of physical force on the part of a child’s caregiver.

Physical force includes, but is not limited to, spanking with hand; dropping; pushing;

shoving; slapping; grabbing; poking; hair-pulling; scratching; pinching; restraining; shaking;

throwing; biting; kicking; hitting with fist; hitting with a stick, strap, or other object;

scalding; burning; poisoning; stabbing; applying force to throat; cutting off air supply;

holding under water; using a weapon.”

Criterion B is, “Significant impact on the child involving any of the following: (1) More than

inconsequential physical injury; (2) Reasonable potential for more than inconsequential

physical injury given the inherent dangerousness of the act, the degree of force used and the

physical environment in which the acts occurred; (3) More than inconsequential fear

reaction.” There are three exclusions, (1) “acts committed to protect self from imminent

physical harm,” which includes three specific criteria [not excerpted here], (2) (a)cts

committed to protect child, others, or pet from imminent harm, as evidenced by…” two
 29

specific criteria [not excerpted here], and (3) (a)cts committed during developmentally

appropriate physical play…”

A full appendix of these definitions has been published (see Slep & Heyman, 2006).

Field trials were conducted to determine the reliability of maltreatment determinations

(i.e., substantiation decisions) in the field as compared with those of master reviewers. After

changes to assessment, training, and changes to the decision-making committee, agreement

between the master reviews and committee members increased from about 50% to over 90%

(Heyman & Slep, 2006). Agreement remained at over 90% after widespread dissemination

throughout the United States Air Force (Heyman & Slep, 2009). Social workers involved in the

maltreatment cases reported finding the new system fair. In an unexpected finding, re-offense

was cut in half. At one year, offenders whose incident met substantiation criteria went from 14%

to 7%. We believe that this effect occurred through a few key mechanisms. First, alleged

perpetrators are imbedded within a system that is aware of and can react to maltreatment

findings. When these findings were made in a clearer, more consistent, and fairer manner, the

entire process and the substantiation decisions likely take on more weight in the eyes of

leadership. Because the Air Force member’s supervisors are part of the proceedings, it is easy to

imagine that a clearer and fairer system could result in clearer messages about inappropriate

behavior being sent to involved families. These findings indicate that reliable criteria, in

combination with a system viewed as just could result in maltreatment prevention (Snarr,

Heyman, Slep, Malik, & USAF Family Advocacy Program, in press) and better inform research.

Conclusion

To move into the next phase of child maltreatment theory, there needs to be a two-fold

approach: use of the uniform definitions of child maltreatment and, as a result, the logical
 30

integration of tested theories. A significant barrier to the progression of the field is the lack of

agreed upon definitions of child maltreatment upon which to base the research frameworks.

Without clear and specific definitions, meaningful advances will be challenging and potentially

unreliable. Operational definitions are needed to create a consistent system in practical and

research settings. The extensive work done with military child welfare systems as discussed

earlier could offer a uniform set of criteria (see Heyman & Slep, 2009; Heyman & Slep, 2006;

Slep & Heyman, 2006; Slep & Heyman, 2004). However, the investigation of the operational

definition of child maltreatment has been limited to military populations. The utility of the

criteria and systems have yet to be examined in non-military populations.

Greater integration across theoretical models of child maltreatment would improve our

understanding of the etiology and maintenance of child maltreatment. Etiological models of child

maltreatment have emphasized individual risk factors, and therefore, they lack the interplay of

that person with the environment. This interplay is the central tenet of ecological theory and in

general, the move into ecological models has been beneficial. Although ecological models of

child maltreatment have been available for several decades, little progress has been made with

regard to identification of risk factors specific to child maltreatment types, protective factors, and

the interactions among them (e.g., Slep & O’Leary, 2007). Given the flexibility of the ecological

model, it lends itself to integration with other theories of violence and maltreatment. All of the

more specific theories reviewed in this chapter can be considered within the ecological

framework. For example, coercion theory clearly operates at the family level. However,

individual risk factors found in other specific theories (e.g., cycle of violence, anger and stress)

operate at the ontogenetic level and might influence a parent’s risk for engaging in coercive

conflict. By carefully considering how specific theories might intersect, we can pose testable
 31

ecological models. Looking ahead, operational definitions of child maltreatment and an

integration of the vast amount of literature on child maltreatment is essential to move the field

forward in all domains to better identify families at-risk for perpetration.

 32

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