3


Causality

As the field of child abuse and neglect has progressed, theoretical models have become more complex (e.g., Belsky, 1993; Cicchetti and Lynch, 1993; Cicchetti and Toth, 1998; Cicchetti and Valentino, 2006), and the number of studies has increased dramatically. Most have reported an association or correlation between a variety of potential risk factors and child abuse and neglect, contributing to the description of the problem, but few have investigated causes. This chapter reviews the literature on the candidate explanatory factors for child abuse and neglect and considers whether it is appropriate to draw causal inferences regarding these associations. Major challenges to the field are discussed, and the committee suggests that research needs to move beyond correlational designs and analyses to test causal models.

In contrast to other areas covered in the 1993 National Research Council (NRC) report, relatively little progress has been made in understanding the causes of child abuse and neglect. Risk factors for child abuse and neglect, which have been identified by research based on nonexperimental and correlational studies, provide valuable information to practitioners working directly with abused and neglected children, as well as policy makers and researchers seeking to launch inquiries into new areas of investigation. For example, the extensive research on risk factors has been applied in the creation of valuable risk assessment tools used by many child welfare agencies to predict whether children are at low, medium, or high risk for reoccurrence of abuse or neglect based on individual case characteristics (see Chapter 5). Yet while the existing research on risk factors can help in predicting abuse or neglect for the purposes of identifying individuals and



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3 Causality A s the field of child abuse and neglect has progressed, theoretical models have become more complex (e.g., Belsky, 1993; Cicchetti and Lynch, 1993; Cicchetti and Toth, 1998; Cicchetti and Valentino, 2006), and the number of studies has increased dramatically. Most have reported an association or correlation between a variety of potential risk factors and child abuse and neglect, contributing to the description of the problem, but few have investigated causes. This chapter reviews the litera- ture on the candidate explanatory factors for child abuse and neglect and considers whether it is appropriate to draw causal inferences regarding these associations. Major challenges to the field are discussed, and the com- mittee suggests that research needs to move beyond correlational designs and analyses to test causal models. In contrast to other areas covered in the 1993 National Research Coun- cil (NRC) report, relatively little progress has been made in understanding the causes of child abuse and neglect. Risk factors for child abuse and ne- glect, which have been identified by research based on nonexperimental and correlational studies, provide valuable information to practitioners working directly with abused and neglected children, as well as policy makers and researchers seeking to launch inquiries into new areas of investigation. For example, the extensive research on risk factors has been applied in the creation of valuable risk assessment tools used by many child welfare agencies to predict whether children are at low, medium, or high risk for reoccurrence of abuse or neglect based on individual case characteristics (see Chapter 5). Yet while the existing research on risk factors can help in predicting abuse or neglect for the purposes of identifying individuals and 69

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70 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH populations in need of prevention and treatment efforts, it cannot explain why these factors result in abuse and neglect in certain situations but not in others. This limits the guidance that the research can provide for the creation and implementation of effective policies and programs. To design more effective prevention and treatment policies and interventions, there- fore, a better understanding of the causal mechanisms of child abuse and neglect is required. ESTABLISHING A CAUSAL CONNECTION Muehrer and Koretz (1992) argue that a theoretical framework explain- ing the mechanisms and processes leading to certain outcomes provides the groundwork for the development and implementation of interventions that are preventive in nature. They stress the importance of identifying “factors that may play a causal, not simply correlational, role in the development of targeted outcomes” (p. 10). According to Blalock (1964), the noted methodologist and statistician, “the fact that causal inferences are made with considerable risk of error does not, of course, mean that they should not be made at all” (p. 5). Similarly, the committee believes it is important to advance the field with respect to determining the causes of child abuse and neglect. According to formal tests of causal models, at least four conditions must be met to support the causal influence of hypothesized risk factors. First, one must demonstrate that a logical relationship exists. Second, one must demonstrate that an empirical association exists. Third, one must demonstrate that the correct temporal sequence exists. And finally, one must demonstrate that the relationship is not spurious, or due to some other characteristic or variable(s) (Hill, 1965; Schuck and Widom, 2001). The vast majority of the existing literature on risk factors for child abuse and neglect provides a logical justification for the relationship, and numerous studies report an empirical association. Determining whether these studies meet the third criterion—demonstration of the correct tem- poral sequence—is more difficult and complex. One of the major problems with studies using retrospective measures of child abuse and neglect is that the temporal ordering of risk factors and abuse and neglect cannot be estab- lished reliably. Although a few prospective longitudinal studies exist (e.g., Dixon et al., 2005; Pears and Capaldi, 2001), most studies rely on cross- sectional designs, with information being collected at one point in time. Although one might assume that the temporal relationships are correct when asking parents whether they were abused as a child and at the same time asking whether they abuse their own children, memories are faulty, and questions have been raised about the validity and reliability of such measures (Gale et al., 1988; Henry et al., 1994; Ross, 1989; Squire, 1989;

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CAUSALITY 71 White et al., 2007; Williams, 1994). According to Offer and colleagues (2000, p. 736), what one remembers depends on many factors, including “length of time since the event; frequency of the event; level of emotional- ity caused by the event; personal interpretation of and value placed on the event; and present expectations, needs, and beliefs” (see also Hardt and Rutter, 2004). The fourth criterion (lack of spuriousness) has been addressed infre- quently. To establish that a relationship is causal rather than spurious, one must control for variables that serve either theoretically or empirically as common covariates. Because many individual, family, and neighborhood risk factors that increase the likelihood of child abuse and neglect are also associated with other outcomes (Korbin, 1980; Leung and Carter, 1983; Widom et al., 1995), a causal relationship between those factors and child abuse and neglect becomes more credible if the relationship persists despite controls for these important covariates. At present, it is difficult to deter- mine the nature of the association between risk factors and the perpetration of child abuse and neglect (Schuck and Widom, 2001). Prospective longitudinal designs, ideally beginning before the birth of the child, provide an opportunity to determine the correct temporal order of risk factors and child abuse and neglect, to adjust for social and individual confounding factors as they occur, and to minimize reliance on recall and the selection of participants on the basis of outcomes (Gilbert et al., 2009). Animal analogue studies also provide an opportunity to examine these relationships systematically, but questions will remain about the extent to which findings can be generalized and the extent to which the experiences of abuse and neglect in animal models are representative of abuse and ne- glect in humans. Longitudinal ethnographic study designs may also offer additional perspectives on how certain life-course and everyday experiences shape child abuse and neglect (Burton et al., 2009). Ethnographies may be particularly helpful in discerning the meaning of abuse and neglect in ev- eryday life and how one might characterize them as “normal” attributes in the lives of those mired in social and economic inequalities and uncertainty. The following excerpt from ethnographic fieldwork is illustrative of the more nuanced understanding of child abuse and neglect experiences that such research can provide: The ten-year-old girl sat on an idle swing, chatting with the caseworker on the swing beside her. “How many times,” the girl asked, “have you been raped?” The question came casually, as if it could merely glide into the conversation. The caseworker, “Barbara,” tried to stay composed. “I said that I hadn’t, and she was surprised,” Barbara recalled. “I thought everybody had been,” she remembered the girl saying. “Her friends talked about it in school,” Barbara observed. “It’s an everyday thing.” (Shipler, 2004, p. 142)

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72 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH CANDIDATE EXPLANATORY FACTORS FOR CHILD ABUSE AND NEGLECT This review is organized into individual-level, family, contextual, and macrosystem factors that have been hypothesized as risk factors for the abuse or neglect of children. The discussion draws on the work of Bronfenbrenner (1979) and Belsky (1980), who identified these interrelated and mutually embedded factors that contribute to child abuse and neglect. Contextual factors represent the broader social systems (e.g., employment, neighborhoods) that influence parental functioning, whereas macrosystem factors represent the social or cultural forces that contribute to and main- tain abuse or neglect. Individual-Level (Parental) Risk Factors Individual-level (parental) risk factors for child abuse and neglect in- clude a history of child abuse and neglect, or intergenerational transmis- sion; early childbearing; and parental psychopathology. History of Childhood Abuse and Neglect (Intergenerational Transmission) The most pervasive assumption on the part of the public and some policy makers is that a parent’s past experience of abuse or neglect during childhood increases the risk for that parent to abuse or neglect his or her own children. This notion of intergenerational transmission was the pre- mier developmental hypothesis in the field of abuse and neglect (Garbarino and Gilliam, 1980); according to these authors, however, the alleged rela- tionship had not really “passed scientific muster” (p. 111). Since that time, a number of studies have found evidence to support a history of child abuse or neglect as a risk factor for perpetration of abuse or neglect. Estimates are that about one-third of individuals who were abused or neglected will abuse or neglect their own children, with the proportion ranging from 25 to 35 percent (Jackson et al., 1999; Kaufman and Zigler, 1987). These figures suggest that the majority of parents with a history of abuse or neglect do not go on to abuse or neglect their own children. Kaufman and Zigler (1987) critically reviewed the literature related to the hypothesis of intergenerational transmission of child abuse and neglect, concluding that many studies lacked the evidence needed to support the hypothesis because of weaknesses in the representative samples, in method- ology, in formal definitions, and in descriptive statistics (Kim, 2009). More than 10 years later, Ertem and colleagues (2000) systematically reviewed studies of the intergenerational transmission of child physical abuse that

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CAUSALITY 73 met two criteria: the study used information about physical abuse in two consecutive generations, and it included a comparison or nonabused group. The authors developed a scale of eight methodological standards derived from a hypothetical experimental design to examine the validity of the studies they included in their review. Among the 10 studies they reviewed, only 1 met all eight standards, 3 met more than four, and 2 met only one. Ertem and colleagues (2000) also calculated the relative risk of child abuse between the abused and nonabused parents, and found that it varied from 1.05 to 37.80 (Ertem et al., 2000; Kim, 2009). Stith and colleagues (2009) conducted a meta-analysis of 155 studies published between 1975 and 2000 in which parents’ prior experience of abuse was included. Collectively, these studies examined 39 different risk factors for child physical abuse and 22 for neglect. Stith and colleagues found that parents’ experience of childhood abuse had a moderate effect size in predicting subsequent acts of physical abuse (d = 0.44) and a smaller, but significant, effect size in predicting neglect (d = 0.31). As Stith and col- leagues (2009) note, the meta-analysis cannot make any claims about the causal relationship between the risk factors examined and child abuse and neglect outcomes because their review encompasses studies that explore causality among indicators in different directions, as well as studies with both cross-sectional and longitudinal designs. Thornberry and colleagues (2012) also examined the strength of the evidence base for the intergenerational transmission of child abuse and neglect, including in their review studies of child neglect and sexual abuse in addition to child physical abuse. They identified 47 studies that they evaluated against 11 methodological criteria. While most of the studies reported support for the hypothesis that a parental history of child abuse and neglect is a risk factor for perpetration of abuse and neglect, the au- thors express concern about the predictive value of many of these studies because of methodological limitations. Most of the studies met fewer than half of the methodological criteria. Among the 9 studies deemed most meth- odologically sound, the results were mixed with regard to the intergenera- tional transmission hypothesis. Four of the studies generally supported the theory (Dixon et al., 2005; Egeland et al., 1988; Pears and Capaldi, 2001; Thompson, 2006), 3 provided very limited support for only one type of abuse or neglect (Berlin et al., 2011; Renner and Slack, 2006; Sidebotham et al., 2001), and 2 found no evidence of transmission of abusive or neglectful behavior (Altemeier et al., 1984; Widom, 1989). The authors conclude that the widespread acceptance of the theory of intergenerational transmission of abuse and neglect is unsupported by these studies given their substantial methodological limitations. Despite the broad acceptance of parental experience of abuse and neglect as a risk factor for perpetration of abuse and neglect and despite

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74 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH some progress in research on this hypothesis, the extent to which this risk factor explains the perpetration of child abuse and neglect remains unclear. Concerns remain as to the methodological validity of the evidence on this subject. A particular challenge to this body of research is the fact that ex- periences of child abuse and neglect need to be measured across two gen- erations. Yet in much of the existing literature, a history of parental abuse and neglect often is measured by asking parents to recount memories across long periods of time, lessening the validity of the results. Also, a single reporter sometimes is called upon to assess a history of abuse and neglect for both generations (parent and child) (Thornberry et al., 2012; Widom, 1989). Problematic as well is when the sample is involved in parent train- ing programs, institutionalized, or in some other specialized setting. Given society’s disapproval of various forms of family violence, this issue is of particular concern because much of the child abuse literature is based on self-reports by parents (often mothers) who are typically participants, either voluntarily or involuntarily, in groups for abusing parents (Widom, 1989). A related issue is whether researchers should focus not on whether parents with a history of abuse directly abuse their children but on whether they consistently put them in harm’s way at the hands of others. Burton and colleagues (2009), reporting findings for the Three-City Study ethnography, indicate that many of the mothers in their sample who had suffered abuse as children serially entered and exited short-term relationships with romantic partners and often “unsuspectingly” invited abusive men into their homes and the lives of their children. In this way, mothers consistently increased the risk for abuse and neglect of their children by others, as had been done to many of them as children. Similarly, Renner and Slack (2006) examined the relationship between mothers’ childhood experiences of family violence—including physical abuse, sexual abuse, neglect, and witnessing domestic violence—and child abuse and neglect reports to child protective services regarding their chil- dren. They found that women with a history of sexual or physical abuse in childhood were three times more likely to have both experiences of adult- hood intimate partner violence and allegations of child abuse and neglect toward their own children than (compared with) women with no history of childhood sexual or physical abuse. In contrast, the study found no associa- tion between any form of victimization during childhood and perpetration of child abuse or neglect in adulthood in the absence of experiences of inti- mate partner violence. Renner and Slack (2006) conclude that the complex relationship among childhood experiences of abuse and neglect, adulthood experiences of intimate partner violence, and adulthood perpetration of child abuse and neglect warrants further study and may shed light on the mixed findings on intergenerational transmission.

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CAUSALITY 75 Early Childbearing Early childbearing has been linked to an increased risk for child abuse (Connelly and Straus, 1992). Compared with older mothers, for example, younger mothers are more likely to have children referred to child protec- tive services for abuse and neglect or circumstances suggestive of child abuse and neglect (Parrish et al., 2011; Putnam-Hornstein and Needell, 2011). Brown and colleagues (1998) found that the relative youth of a mother at childbirth was a significant risk factor for physical abuse, sexual abuse, and neglect. Using data from two waves of the National Institute of Mental Health’s Epidemiologic Catchment Area Study, Chaffin and colleagues (1996) sepa- rately assessed the relative impact of potential risk factors for child physi- cal abuse and neglect in a representative community sample. To assess risk factors for their impact on the initiation of abuse and neglect, the analysis focused on parents who did not report any abuse or neglect in the first wave of the study but reported either physical abuse or neglect in the sec- ond wave. Parental age (mothers younger than 18 at the birth of their first child) was one of only two social or demographic factors shown to have a significant effect on the onset of both physical abuse and neglect, with younger parents showing a higher likelihood to commit both. On the other hand, Klerman (1993) notes that the increased risk of child abuse and neglect for young compared with older mothers may be due in part to socioeconomic factors, such as income, education, family size, mobility, and stress. Using demographic data on parents with indicated abuse and neglect reports in 1988 and parents with children in out-of- home care in Illinois in 1990, Massat (1995) found that adolescent parents were not overrepresented among abusing and neglecting parents or among parents with children in out-of-home care, although low maternal age was associated with a number of negative outcomes for children. As Simkins (1984, p. 45) notes: “Age happens to be correlated with a large array of other variables such as the quality of prenatal and postnatal care, the so- cioeconomic status of the mother, and whether there are other caretakers in addition to the teenage mother.” Thus, low socioeconomic status is a risk factor for early childbearing as well as for child abuse and neglect. Using data from the Fragile Families and Child Wellbeing Study, Lee (2009) examined the relationship between harsh parenting behaviors (self- reports that included maternal spanking) by mothers who were aged 19 or younger compared with mothers who were 26 or older at the birth of the target child. Adolescent motherhood was significantly related to harsh parenting behavior, even after controlling for demographic and maternal characteristics. It is unclear why Lee omitted mothers who were aged 20- 25 at the birth of the target child and whether the study controlled for the

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76 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH number of other children the mother had at the time of the birth of the target child. A different picture emerges from an inspection of national statistics on child abuse and neglect. Table 3-1 summarizes the age of the perpetrators identified in child abuse and neglect reports by state and overall. Overall, only 6 percent of substantiated cases involve perpetrators under age 20; in contrast, 18 percent of all first-time births are to women (girls) under 20. The percentage has dropped dramatically since the 1970s, when 35 percent of all first-time births were to teens. This discrepancy between research find- ings and national statistics suggests a need for further exploration of the complex relationship between early childbearing and perpetration of child abuse and neglect. One question is whether a substantial proportion of teen parents who are reported/confirmed for child abuse were themselves foster children. This group of teen parents might be a good target for and benefit substantially from preventive services. Nonetheless, this body of research suggests that early childbearing may be implicated as a risk factor for child abuse and neglect, but not necessarily a causal factor. Parental Psychopathology Early writings reflected a belief that parental psychopathology was one of the causes of child abuse and neglect (Baumrind, 1993, 1995). While maternal mental health problems have been linked to an increased risk of child abuse and neglect (Brown et al., 1998), Wolfe (1999) found that fewer than 10 percent of abusing parents had a primary psychiatric disorder that was linked to their abusive behavior. Reviewed below is the literature on several psychiatric disorders that have been implicated in the etiology of child abuse and neglect, although few of these studies meet the criteria for drawing conclusions about causality. At present, the existing evidence sug- gests that specific forms of psychopathology may play a role in a parent’s abuse or neglect of a child. In one of the rare longitudinal studies of risk for child abuse and ne- glect beginning in infancy, Kotch and colleagues (1995) recruited mothers of newborn infants with biomedical and sociodemographic risk factors from community and regional hospitals and local health departments in 42 counties of North and South Carolina. The study considers maternal psychopathology, along with other risk factors for child abuse and neglect. For every four at-risk mother and infant pairs, the next mother to deliver a normal newborn was recruited to serve as part of a comparison group, and both groups were interviewed shortly after giving birth. State central registries of child abuse and neglect were reviewed when each infant was 1 year old. Kotch and colleagues found that several characteristics of the mothers (education, depression, and whether the mother lived with her own

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CAUSALITY 77 mother at age 14) were the best predictors of an abuse or neglect report. However, they also found that the number of other dependent children in the home and receipt of Medicaid were significant predictors of abuse and neglect reports, suggesting that multiple factors must be considered in thinking about causality. Depression  Several prospective studies have reported high rates of depres- sion in abusing and neglecting parents (Kotch et al., 1999); thus, these find- ings meet at least one of the important criteria (correct temporal sequence) for establishing causality. Mothers who are depressed and/or anxious are at higher risk for physically abusing their children (Brown et al., 1998). Ma- ternal depression also has been associated with childhood neglect (Bishop and Leadbeater, 1999; Brown et al., 1998; Éthier et al., 1995). Studies have shown that mothers who experience depression may be more disparaging, pessimistic, and ill tempered and less responsive to their children’s needs relative to mothers without depression (Downey and Coyne, 1990; Nolen- Hoeksema et al., 1995). Pears and Capaldi (2001) found that, in addition to a history of abuse reported by parents, disciplinary inconsistency, depres- sion, and posttraumatic stress disorder among parents were predictive of their abuse of their male children. In a review of the literature on this topic, Knutson and Schartz (1997) conclude that about half of the studies examined failed to support the rela- tionship between depression and child abuse. They suggest that unexamined moderators or confounders may play a role. In addition, since most of the research on this topic is based on cross-sectional studies, the temporal order of these relationships is unknown. The link between maternal depression and child abuse may be a consequence of having engaged in abusive behav- ior toward a child, or depression may play a causal role in the perpetration of child abuse because depressed parents may be more likely to react to their child’s misbehavior with abuse or other forms of harsh or neglectful parenting (Belsky, 1993). The findings of the few existing prospective stud- ies provide some evidence that maternal depression may play a causal role, but further research clearly is needed. Substance abuse Substance (alcohol and drug) abuse is thought to be a major risk factor for the perpetration (Dubowitz et al., 2011; Ondersma, 2002) and recurrence (Jonson-Reid et al., 2010) of child abuse and neglect. Chaffin and colleagues (1996) found that parents who had a substance abuse disorder at the onset of their study were more than four times as likely as parents without such a disorder to commit physical abuse and more than 2.5 times as likely to have an episode of neglect. In an analysis of administrative data on a large sample of abused and neglected children in Florida, Yampolskaya and Banks (2006) found that caregiver alcohol and

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TABLE 3-1  Perpetrators Identified in Child Abuse and Neglect Reports by Age, 2010 (Unique Count) 78 6-19 20-29 30-39 40-49 State Number Percent Number Percent Number Percent Number Percent Alabama 848 10.8 2,845 36.1 2,099 26.6 820 10.4 Alaska 82 3.8 823 38.2 690 32.0 376 17.4 Arizona 248 4.0 2,373 38.1 2,198 35.3 991 15.9 Arkansas 1,012 10.1 3,582 35.6 2,859 28.4 1,318 13.1 California 3,141 5.2 20,075 33.5 19,909 33.3 10,923 18.2 Colorado 629 7.3 3,002 35.0 2,812 32.7 1,328 15.5 Connecticut 310 3.8 2,782 34.2 2,571 31.6 1,650 20.3 Delaware 87 5.3 616 37.3 540 32.7 314 19.0 District of Columbia 62 3.1 663 32.8 674 33.3 325 16.1 Florida 1,127 3.0 14,525 39.0 12,241 32.9 6,355 17.1 Georgia* Hawaii 44 3.2 456 32.7 458 32.8 286 20.5 Idaho 48 3.6 515 38.6 471 35.3 239 17.9 Illinois 1,535 8.0 7,716 40.3 5,958 31.1 2,677 14.0 Indiana 1,639 9.3 6,783 38.6 5,216 29.7 2,088 11.9 Iowa 550 5.6 3,882 39.8 3,250 33.4 1,337 13.7 Kansas 205 16.9 408 33.7 333 27.5 163 13.4 Kentucky 456 3.9 4,924 42.3 3,895 33.5 1,507 13.0 Louisiana 248 4.0 2,557 41.7 2,175 35.4 805 13.1 Maine 127 4.2 1,246 41.1 944 31.1 494 16.3 Maryland 753 8.2 2,527 27.5 2,958 32.2 1,772 19.3 Massachusetts 780 3.9 6,833 34.4 6,427 32.3 3,876 19.5 Michigan 1,174 4.7 9,876 39.3 8,625 34.3 3,995 15.9 Minnesota 327 9.4 1,231 35.5 1,171 33.8 528 15.2 Mississippi 435 7.5 2,082 35.9 2,003 34.5 832 14.3 Missouri 213 4.5 1,668 35.4 1,460 31.0 762 16.2 Montana 54 5.3 384 37.8 333 32.7 132 13.0 Nebraska 181 5.7 1,310 41.2 1,011 31.8 499 15.7

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Nevada 122 3.2 1,465 38.7 1,304 34.5 654 17.3 New Hampshire 65 8.8 262 35.4 225 30.4 138 18.6 New Jersey 258 3.7 2,203 31.8 2,194 31.6 1,383 19.9 New Mexico 191 4.2 1,639 36.2 1,396 30.8 539 11.9 New York 2,117 3.4 18,998 30.7 20,985 33.9 14,015 22.6 North Carolina 167 3.6 1,663 35.9 1,606 34.7 825 17.8 North Dakota 26 3.4 223 29.4 210 27.7 120 15.8 Ohio 2,566 10.1 9,292 36.4 7,008 27.5 2,993 11.7 Oklahoma 393 5.6 2,988 42.4 2,145 30.5 888 12.6 Oregon* Pennsylvania 447 12.4 1,011 28.1 973 27.1 714 19.8 Puerto Rico 162 2.5 1,192 18.2 1,248 19.1 579  8.9 Rhode Island 186 7.1 981 37.6 862 33.1 424 16.3 South Carolina 261 3.0 3,318 37.7 3,237 36.8 1,456 16.5 South Dakota 34 3.7 436 47.0 284 30.6 126 13.6 Tennessee 795 15.1 2,028 38.5 1,364 25.9 586 11.1 Texas 4,765 9.3 22,179 43.1 15,254 29.7 6,198 12.1 Utah 1,026 11.3 3,220 35.6 3,016 33.3 1,263 14.0 Vermont 116 21.0 152 27.5 148 26.8 75 13.6 Virginia 236 4.4 1,859 34.7 1,558 29.1 901 16.8 Washington 136 2.4 2,023 36.1 1,978 35.3 940 16.8 West Virginia 118 3.4 1,354 38.7 1,185 33.9 430 12.3 Wisconsin 286 7.4 1,154 29.8 955 24.7 451 11.7 Wyoming 26 4.8 223 40.8 182 33.3 65 11.9 Total 30,814 185,547 162,598 82,155 Percent 6.0 36.3 31.8 16.1 States Reporting 50 50 50 50 continued 79

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100 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH rates of 2-15 percent at the Yerkes Primate Research Center (Sanchez et al., 2010). The behaviors constituting physical abuse occur in short bouts amid otherwise more normal parenting, but when infant abuse occurs, it is severe and results in infant distress, serious injury, and occasionally death. Thus, animal analogue studies provide a way to manipulate characteristics of parents to determine whether some of the candidate risk factors identified by research in humans lead to animal versions of abuse and neglect. The findings from these animal studies will likely provide important hypotheses for processes to investigate among humans. Research needs to examine whether there are common underlying factors that result in child abuse and neglect, or discrete behaviors have different etiologies. Are there differences or similarities in the causes of child abuse and neglect by the cultural context, sex, race, and ethnicity of parents? Some of the research described here suggests that candidate risk factors are similar across different contexts. However, relatively little atten- tion has been paid to this issue. Although children often experience multiple forms of abuse and/or neglect over their lifetimes, little is known about risk factors for specific types of abuse or neglect. That is, are the causes of physical abuse similar to the causes of neglect? Are the causes of sexual abuse different from those of physical abuse and neglect? Research addressing these questions will have direct implications for interventions and prevention programs. Are the causes of child abuse and neglect different in the context of multiple- problem families and communities compared with more cohesive and non- problematic families and communities? This issue is related to the concern described by Damashek and Chaffin (2012) as the “bundling” of child abuse and neglect with other life adversities. They argue that this bundling results in the inclusion of other risk factors—unmeasured or unaccountable for in research designs—that make it difficult to attribute effects to particu- lar risk factors. This bundling also ignores one of the recommendations of the 1993 NRC report that identifies as essential “research that clarifies the common and divergent pathways in etiologies of different forms of child maltreatment for diverse populations” (p. 32). Finally, in this chapter, the term “parental” has been used to refer to characteristics of the individual at risk for becoming abusive or neglectful. Because of the nature of laws determining who is reported and defined as an abusing and neglecting parent, however, it is the biological mother (or sub- stitute mother) who is most often the caretaker and whose characteristics have been examined. Fortunately, recent research has begun to address the role of fathers as perpetrators of child abuse and neglect (Lee et al., 2008, 2011). In the future, particularly with the increase in fathers who remain at home, more attention should be paid to paternal characteristics that place children at risk for abuse and neglect.

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