Child maltreatment in the “children of the nineties”: A cohort study of risk factors

https://doi.org/10.1016/j.chiabu.2005.11.005Get rights and content

Abstract

Aim

To analyze the multiple factors affecting the risk of maltreatment in young children within a comprehensive theoretical framework.

Methods

The research is based on a large UK cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14,256 children participating in the study, 293 were investigated by social services for suspected maltreatment and 115 were placed on local child protection registers prior to their 6th birthday. Data on the children have been obtained from obstetric data and from a series of parental questionnaires administered during pregnancy and the first 3 years of life. Risk factors have been analyzed using an hierarchical approach to logistic regression analysis.

Results

In the stepwise hierarchical analysis, young parents, those with low educational achievement, and those with a past psychiatric history or a history of childhood abuse were all more likely to be investigated for maltreatment, or to have a child placed on the child protection register, with odds ratios between 1.86 and 4.96 for registration. Examining strength of effect, the highest risks were found with indicators of deprivation (3.24 for investigation and 11.02 for registration, after adjusting for parental background factors). Poor social networks increased the risk of both investigation (adjusted OR 1.93) and registration (adjusted OR 1.90). Maternal employment seemed to reduce the risk of both outcomes but adjusted odds ratios were no longer significant for registration. After adjusting for higher order confounders, single parents and reordered families were both at higher risk of registration. Reported domestic violence increased the risk of investigation and registration but this was no longer significant after adjusting for higher order variables. Low birthweight children were at higher risk of registration as were those whose parents reported few positive attributes of their babies.

Conclusions

This study supports previous research in the field demonstrating that a wide range of factors in the parental background, socio-economic and family environments affect the risk of child maltreatment. By combining factors within a comprehensive ecological framework, we have demonstrated that the strongest risks are from socio-economic deprivation and from factors in the parents’ own background and that parental background factors are largely, but not entirely, mediated through their impact on socio-economic factors.

Resumen

Spanish-language abstract not available at time of publication.

Résumé

But

Analyser les facteurs multiples qui favorisent le risque de maltraitance chez les jeunes enfants dans un cadre théorique global.

Méthodes

La recherche est basée sur l’étude d’une cohorte importante au Royaume Uni, “l’Etude Longitudinale des Parents et des Enfants de l’Avon”. Sur les 14256 enfants qui ont participé à l’étude, 293 ont été signalés aux services sociaux pour suspicion de maltraitance et 115 ont été inscrits sur les registres de la protection locale infantile avant leur 6éme anniversaire. Les renseignements sur ces enfants ont été obtenus d’aprés les observations obstétricales et une série de questionnaires parentaux remplis pendant la grossesse et les 3 premiers mois de la vie. Les facteurs de risque ont été analysés en utilisant une analyse hiérarchique vers une régression logistique.

Résultats

Dans l’analyse hiérarchique à pas sucessifs, les jeunes parents, ceux avec un bas niveau d’éducation, et ceux avec passé psychiatrique ou antécédents de maltraitance infantile étaient plus susceptibles d’être signalés pour maltraitance, ou d’avoir un enfant inscrit sur le registre de protection infantile, avec des rapports de risque d’enregstrement allant de 1,86 à 4,96. En étudiant l’importance relative des différents paramètres, on a trouvé les plus hauts risques dans les indicateurs de carence (3,24 pour le signalement et 11,02 pour l’enregistrement, aprés analyse des facteurs du contexte parental). Une mauvaise insertion sociale augmentait le risque à la fois de signalement (rapport de risque ajusté de 1,93) ou d’enregistrement (rapport de risque ajusté de 1,90). Le travail maternel semblait réduire le risque des deux éventualités mais les rapports de risque ajustés n’étaient plus significatifs pour l’enregistrement. Aprés analyse plus élaborée des paramètres, les familles monoparentales et recomposées étaient toutes les deux davantage à risque d’enregistrement. La constatation de violence domestique augmentait le risque de signalement et d’enregistrement mais ceci n’était plus significatif aprés analyse plus fine. Les enfants avec poids de naissance bas avaient un plus grand risque d’enregistrement que ceux dont les parents constataient peu de caractéristiques positives.

Conclusions

Cette étude confirme des recherches antérieures en montrant qu’un large éventail de facteurs dans le contexte parental, l’environnement familial et socio-économique influe sur le risque de maltraitance infantile. En associant les facteurs dans un cadre environnemental global, nous avons démontré que les risques les plus élevés proviennent d’une carence socio-économique et de facteurs liés au propre passé des parents et que les facteurs du contexte parental sont en grande partie, mais pas entièrement influencés par leur retentissement sur les facteurs socio-économiques.

Section snippets

Background

As well as being of direct individual and public concern, child maltreatment places considerable burdens on both health and social services. In the early 1990s in the UK, 27 per 10,000 children were placed on child protection registers each year (Department of Health, 1995). This figure represents those children identified as having been abused or neglected and in whom ongoing risk warrants professional involvement, but underestimates the true prevalence of child maltreatment. At least 100

Parental background

Reviewing the published literature on risk factors in the parents’ background, four features consistently emerge as having strong associations with subsequent maltreatement: young parental age (Brown, Cohen, Johnson, & Salzinger, 1998; Connely & Straus, 1992; Egeland & Brunnquell, 1979; Kinard & Klerman, 1980; Leventhal, Egerter, & Murphy, 1984, Lynch & Roberts, 1977; Smith & Adler, 1991); low educational achievements (Brown et al., 1998; Egeland & Brunquell, 1979; Kotch et al., 1995; Kotch,

Socio-economic environment

The association between poverty and child maltreatment is one of the most consistent observations in the published research, both in relation to individual poverty and to neighborhood characteristics (e.g., Baldwin & Spencer, 1993; Brown et al., 1998; Garbarino & Kostleny, 1992; Kotch et al., 1995, Kotch et al., 1997, Kotch et al., 1999). However, interpretation of this association is not without its problems (Crittenden, 1999, Pelton, 1981). In particular, there is a substantial risk of

Family environment

Among the more proximate factors affecting risk of maltreatment, the structure and dynamics of the family are of prime importance. Children of single mothers have been shown to be at higher risk (Brown et al., 1998; Browne & Saqi, 1988; Egeland & Brunquell, 1979). The presence of a step-parent has also been shown to increase the risk (Browne & Saqi, 1988; Fergusson et al., 1996; Radhakrishna, Bou-Saada, Hunter, Catellier, & Kotch, 2001), particularly in relation to sexual abuse. Family size may

Child characteristics

A number of child characteristics have previously been shown to be associated with risk of maltreatment. Prematurity or low birthweight is frequently reported, although empirical evidence to support this is limited (e.g., Browne & Saqi, 1988; Creighton, 1985; Friedrich & Boriskin, 1976), and other researchers have not found any link (e.g., Brown et al., 1998, Leventhal et al., 1984). Other reported factors in the child include health, behavior or developmental problems, and disability (

Setting

The Avon Longitudinal Study of Parents and Children (ALSPAC) is a large study following a cohort of children born to mothers resident in Avon, UK with expected dates of delivery between 1.4.91 and 31.12.92. The ALSPAC study area has a population of approximately one million and includes the city of Bristol (population 500,000), a mixture of inner city deprivation (7% of Avon children live in poor urban areas), rural areas (15%), suburbs and moderate sized towns. Children living in Avon have

Results

Out of the total 14,256 children in the ALSPAC study, 293 (2.1%) were investigated by social services for suspicion of abuse before their sixth birthday. Of these, 115 were placed on the child protection register (44% of those investigated; 0.8% of the total cohort). The age at registration is given in Table 2. The pattern of registration has been previously reported with 31.7% of registrations being for physical injury, 10.9% for sexual abuse, 25.1% for emotional abuse, 29.0% for neglect and

Discussion

Through a multivariate analysis of data in the parents’ backgrounds, socio-demographic environment, and characteristics of the child and family, we have been able to explore risk factors for child maltreatment within a comprehensive ecological framework. The use of different outcome variables has enabled an exploration of factors affecting reporting of child maltreatment (leading to investigation) or registration (approximating to officially recognized or substantiated maltreatment).

Conclusions

In the assessment and management of child abuse, practitioners in all agencies are being encouraged to take a broad view of the child and the environment within which they are growing (Department for Education and Skills, 2004, Department of Health, 2000). This research provides empirical material to inform such an approach. By combining factors within a comprehensive ecological framework we have demonstrated that the strongest risks are from socio-economic deprivation and from factors in the

Acknowledgments

We are extremely grateful to all the mothers who took part and to the midwives for their cooperation and help in recruitment. The whole ALSPAC Study Team comprises interviewers, computer technicians, laboratory technicians, clerical workers, research scientists, volunteers, and managers who continue to make the study possible.

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    This study could not have been undertaken without the financial support of the Medical Research Council, the Department of Health, the Department of the Environment, the Wellcome Trust and other funders including the NHS executive, South West, Research and Development Directorate. The ALSPAC study is part of the WHO initiated European Longitudinal Study of Pregnancy and Childhood.

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