The results of this study revealed fairly large differences in child maltreatment rates according to the methodology used to identify the occurrence of maltreatment. In a comparison of single identification methodologies (i.e., prospective only or retrospective only), the prospective only method identified a greater number of cases of maltreatment (20.6% of the sample) than the retrospective method (7.1% of the sample). The total number of cases identified through a combination
of prospective and retrospective report methods also resulted in greater frequencies of maltreatment identification than those identified using the retrospective method only, and the largest number of maltreatment occurrences (22.9% of the sample) was identified by summing across both methodologies. These results may thus be viewed as lending additional support to what many other researchers have previously noted, that the employment of a single method to detect instances of child maltreatment is frequently inadequate or incomplete (Briere, 1992
; Finkelhor, 1986
; Finkelhor & Hotaling, 1984
), and may under-represent the actual incidence of maltreatment in a population.
However, investigations of occurrences of childhood maltreatment rarely have access to both retrospective and prospective data, nor do researchers often have the ability to combine these data in order to identify maximal instances of maltreatment. Therefore, an important question addressed by this study is the direct comparison of maltreatment occurrences identified via different methodologies. Across all types of maltreatment investigated, discrepancies in identifications of maltreatment were noted according to the methodology utilized. Contrary to predictions, rates of both physical and sexual abuse were higher using prospective identification methods, as opposed to retrospective reports. Greater rates of neglect were also identified via prospective methods, as hypothesized. Taken together, these results suggest that prospective methodologies detect more occurrences of child maltreatment than retrospective reports; however, this finding is most likely due to the repeated number of assessments and detailed reviews of records that occured over time, features which are unique to this prospective longitudinal study. This methodological discrepancy may be especially relevant in identifying sexually abused males, as no gender differences were observed in prospectively identified occurrences of sexual abuse. This finding is in contrast to the preponderance of sexually abused females identified via retrospective self-report methods, a phenonmenon which is more frequently noted in the literature (e.g, Sedlak & Broadhurst, 1996
A second purpose of the current study was to investigate the relations of different maltreatment identification methodologies with multiple measures and multiple reporters of emotional and behavioral disturbance. Overall, and as expected, the nonmaltreated control group generally had the lowest levels of disturbance as compared to the participants who were identified (either prospectively or retrospectively) as maltreated in childhood. Furthermore, the maltreatment identification group that was exposed to the most types of abusive experiences – the combined prospective/retrospective group – generally had the highest levels of emotional and behavioral problems across assessments, a finding which is consistent with previous research (e.g., Cohen et al., 2001
). For example, from the K-SADS assessment at age 17.5, the combined group had significantly greater internalizing, externalizing, and total diagnoses when compared to the nonmaltreated control group. From the age 16 assessment, using the parent-and self-report versions of the Achenbach behavior problems scales, the same general trend was observed such that the combined group had significantly higher levels of problems than the nonmaltreated controls in all but one comparison. Among the other maltreatment identification groups, participants who were identified by a single method (either prospective only or self-report only) did not consistently demonstrate elevated levels of psychopathology relative to the nonmaltreated control group. However, the retrospective only group did have a significantly greater number of externalizing and total diagnoses than the control group as assessed via the KSADS at age 17.5, and the prospective only group had a greater number of internalizing diagnoses than the control group using the same assessment instrument.
Several more specific hypotheses regarding the use of different reporters were also tested. The hypothesis that retrospectively self-reported maltreatment would be associated with greater self-reported psychological problems was partially supported; those who self-reported child maltreatment, with or without additional prospective identification, had significantly more diagnoses on the K-SADS than the nonmaltreated controls, and showed trends toward exceeding the number of diagnoses in the prospective only group. However, this pattern of findings was not detected in the Youth Self Report version of the Achenbach behavior problem scales. The specific hypothesis that parent and teacher ratings of emotional and behavioral disturbance would be highest among the most severe maltreatement cases (i.e., those cases identified via both prospective and self-report methodologies) was supported, as noted above. However, no other group differences by maltreatment identification methodology were detected using the parent-report Child Behavior Checklist. The results for the Teacher Report Form did not reveal statistically significant differences among the groups for either the internalizing or the externalizing scales. These results from the parent and teacher reports raise the possibility that the “objective” raters employed in this study were not the most accurate reporters of the participants’ adjustment. Teachers, for example, generally only observe a student for a relatively brief period each day in larger classes during adolescence, as compared to earlier in childhood. Parents may also be less aware of problems that their children may be experiencing in adolescence, due to increased independence and reduced supervision. In addition, many potential confounding factors attend the use of parent reports in studies of child maltreatment (if, for example, the parent was also the abuser), which may compromise the validity of parent reports.
Although the overall findings indicate that maltreated children are more likely to have behavior problems and psychopathology in adolescence than nonmaltreated children, these findings mostly hold true for the group identified via both retrospective and prospective methods, which represents the more severe, multiple-incident cases of abuse. We failed to detect a pattern of significant differences in levels of behavioral and emotional disturbance between the nonmaltreated control group and either the prospective only group or the retrospective only group. One possible explanation for these findings may be the high-risk nature of the sample: it may be that emotional or behavioral disturbance is somewhat prevalent among all participants, regardless of maltreatment status. For example, approximately 40% of the nonmaltreated participants met diagnostic criteria for at least one mental disorder in late adolescence. Certainly, while maltreatment has consistently been found to be a serious risk factor for later psychopathology, many other factors which are associated with low socioeconomic status such as family life stress, maternal depression, and parental conflict are also predictors of later psychological problems.
On the other hand, the findings may demonstrate that, regardless of maltreatment identification methodology, the most severe cases of child maltreatment are discovered. In the current study, the cases which were identified both prospectively and retrospectively, which were analyzed as a separate category, were judged to have likely been the most severe cases as well. Therefore, the cases which comprised the prospective only and retrospective only groups were probably less severe in nature, which may partially explain the inconsistent ability to detect differences in psychological disturbance between these groups and the nonmaltreated control group. These findings support the suggestion that future outcome analyses may be more meaningful if they are based on indicators of maltreatment severity rather than dichotomous classification.
An additional caveat regarding the interpretation of the findings in the current study regards the composition of the maltreatment identification groups. In order to create non-overlapping groups and simultaneously assess the rate of individuals who were identified using both methods, the retrospective and prospective identification groups represent those who were only identified via a single method of detecting maltreatment, and not the entire set of participants identified via that method. Although this may limit some comparisons to previous research using retrospective or prospective methods, it also allows the current study a rare opportunity to elucidate differences among those identified by each method and especially those identified by both methods, an option which is not typically available to maltreatment researchers.
Taken together the results clearly support findings from a large number of studies which empirically demonstrate the negative consequences of childhood maltreatment (e.g., Cicchetti & Toth, 1995
; Egeland, 1997
; McGee et al., 1997
). However, it is also evident that the extent to which psychopathological sequelae occur and/or are detected depends in part on the selection of maltreatment samples, informants, and control groups (Carlin et al., 1994
; Cohen et al., 2001
; McGee et al., 1995
; Wekerle et al., 2001
). These findings highlight the difficulties inherent in accurately identifying incidents of child maltreatment and the differing outcomes which can result from utilizing various research methodologies. Discrepancies seem particularly likely to occur in the detection of less severe (i.e., single occurrence or less physically evident) cases of child maltreatment. In this study, for example, the participants who experienced the most incidents of maltreatment in childhood were more likely to be those who were identified by both the prospective and the retrospective methods, whereas those whose abuse experiences were characterized as less severe were more likely to be identified by only one of the methodologies used.
The current study has some limitations that should be noted. Certainly, this study is limited by its characterization of maltreatment severity (i.e., based on the number of different types of maltreatment experienced), and a more thorough examination of other aspects of maltreatment severity (e.g., duration, frequency) may provide additional insight to this question. Furthermore, the study is limited by a small sample size, a common issue in many studies of child maltreatment, which limits the empirical power to detect significant differences among groups. Finally, particular characteristics of the current sample, such as the low-SES status of the participants, limit the generalizability of the findings and the relatively high frequency of prospective data collection (while a strength of the current study’s design) limits the ability to compare the results of this study to other prospective studies of child maltreatment.
This study raises a question of both methodological and clinical interest in attempting to characterize the cases of maltreatment that were identified only by retrospective self-report, and not detected via prospective methods. It is clear that many incidents of maltreatment are not identified by CPS or other outside sources and only identified through retrospective self-report. While it may be the case that many of these cases were simply missed by prospective methods such as inspections of CPS reports, there may be other cases in which the adolescent has retrospectively concluded that an experience (or collection of experiences) in childhood was abusive. The subjective identification of such experiences might potentially have a nontrivial influence on the development of psychopathology, or may itself be colored by concurrent psychopathology.
In conclusion, it is erroneous to assume that retrospective reports of child maltreatment are inherently problematic as compared to prospectively identified reports. Rather, both methods provide valuable information regarding maltreatment experiences (Kendall-Tackett & Becker-Blease, 2004
). This study represents a rare opportunity to combine methods for identifying maltreatment, and offers the reassuring conclusion that the most severe cases are identified via a combination of both methods. We also reiterate the caveat that no single method provides a complete picture of maltreatment histories, and the differences among cases identified by varying methods may be significant. Future research is needed to replicate and extend these results and conclusions.