In the interest of improving the prevention of child maltreatment, this study examined (a) direct associations between mothers’ experiences of childhood maltreatment and their offspring’s maltreatment, and (b) mothers’ mental health problems, social isolation, and social information processing patterns as mediators of these associations. Given the potential value of understanding such developmental processes for improving child maltreatment prevention, and the paucity of rigorous research examining these processes, the current study offers an important next step in the application of developmental science to improving children’s wellbeing.
Direct and Indirect Associations between Mothers’ History of Child Maltreatment and Offspring Victimization
We found that mothers’ childhood physical abuse - but not neglect - directly predicted offspring victimization, and that this association was mediated by mothers’ social isolation and aggressive response biases. The association between mothers’ childhood physical abuse and their offspring’s maltreatment was robust, emerging after accounting for maternal race/ethnicity, age, education, family income, and co-occurring childhood neglect. Compared to mothers who did not experience childhood physical abuse, the mothers who did experience childhood physical abuse were 19% more likely to have children who were victimized by the age of 26 months. Moreover, given evidence in the literature that rates of intergenerational continuity of maltreatment increase with the duration of longitudinal follow-up (e.g., Egeland et al., 2002
), it is quite possible that the rate of intergenerational continuity in this sample will increase as participants are followed longer. At the same time, it is important to note that the vast majority of mothers who experience physical abuse do not go on to have children who become victim of maltreatment themselves. In this study, 83% of the mothers who experienced physical abuse did not
have offspring who became victims of maltreatment by age 26 months. Thus, mothers’ histories of physical abuse increase the risk of their children’s victimization but by no means ensure it.
The lack of a direct association between mothers’ childhood neglect and their offspring’s maltreatment is also notable. As with physical abuse, it is possible that the intergenerational effects of mothers’ childhood neglect will increase as our participants are followed longer. Recent research demonstrating effects of early neglect (allegations and substantiations) – but not early physical abuse - on later child aggression illustrates the negative effects that early neglect can have (Kotch et al., 2008
), and emphasizes the importance of continued research into the differential sequellae of different types of maltreatment. In addition, it is important to remember that approximately one third (32%) of the neglected mothers in this sample also reported childhood abuse, and that this cormorbidity was covaried in our analysis of the effects of mothers’ neglect histories. Thus, when coupled with childhood physical abuse, mothers’ childhood neglect may have different implications for their children’s victimization than mothers’ neglect alone. Last, we note that our method of assessing mothers’ maltreatment histories, self-reported childhood experiences according to the PC-CTS, may have been better suited to assessing childhood physical abuse than neglect. The PC-CTS items concerning neglect are somewhat more subjective (e.g., asking about being left alone “when an adult should have been with you,” without specifying at age at which this occurred). In addition, explicit memories of physical abuse may be more accessible than those of neglect.
In addition to finding a direct association between mothers’ experiences of childhood physical abuse and their offspring’s victimization, we find that two relationship-specific processes, social isolation and aggressive response biases, both reported during pregnancy, mediate this association. It is consistent with what is understood about the influence of childhood maltreatment on adult relationships and social networks (e.g., Weisbart et al., 2008
), and about the role of parental social isolation in childhood maltreatment (e.g., Kotch et al., 1999
), that mothers’ perceptions of others being less available to help in times of need mediate the association between physical abuse and child victimization. Outside of the realm of maltreatment, even more normative variations in the quality of early child-parent relationships have strong implications for children’s later relationships (Berlin, Appleyard, & Cassidy, 2008
). To the extent that the negative effects of early physical abuse on relationship skills are not remediated, women who were abused during childhood are at risk of developing inadequately supportive friendships, romantic partnerships, and social networks, all of which can hinder their abilities to support and protect their own children.
It is consistent with social information processing theory and research about aggressive tendencies, as both predicted by physical abuse and predictive of later aggression (e.g., Dodge et al., 1990), that mothers’ aggressive response biases were found to mediate the association between physical abuse and child victimization. Furthermore, for mothers who had been physical abused, aggressive response biases mirror a history of aggressive parenting. Thus, our findings raise the question of whether mothers who were physically abused may be repeating - intergenerationally – not only maltreatment but also the very behavioral tendencies that were inflicted on them. At the same time, we note that the low frequency of aggressive response biases in this sample makes it necessary to interpret this finding with caution. Moreover, in the current study, because we assessed social information processing patterns during pregnancy, we focused on mothers’ hostile attributions and aggressive response biases towards other adults. Future child maltreatment research should also examine mothers’ hostile attributions and aggressive response biases towards children, as such biases may be more directly related to childrearing and maltreatment. Mothers’ tendencies to make hostile attributions about their children’s ambiguous behaviors have in fact been found to predict harsh disciplinary practices (e.g., Nix, Pinderhughes, Dodge, Bates, Pettit, & McFadyen-Ketchum, 1999
) and less positive mother-infant interaction (e.g., Burchinal, Skinner, & Reznick, in press
We also note that our finding of two significant mediators raises the question of how these mediators, which are weakly positively correlated (see ), might interact with one another. For example, there may be indirect effects through both mediators simultaneously, or there might be double mediation (e.g., childhood physical abuse ➔ aggressive response biases ➔ social isolation ➔ offspring victimization). There may also be conditions that affect the magnitude of one or another mediated pathway (i.e., moderated mediation or mediated moderation). Future research examining these possibilities will be valuable.
Unlike our relationship-specific mediators of social isolation and aggressive response biases, our broader-based mediator, mothers’ mental health problems, did not mediate the association between mothers’ physical abuse and offspring victimization, although mental health problems were predicted by mothers’ childhood physical abuse. Compared to previous research which has reported mothers’ mental health treatment
as a mediator of intergenerational continuity in maltreatment (Dixon, Browne, et al., 2005
), it may be that our measure of mental health problems, which identified a sizable proportion (44%) of the sample as having at least one mental health problem during the past year, was overly liberal, especially given the mood swings that often accompany pregnancy. Thus, our measure of mental health problems may not have adequately targeted the more severe mental health problems that both result from maltreatment and impinge on parenting and child protection.
Similarly, the lack of evidence for mothers’ hostile attributional biases as a mediator was somewhat surprising. It may be that this study’s measure of hostile attributions was overly general and did not tap attributions that were adequately relevant to parenting an infant or toddler.
Limitations and Suggestions for Future Research
As noted earlier, child maltreatment research is rife with methodological complexity, especially vis-a-vis the measurement of both parents’ and offspring’s victimization. Specifically, legally-defined cases of maltreatment underestimate prevalence (e.g., Theodore et al., 2005
), whereas self-report data are subject to reporting distortions that themselves may be a product of childhood maltreatment (e.g., Chu, Frey, Ganzel, & Matthews, 1999
). The use of multiple measures to assess maltreatment in both generations is ideal, and helps to avoid the problem of method variance. The current study is limited by its reliance on maternal report for both independent and mediating variables, although it is strengthened by its use of non-maternal report assessments for its dependent variable. At the same time, this approach means that we used different metrics to assess maltreatment in mothers than in their children, which may be criticized as an “apples to oranges” comparison. In order to create more parallel measures, even if studies cannot provide prospective, official data on both parents’ and children’s victimization, parents could be asked if their parent(s) were ever reported for abuse or neglect, a step we recommend for future research on intergenerational continuity in child maltreatment.
A second recommendation for future research centers on the importance of testing not only mediators but also moderators of intergenerational continuity in child maltreatment. For example, what processes account for the fact that 83% of the physically abused mothers in this sample did not have a child who was victimized by age 2? What buffering factors help physically abused women not to be socially isolated, and instead to form supportive friendships, romantic partnerships, and social networks? Research that addresses these questions will also help to inform prevention efforts.
Finally, we note that it is a limitation of the present data set – to be overcome by future studies - that neither the perpetrator nor the type(s) of maltreatment experienced by the offspring could be rigorously analyzed. It would be extremely valuable to know if mothers’ maltreatment histories lead them to perpetrate maltreatment, themselves, and/or to have children who are victimized by others. It is likely that a good proportion of intergenerational continuity in the experience of child maltreatment is accounted for by intergenerational transmission (mother history ➔ mother perpetration), because often mothers are the actual perpetrators, and, even when they are not, they may be defined as such for failing to protect their child from being victimized by someone else. These issues remain to be tested. In terms of promoting public health, however, what are especially valuable are findings that speak to proximal intervention targets for improving child maltreatment prevention. This study begins to offer such findings.
Raising Healthy Children: Implications for Policy and Practice
Taken as a whole, our study has two key implications for the prevention of child maltreatment. First, it suggests that a mother’s history of childhood physical abuse should be considered an important risk factor by maltreatment prevention programs. Widely disseminated home visiting programs such as the Nurse-Family Partnership (implemented in over 250 U.S. counties; Olds, 2006
) and Healthy Families (implemented under the auspices of Prevent Child Abuse America in over 400 communities throughout the U.S.; Healthy Families America, 2007
) define mothers’ risk for maltreatment (and program eligibility) on the basis of their demographic characteristics or cumulative psychosocial risks. Our findings suggest that early in the course of intervention, ground-level service providers should have a thorough understanding of mothers’ maltreatment histories. Of course, such information must be carefully and sensitively elicited, and may require specific training. In addition, such intimate information may or may not be provided by mothers until significant trust in their home visitor (or social worker) is established. At the same time, in focus groups conducted by our research team, home visitors and social workers have commented that when they ask mothers about their own childhoods, mothers are often extremely forthcoming because it is the first opportunity that they have had to tell their “story,” and they are eager for a caring professional to listen.
Mothers’ social isolation and aggressive response biases, while particularly relevant to mothers with histories of physical abuse, can also be examined as general risk factors by maltreatment prevention programs. Moreover, assessing social isolation through discussion of the mother’s support system, and aggressive response biases through the use of hypothetical vignettes, may elicit less discomfort or defensiveness than more direct assessments of mothers’ maltreatment histories.
Second, this study responds to program evaluations that have highlighted the need for child maltreatment prevention programs to improve the fit of their services to the particular strengths and challenges of families served. For example, although the Nurse-Family Partnership has demonstrated effects in reducing early maltreatment, these effects are typically concentrated among mothers who are poor, unmarried, or have fewer “psychological resources” (Olds et al., 1997
; Olds, Henderson, Chamberlin, & Tatelbaum, 1986
). Randomized evaluations of the Healthy Families program have indicated limited efficacy and/or effects for specifically defined subgroups only (Duggan, Berlin, Cassidy, Burrell, & Tandon, in press
; Duggan et al., 2007
). Thus, more carefully fitted services are required.
Our findings suggest specific strategies for tailoring services to participants’ needs. For mothers who were victims of physical abuse, our findings underscore the importance of reducing mothers’ social isolation. Empirical support for an intervention strategy of increasing social support as a mechanism for “breaking the cycle” of child maltreatment has come from several descriptive studies. For example, Hunter and Kilstrom (1979)
found that “non-repeating” mothers were more likely to have supportive social networks than “repeating” mothers (see also Egeland, Jacobvitz, & Sroufe, 1988
The goal of engaging isolated families and increasing social support is, in fact, part of the rationale for home visiting programs, including the Nurse-Family Partnership and Healthy Families. Yet, as demonstrated by evaluations of these programs’ effects and by other studies, the programmatic provision of social support is a challenging endeavor (Thompson & Ontai, 2000
). One particular challenge concerns the mother’s ability to commit to treatment (Spieker, Solchany, McKenna, DeKlyen, & Barnard, 2000
). That is, individuals’ histories of maltreatment may directly inhibit their ability to trust and rely on others for support. Maltreatment prevention programs need to continue to develop their approaches for actively engaging participants and for enhancing and sustaining social support, especially for mothers with a history of physical abuse.
Our findings also suggest that mothers who were victims of physical abuse require help in reducing aggressive response biases. Such help may take the form of cognitive reframing exercises, such as those developed by Bugental and her colleagues that have been found, in a randomized trial, to reduce mothers’ self-reported harsh parenting and physically abusive behaviors (Bugental et al., 2002
Finally, because child maltreatment is, at its core, a malfunctioning relationship, and because both social isolation and aggressive response biases could be improved through enhancing mothers’ relationship skills, interventions that directly target mothers’ relationship skills may be especially valuable for mothers with histories of child maltreatment. Such interventions may be as brief as Dozier’s Attachment and Biobehavioral Catch-up
, a 10-session, home-based protocol that has shown positive effects on infant-mother attachment and infants’ stress regulation (Dozier, Peloso, Lewis, Laurenceau, & Levine, 2008
; Dozier, Peloso, Zirkel, & Lindheim, 2007
). Such brief yet powerful interventions may increase the effectiveness of existing maltreatment prevention programs. Such interventions may also be powerful tools in and of themselves for preventing child maltreatment.