Evidence for specific effects of childhood sexual abuse on mental well-being and physical self-esteem.

Women who are sexually abused are at increased risk for having mental health problems long after the abuse. Other nonexploitive experiences can also be psychologically detrimental, may coexist with sexual abuse, and may explain some portion of subsequent mental health problems. This study addresses the association between childhood sexual abuse and a woman's psychological functioning, independent of the quality of parental nurturance received during childhood and other variables which may influence mental health. Of 609 women completing mental health and self-concept measures, 98 reported sexual abuse; 110 of the remaining women were selected as comparisons. Women sexually abused as children scored lower on measures of mental health status. Both sexual abuse and fewer years of education were related to lower scores on a psychological well-being scale after variance accounted for by family and demographic variables was removed. Sexual abuse was not a predictor of general self-concept scores after the removal of family and demographic variables, but sexual abuse was independently associated with the subscale measuring the physical aspect of self-concept. These findings lend support to theorized causal links between child sexual abuse and some aspects of later psychological difficulties.

The prospective assessment of self-concept in neglectful and physically abusive low income mothers.

Maternal self-esteem has long been associated with the quality of maternal-child interactions and many assume that low self-esteem contributes to the cause of maltreatment. Assessments of the self-concepts of maltreating parents, however, have been done only after maltreatment has occurred. Prospective measurement of self-concept would help to clarify its role in the etiology of maltreatment. In this study, 471 pregnant women completed the Tennessee Self-Concept Scale (TSCS). State protective services' records were reviewed 3 years after these children were born. When records of the 459 women with a known live-born child were reviewed, 29 were found to have maltreated their children (neglect n = 22; physical abuse n = 11; four women found to have both neglected and abused their children). Neglectful mothers had lower scores on scales measuring overall self-esteem, moral self-worth, personal and social adequacy, and perception of self-worth in family relationships than matched nonreported mothers. They described their identity and behavior more negatively and had greater general maladjustment and neurotic symptoms. Physically abusive mothers had lower scores on self-worth in family relationships. When measured prospectively, low self-esteem appears to be a risk factor for child neglect, but is not a strong predictor for physical abuse. Implications for prevention programs are discussed.

A prospective study of secondary prevention of child maltreatment.

This study sought (1) to retest an approach to the prediction of risk of child maltreatment and (2) to test the effect of a comprehensive prenatal and pediatric health services program on the rate of maltreatment. Of 2585 women screened at their first prenatal visit, 1154 qualified for the study. Risk assignment was determined by a structured interview. High-risk women (n = 314) were assigned to receive standard (high-risk control group; n = 154) or intervention (high-risk intervention group; n = 160) services throughout the prenatal period and during the first 2 years of their infants' life. A third group (low-risk control group; n = 295) was selected among low-risk women and received standard care without intervention services. State records were searched for substantive reports of child maltreatment up to 36 months after birth. Physical abuse was found for 5.1% of the study population; neglect was substantiated for 5.9%. Prediction efforts were effective in identifying risk of physical abuse but not of neglect. Comprehensive health services did not alter the reported abuse rate for high-risk parents and was associated with an increased number of neglect reports. Intervention reduced subject attrition and appeared to serve as a bias for detection of maltreatment. Thus this long-term, prospective approach was ineffective for child abuse prevention, perhaps because of detection biases and societal changes.

Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight.

The effect of comprehensive prenatal care on birth weight was examined using a prospective randomized design. A total of 428 pregnant women were randomly assigned to comprehensive prenatal care (n = 217) or standard prenatal care (n = 211). Comprehensive care was provided by a multidisciplinary team of nurse-midwives, social workers, a nutritionist, paraprofessional home visitors, and a psychologist. Standard prenatal care consisted of medical care provided by obstetric residents. Multiple regression analysis using behavioral, demographic, and medical variables showed a strong relationship between the set of predictors and birth weight. Comprehensive care was related to higher birth weights for primiparous but not multiparous mothers. Separate analyses of variance for primiparas and multiparas similarly showed a favorable effect of comprehensive care on birth weight for primiparous but not multiparous mothers.

Context of directives given to young children with Down syndrome and nonretarded children: development over two years.

The context in which directives are given in parent-child interactions was studied for 2 years in 6 families who had children with Down syndrome and 4 families with nonretarded children, beginning when the children were 12 months old. Comparisons were based on chronological, mental, and verbal age. Measures included implicit and explicit directives, children's moods, play behaviors, attention, and compliance behaviors. The hypothesis that all of these parents would give directives in similar situations was supported by the data. The differences found when the children were matched on CA essentially disappeared when MA was considered. All parents showed similar patterns of change over time, but for parents of children with Down syndrome, the significant changes often started 6 to 12 months later than for parents of nonretarded children.

Outcome of abuse during childhood among pregnant low income women.

The outcome of experiencing abuse as a child was studied by comparing pregnant women who did recall versus those who did not recall this type of maltreatment. Fourteen hundred low income women were interviewed in prenatal clinic; those who said they were both punished by abuse and beaten by caretakers as children were considered abused. Abuse was recalled by more white than black women but families were followed after delivery and protective service reports of abuse for their offspring were equal. Because of low numbers, black subjects were dropped and the 95 white women who recalled abuse during childhood were compared to the remaining 832 white subjects. The groups did not differ in attitude about current pregnancy, age or marital status, and no differences were found for their children at birth. Abused mothers were more likely to have felt unwanted and unloved as children and to have lower self-images and more isolation than controls. Abused mothers had greater stress, and many of their stresses reflected disturbances in interpersonal relationships. Thus, women abused as children had some characteristics similar to those of known child abusers. Although abused women had more aggressive tendencies, their children were reported to protective services for abuse at the same frequency as control children. Intergenerational transmission of abuse was therefore not demonstrated prospectively. Classic theories of child abuse suggest a special child, special parent and stress act as independent agents to cause abuse. The above data suggest, alternatively, that abuse during childhood may lead to other risk characteristics and to greater stress. These may act together to increase risk for abuse. The special child may have an independent influence on abuse.

Prospective study of antecedents for nonorganic failure to thrive.

The cause of nonorganic failure to thrive (NFT) was studied prospectively in 274 low-income pregnant mothers by interviewing them for characteristics that retrospective studies indicated were associated with child maltreatment. After delivery, medical charts of mothers and infants were reviewed for complications of pregnancy, delivery, and postdelivery hospitalization, and the infants were observed for growth failure. The characteristics of 15 families with infants who developed NFT were compared with those of 86 selected randomly from the remaining families. Interview results suggest that NFT correlates significantly with aberrant nurture during the mother's childhood and with conflicts between the parents of the infants. Perinatal events correlating significantly with NFT include complications of pregnancy, short gestation, and residual minor medical problems at discharge from the nursery. We speculate that these events predispose to NFT by disturbing the development of the mother-infant relationship.

Child health and maltreatment.

Children who are abused have been said to have more illnesses than children who are not maltreated. The relationship between abuse and illness has been hypothesized to function in 2 ways: (1) that abuse precedes the illnesses and children from abusive homes become ill because of the damaging environment they endure, or, conversely, (2) that the illnesses precede the abuse, with the fussy behavior of ill children eliciting abuse. This study was intended to clarify the temporal relationship between illnesses and maltreatment. Health data were collected on a sample of 80 children: 11 from abusive families, 31 with nonorganic failure to thrive (NOFT), 14 from neglectful families, and 24 from control families. Hospital records (both inpatient and outpatient) for these children from the time of birth until they were 3 years old were searched by data collectors unaware of the child's classification. Children from abusive families or with NOFT appeared to be ill more often than control children, particularly during the first few months after birth, before abuse had been reported, but not necessarily before NOFT had been discovered. Health records of neglected children were not significantly different from those of controls. In addition to the abused. These 6 children also had more illnesses than control children, again particularly during the first few months after birth. Having ill children is described as a source of stress that may trigger abuse in an already stressed family.

Antecedents of child abuse.

The qualities of parents who batter their children have been determined by interviewing known abusers. Because most studies lack controls and because family characteristics may be changed by abuse, a prospective study was instituted. Fourteen hundred low-income mothers were interviewed in a prenatal clinic, and the characteristics of 23 reported for abuse within two years were compared to the characteristics of the remaining mothers. The predominant antecedents of child abuse were: unwanted pregnancy, aggressive tendencies, and aberrant childhood nurture in which disturbed family relationships were more important than outright abuse. Abusive mother had slightly less self-esteem. Factors which increased exposure between parents and children seemed to increase risk for abuse. In contrast to retrospective findings, abusive mothers did not differ in support available from others, age, education, isolation, family alcohol or drug problems, and expectations of child development.

Relationship of maternal language to language development and language delay of children.

Maternal language characteristics associated with language-delayed children were examined. Two age groups of Down syndrome children were matched on mean length of utterance (MLU) with two groups of nonretarded, language-delayed children and two groups of "normal" children, mostly from middle-class families. Twenty-minute audio tapes were recorded for each dyad in the home during free play, and the first 10 minutes were transcribed and coded into functional types of maternal language. Mothers of nonretarded, language-delayed children used more language irrelevant to the interaction than did mothers of Down syndrome children, who, in turn, used more irrelevant language than did mothers of "normal" children. Mothers of nonretarded, language-delayed children focused less on their children's utterances than did other mothers and more on their physical behavior. Maternal language patterns appeared to be related more to language problems for nonretarded, language-delayed children than for Down syndrome children.

Reduced incidence of parenting inadequacy following rooming-in.

Low-income mother-infant pairs were randomly assigned to rooming-in (N = 143) or to routine (N = 158) postpartum contact to determine whether rooming-in affects subsequent adequacy in parenting. At mean age 17 months, two rooming-in and ten control children had experienced inadequate parenting. One rooming-in and eight control children were hospitalized for these problems. One rooming-in and five control families were reported to Protective Services for mistreatment of the study child; five control and no rooming-in children were in the care of adults other than their parents at the time of data analysis. In this study, rooming-in correlated with fewer subsequent cases of parenting inadequacy.

Maternal language to prelinguistic infants: syntactic aspects.

Maternal speech to children has been shown to vary by age and language ability of the children. Previous studies have usually involved children over 1 year of age. In this study maternal speech to male and female 4-, 6-, and 8-month-old infants was recorded in the laboratory. Mothers used shorter utterances to 8-month-olds than to 4- or 6-month-olds, presumably in response to the infant's changing level of comprehension. Mothers used more sentences with subjects, verbs, or objects deleted to 8-month-olds and more complex sentences to 4-month-olds.

Open-field behavior of prenatally irradiated and/or postnatally handled C57BL/6 mice.

Mice (C57BL/6) were prenatally irradiated with 60Co and/or handled on postnatal Days 1-10, and subsequently tested in an open field on Days 21, 42, and 63, and in a shuttle box on Days 30 and 60. Another group of mice was treated and tested similarly, but the shuttle box testing was omitted. All animals were cross-fostered at birth. Handling increased open-field activity and decreased defecation whereas irradiation decreased activity and had inconsistent effects on defecation. A comparison of the data from both groups of mice indicated that the shuttle box experience decreased open-field activity, particularly for the irradiated and unhandled animals. Direct and indirect irradiation effects--revealed by the cross-fostering procedure--were both significant and about equal in magnitude, underlining the importance of attending to irradiation effects on maternal as well as on offspring behavior.