Type and timing of mothers' victimization: effects on mothers and children.

OBJECTIVES: There is mounting concern about how mothers' own victimization experiences affect their children. This study examines the effects of mothers' victimization on their own mental health and parenting and on their children's behavior, development, and health. The effects of both timing and type of victimization are assessed. A related objective was to determine if there was a cumulative risk effect produced by victimization during both childhood and adulthood, or both physical and sexual. SETTING: Urban families in an eastern state and urban and rural families in a southern state. PARTICIPANTS: A total of 419 mothers and their children 6 to 7 years old were identified from 2 sites. The eastern sample was recruited in the first 2 years of life from 3 pediatric clinics: 1 for children at high risk for human immunodeficiency virus disease, 1 for children with failure to thrive, and a third providing pediatric primary care. The southern sample was derived from a cohort of children at risk for adverse health or developmental outcomes, plus a systematic sampling of controls, recruited from area hospitals. At age 4, a random sample of children from the original cohort who had been maltreated along with a matched comparison group of nonmaltreated children were selected. RESULTS: In general, mothers victimized during both childhood and adulthood had poorer outcomes than mothers victimized during either childhood/adolescence or adulthood who in turn had worse outcomes than mothers with no history of victimization. This manifested as more maternal depressive symptoms, harsher parenting, and more externalizing and internalizing behavior problems in their children. There were no significant differences in maternal functioning or child outcomes between those abused in childhood and those abused in adulthood. These findings were similar for type of victimization. Mothers' depression and harsh parenting were directly associated with their children's internalizing and externalizing behavior problems. CONCLUSIONS: Maternal victimization appears to be a highly prevalent problem in high-risk samples and is associated with harmful implications for mental health and parenting, as well as for the offspring. Pediatricians need to consider past and current victimization of mothers. Routine screening for these problems, followed by appropriate evaluation and intervention may reduce maternal depression, improve parenting, and reduce the incidence of behavior problems in children.

Fathers and child neglect.

OBJECTIVE: To examine the association between father involvement and child neglect. DESIGN: Cohort study. SETTING: Participants were recruited from an inner-city pediatric primary care clinic and a clinic for children at risk for human immunodeficiency virus infection in a teaching hospital. PARTICIPANTS: Mothers and fathers or father figures, and 244 five-year olds participating in a longitudinal study. MAIN OUTCOME MEASURES: Child neglect measured via home observation, a videotaped mother-child interaction, and child protective services reports. RESULTS: A father or father figure was identified for 72% of the children. Rates of neglect ranged between 11% and 30%. Father absence alone was not associated with neglect. However, in families with an identified and interviewed father, a longer duration of involvement (P<.01), a greater sense of parenting efficacy (P<.01), more involvement with household tasks (P<.05), and less involvement with child care (P<.05) were associated with less neglect. The overall model explained 26.5% of the variance in neglect. CONCLUSIONS: There is substantial involvement of fathers in a subset of this high-risk sample, although more than a quarter of the children lacked a father or father figure. The mere presence of a father did not significantly influence the neglect of the children; rather, the nature of his involvement did. Fathers who felt more effective as parents were less likely to have neglected their children. A greater sense of efficacy may reflect parenting skills and be important in enhancing the contribution of fathers to their children's well-being. Pediatric health care providers can play a valuable role in enhancing the involvement and skills of fathers.

African American fathers in low income, urban families: development, behavior, and home environment of their three-year-old children.

This study examined the relationship between paternal roles, regardless of residence, and the well-being of 175 3-year-old children from low income, African American families. There were no differences in children's cognition, receptive language, behavior, or home environment related to father presence. Fathers (or father figures) were identified in 73% of the families, and 64% participated in an interview and videotaped observation. The relationships between paternal roles (parenting satisfaction, economic support, nurturance during play, child care, and household responsibilities) and children's cognitive skills, receptive language, behavior, and home environment were examined. After controlling for maternal age, education, and parenting satisfaction, there were significant relationships between paternal roles and each index of children's well-being, suggesting that fathers' contributions were unique. Fathers who were satisfied with parenting, contributed financially to the family, and were nurturant during play had children with better cognitive and language competence; fathers who were satisfied with parenting and employed, had children with fewer behavior problems; and when fathers were living with the child, the home was more child-centered. Neither the biological relationship of the father nor the parents' marital status entered into the models. These findings support ecological theories linking paternal involvement with children's well-being and argue for the institution of family-oriented policies that promote positive father involvement.

Child neglect: relation to child temperament and family context.

Relationships among neglect and child and family characteristics were examined in a sample of 121 urban, low-income families with a child under 30 months. Maternal reports of more difficult child temperament predicted emotional neglect; family context was indirectly related, as mothers in well functioning families with more support reported their children as being less difficult. Neither child temperament nor family context was related to physical neglect.

The cumulative effect of neglect and failure to thrive on cognitive functioning.

OBJECTIVE: A cumulative risk model was used to examine the relationship among neglect, failure to thrive (FTT), and cognitive functioning in low income children. METHOD: A sample of 177 children 3 to 30 months old was recruited from a pediatric clinic serving low-income, primarily African American families. Four groups were formed based on neglect and FTT status: Neglect and FTT, Neglect Only, FTT Only, and No Neglect or FTT. FTT was defined as weight-for-age below the 5th percentile on growth charts. To avoid the biases associated with Child Protective Service reports as definitions of neglect, the HOME scale (Caldwell & Bradley, 1984) was used to define neglect. RESULTS: The cognitive performance of the group with neglect and FTT was significantly below that of the children in the Neglect Only, FTT Only, and No Neglect or FTT groups. CONCLUSIONS: These findings support a model in which the accumulation of risk factors is detrimental to cognitive functioning. The results also underscore the need for thorough evaluation when one risk factor has been identified. Growth failure may come to the attention of medical personnel, but neglect may not be detected. However, a child experiencing both neglect and FTT may be at risk for significant deficits in cognitive functioning.

Risk status and home intervention among children with failure-to-thrive: follow-up at age 4.

Examined the moderating effects of risk status on the impact of home intervention in a follow-up study of children with failure-to-thrive (FTT). Two types of risk (demographic and maternal negative affectivity) and two levels of intervention were examined. In this randomized clinical trial, all children received services in a multidisciplinary growth and nutrition clinic, and half the children also received home visits from a lay home visitor for 1 year. There were no effects of demographic risk, maternal negative affectivity, or intervention status on child outcome at the close of the home intervention. However, at age 4, more than 1 year after the home intervention ended, there were effects of the home intervention on motor development among all children and on cognitive development and behavior during play among children of mothers who reported low levels of negative affectivity. Results highlight the importance of conducting follow-up assessments in the evaluation of home intervention services, and suggest that among low-SES families of children with FTT, home intervention may be most useful among mothers with low negative affectivity.

Sources of health care and health needs among children in kinship care.

OBJECTIVES: To determine the characteristics of children in kinship care and their caregivers who have access to health care (a single source of health care or a single provider), and to determine the relation between indicators of access and health needs. DESIGN: Cross-sectional. SETTING: A large eastern city. SUBJECTS: Two hundred ten children selected from households with children in kinship care in April 1989. METHODS: Data were obtained from medical records, access and demographic questionnaires, and a medical and psychologic evaluation. RESULTS: A single facility for health care was reported by 93% of the sample; two thirds of those identified one health care provider. One source of care or one provider was associated with variables such as young age at placement and medical assistance insurance. Children who did not have a single source of care were more likely to have unmet health needs (87% vs 61%, P < .05), especially unmet mental health needs (60% vs 31%, P < .05). CONCLUSIONS: Children in kinship care had good access to health care, but the level of unmet health needs was high. Children who did not have a single source of health care were more likely to have unmet health needs, especially unmet mental health needs. These findings have implications for future health care planning for children in out-of-home care.

A randomized clinical trial of home intervention for children with failure to thrive.

OBJECTIVE: To evaluate the efficacy of a home-based intervention on the growth and development of children with nonorganic failure to thrive (NOFTT). DESIGN: Randomized clinical trial. PARTICIPANTS: The NOFTT sample included 130 children (mean age, 12.7 months; SD, 6.4) recruited from urban pediatric primary care clinics serving low income families. All children were younger than 25 months with weight for age below the fifth percentile. Eligibility criteria included gestational age of at least 36 weeks, birth weight appropriate for gestational age, and no significant history of perinatal complications, congenital disorders, chronic illnesses, or developmental disabilities. Children were randomized into two groups: clinic plus home intervention (HI) (n = 64) or clinic only (n = 66). There were no group differences in children's age, gender, race, or growth parameters, or on any of the family background variables. Most children were raised by single, African-American mothers who received public assistance. Eighty-nine percent of the families (116 of 130) completed the 1-year evaluation. INTERVENTIONS: All children received services in a multidisciplinary growth and nutrition clinic. A community-based agency provided the home intervention. Families in the HI group were scheduled to receive weekly home visits for 1 year by lay home visitors, supervised by a community health nurse. The intervention provided maternal support and promoted parenting, child development, use of informal and formal resources, and parent advocacy. MEASUREMENTS: Growth was measured by standard procedures and converted to z scores for weight for height and height for age to assess wasting and stunting. Cognitive and motor development were measured with the Bayley Scales of Infant Development, and language development was measured by the Receptive/Expressive Emergent Language Scale. Both scales were administered at recruitment and at the 12-month follow-up. Parent-child interaction was measured by observing mothers and children during feeding at recruitment and at the 12-month follow-up, and the quality of the home was measured by the Home Observation Measure of the Environment 18 months after recruitment. ANALYSES: Repeated-measures multivariate analyses of covariance were used to examine changes in children's growth and development and parent-child interaction. Analyses of covariance were used to examine the quality of the home. Independent variables were intervention status and age at recruitment (1.0 to 12.0 vs 12.1 to 24.9 months). Maternal education was a covariate in all analyses. When changes in developmental status and parent-child interaction were examined, weight for height and height for age at recruitment were included as covariates. RESULTS: Children's weight for age, weight for height, and height for age improved significantly during the 12-month study period, regardless of intervention status. Children in the HI group had better receptive language over time and more child-oriented home environments than children in the clinic-only group. The impact of intervention status on cognitive development varied as a function of children's ages at recruitment, with younger children showing beneficial effects of home intervention. There were no changes in motor development associated with intervention status. During the study period, children gained skills in interactive competence during feeding, and their parents became more controlling during feeding, but differences were not associated with intervention status. CONCLUSIONS: Findings support a cautious optimism regarding home intervention during the first year of life provided by trained lay home visitors. Early home intervention can promote a nurturant home environment effectively and can reduce the developmental delays often experienced by low income, urban infants with NOFTT: Subsequent investigations of home intervention should consider alternative options for toddlers with NOFTT:

Behavior problems of children in kinship care.

An increasing number of children needing out-of-home care are being placed with relatives. Despite this pervasive policy, there has been scant research on children in this arrangement called kinship care. The objectives of this study were (1) to assess the behavior of children in kinship care and (2) to identify predictors of their behavior. The caregivers of 346 children in kinship care completed the Child Behavior Checklist (CBCL). Background information was obtained from caregivers and caseworkers. Forty-two percent of boys and 28% of girls had overall CBCL scores in the clinical range, compared with an expected 10% in the general population. Logistic regressions revealed several variables significantly associated with behavior problems including: reason for placement, gender, race, caregiver's perception of the child, caregiver's educational level, number of contacts between caregiver and caseworker, long-term plan, and child's age. The frequent behavior problems among these high-risk children in kinship care suggest they all deserve mental health evaluations; at a minimum, periodic screening is indicated.

Developmental differences in interactional characteristics of mothers and their children with failure to thrive.

Observed interactional characteristics during feeding sessions among 68 pairs of low-income mother-child dyads. Half of the children were experiencing non-organic failure to thrive (NOFTT) and half were growing adequately. Children were spoon-fed and ranged in age from 8 to 26 months. Across NOFTT and comparison groups, toddlers (13.5 to 26 months) were perceived by their mothers as more difficult than were infants (8 to 13.4 months). Although there were few differences between the NOFTT and comparison groups on interactional characteristics overall, mothers of NOFTT toddlers were more hostile, intrusive, and less flexible than mothers of NOFTT infants and there was more tension and anger in their interactions. Maternal behavior did not differ among the comparison group. Mothers of NOFTT children may experience difficulties in responding to the increasing demands for autonomy during feeding among toddlers. Finally, when the interaction was observed in dyadic terms, toddlers in both groups tended to be more active and involved than infants.

Clinical judgment of abuse-proneness based on parent-child interactions.

Professionals skilled in working with abusive families and a sample of university undergraduates viewed video tapes of abusive and matched control parent-child dyads interacting in a free play setting. Subjects were asked to indicate which of each pair of dyads was abusive and the reasons for their judgment. Performance of both groups was at chance levels. Implications of these results for the prediction and prevention of child abuse and the training of clinicians are discussed.

Current research on the developmental ecology of lead exposure during childhood.

A model for understanding the effects of lead on child development, which focuses on the ecology of childhood is presented. The methods used in 10 prospective, longitudinal studies of the effects of lead are summarized and preliminary results presented. Differences between studies lead to a conclusion that there should be more interinvestigator collaboration to ensure greater comparability across studies.

Affective behavior of abused and control children: comparisons of parent-child interactions and the influence of home environment variables.

Affective behaviors of 14 pairs of infant and preschool abused and control children matched on age, race, sex, and socioeconomic level were assessed in parent-child interaction. Subgroups of abused and control samples were formed by introduction of selected home environment variables chosen to represent properties of the parent-child dyad. Matched-pairs analysis showed few matched t-test comparisons to be significant. However, significant interactions were observed when two-way analyses of variance were performed with abused-control and status of home environment as factors. For positive affective behaviors, the abused group favored on home environment variables was higher than the favored control group. For negative affective behaviors, the abused group less-favored on home environment variables was higher than the less-favored control group. As a response to abuse, an increased sensitivity to the physical and social stimulation of the home environment is proposed.

Infant maltreatment: caretaker-infant interaction and developmental consequences at different levels of parenting failure.

A total of 53 mother-infant dyads, divided into five diagnostic groups (nonaccidental trauma combined with failure-to-thrive, nonaccidental trauma combined with iron-deficiency anemia, nonaccidental trauma only, neglect only, and normal control subjects) were observed during a feeding session. Qualitative differences were found in the relational characteristics of dyads in which multiple forms of maltreatment existed. Developmental examinations revealed that infants subjected to severe abuse and neglect were significantly retarded in their mental and motor development compared with the remaining index and control groups. The results were interpreted to suggest that relational disturbances are at the core of the problem of infant maltreatment and that on the basis of interactional symptomatology, two broadly different clinical conditions have been identified.

Motor and social behavior in abused and control children: observations of parent-child interactions.

Motor and social contact behaviors of 13 matched pairs of abused and control children were observed in dyadic interaction with their mothers. Few distinctions were found between these groups. Using post hoc rationale, abused and control groups were further differentiated on the basis of the quality of mother-child interaction. Quality of interaction was inferred from three factors of Caldwell, Heider, and Kaplan's Inventory of Home Stimulation. One factor (i.e., mother's use of restriction and punishment), in interaction with abause and control classifications, revealed a number of significant comparisons on motor and social behavior. Abused children employed more covert forms of communication while control children used more overt form. Results were discussed in terms of the identification of developmentally relevant aspects of the child's environment.

Behavioural concomitants of prenatal addiction to narcotics.

Behavioral characteristics of infants of methadone-treated and nonaddicted women were studied during the neonatal period and at three, six, and 12 months of age. Several Brazelton Neonatal Behavioral Assment Scale measures differentiated between groups. Major differences occurred in irritability of the central nervous system, and these measures appeared able to predict severity of withdrawal. The increased tremulousness of addicted infants remained through at least the first month of life. Mental and motor development was within normal limits in both groups throughout the year. However, the addicted infants showed a progressive decline in psychomotor performance whereas nonaddicted infants' scores remained stable.

Behavior of narcotics-addicted newborns.

The behavior of narcotics-addicted and nonaddicted newborns on the first 2 days of life was assessed with the Brazelton Neonatal Behavioral Assessment Scale. In addition to classic signs of narcotics abstinence, addicted infants were less able to be maintained in an alert state and less able to orient to auditory and visual stimuli. These deficits were especially pronounced at 48 hours of age. Addicted infants were as capable of self-quieting and responding to soothing intervention as normal neonates, although they were substantially more irritable. These characteristics and addicted infants' greater resistance to cuddling are discussed in terms of their potential impact on early infant-care-giver interaction.