Desmond K. Runyan

Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas

Context. Child maltreatment remains a significant public health and social problem in the United States. Incidence data rely on substantiated reports of maltreatment known to official social service agencies. Objective. The objective of this study was to describe the epidemiologic features of child physical and sexual abuse, on the basis of maternal self-reports. Design, Setting, and Participants. Computer-assisted, anonymous, cross-sectional, telephone surveys (N = 1435) were conducted with mothers of children 0 to 17 years of age in North and South Carolina. Mothers were asked about potentially abusive behaviors used by either themselves or their husbands or partners in the context of other disciplinary practices. They were also asked about their knowledge of any sexual victimization their children might have experienced. Main Outcome Measures. The incidence of physical and sexual maltreatment determined through maternal reports. Results. Use of harsh physical discipline, equivalent to physical abuse, occurred with an incidence of 4.3%. Shaking of very young children as a means of discipline occurred among 2.6% of children <2 years of age. Mothers reported more frequent physical discipline of their children, including shaking, for themselves than for fathers or father figures. Nearly 11 of 1000 children were reported by their mothers as having been sexually victimized within the past year. The incidence of physical abuse determined with maternal self-reports was 40 times greater than that of official child physical abuse reports, and the sexual abuse incidence was 15 times greater. For every 1 child who sustains a serious injury as a result of shaking, an estimated 150 children may be shaken and go undetected. There was no statistically significant difference in the overall rates of physical or sexual maltreatment between the 2 states. Conclusions. Official statistics underestimate the burden of child maltreatment. Supplemental data obtained with alternative strategies can assist policymakers and planners in addressing needs and services within communities and states. These data support the need for continued interventions to prevent maltreatment.

Longscan: A consortium for longitudinal studies of maltreatment and the life course of children

The National Research Council (1993) has issued an urgent call for theory-based, longitudinal research to examine the antecedents and consequences of child maltreatment. Many of the concerns raised by the National Research Council are addressed by LONGSCAN (LONGitudinal Studies of Child Abuse and Neglect), a consortium including a coordinating center and five independent prospective longitudinal investigations sharing common protocols for data collection, entry, and management. The children in the five investigations vary by their level of risk, ranging from a community sample with no identified risk beyond low income status, to children placed in foster care. The longitudinal study has been designed with six age-specific data collection points extending from 4 through 20 years of age. The conceptual model, organization, and analytic strategy for LONGSCAN are described.

A Population-Based Comparison of Clinical and Outcome Characteristics of Young Children With Serious Inflicted and Noninflicted Traumatic Brain Injury

Objective. Diagnosing inflicted traumatic brain injury (TBI) in young children is difficult in practice. Comparisons of children with inflicted and noninflicted TBI may help to identify markers of inflicted TBI. The objective of this study was to compare inflicted and noninflicted TBI in terms of presenting complaints, clinical features, and hospital outcomes. Methods. The presenting complaint, clinical finding, hospital course, and outcome of all children who were aged 2 years or younger in North Carolina and were admitted to a pediatric intensive care unit or died with a TBI in 2000 and 2001 were reviewed. Clinical presentation and injury types were compared between children with inflicted and noninflicted TBI. Risk ratios were used to compare clinical and outcome characteristics between the 2 groups. Among survivors, multivariate binomial regression was used to examine the adjusted risk of a poor outcome dependent on injury type. Results. A total of 80 (52.6%) children had inflicted and 72 (47.3%) children had noninflicted TBI. Children with noninflicted TBI (not in a motor vehicle crash) were more likely to present to the emergency department asymptomatic (44.8% vs 8.3%) and to have a specific history of trauma than children with inflicted TBI. Retinal hemorrhage, metaphyseal fracture, rib fracture, and subdural hemorrhage were more commonly found in children with inflicted compared with noninflicted TBI. Skeletal survey and ophthalmologic examination combined would have missed 8 (10.0%) inflicted TBI cases. Conclusions. Manner of presentation and injury types are helpful in distinguishing inflicted TBI. Clinicians should not rule out inflicted TBI on the basis of skeletal survey and ophthalmoscopy alone but should proceed to computed tomography and/or magnetic resonance imaging.

Risk factors for chronic lung disease in infants with birth weights of 751 to 1000 grams

We performed a multicenter, historical-cohort analysis to identify factors associated with chronic lung disease (CLD) in extremely low birth weight infants. The 235 infants who were born in 1984 with birth weights of 751 to 1000 gm and admitted to any of 10 participating neonatal intensive care units comprised the study population. We analyzed demographic characteristics, status at birth, severity of acute atelectasis, and early respiratory treatment in relation to CLD, which we defined as having received oxygen at age 30 days. By univariate analysis, CLD was associated with lower gestational age (p less than 0.001), male sex (p = 0.004), more severe acute atelectasis as indicated by a higher roentgenographic score (p less than 0.001), a higher ventilation rate at 96 hours (p = 0.012), and lower PaCO2 at 48 hours (p = 0.04). Infants receiving mechanical ventilation whose highest PaCO2 levels at 48 or 96 hour were less than 40 mm Hg were 1.45 times as likely to develop CLD as those whose highest PaCO2 levels were greater than 50 mm Hg (95% confidence interval 1.04 to 2.01). CLD rates by center were inversely related to mean PaCO2 levels in infants receiving mechanical ventilation at 48 and 96 hours (Spearman rank correlations 0.60 and 0.55; p less than 0.001). A logistic risk model that included sex, PaCO2 at 48 hours, roentgenographic score, gestational age, and race showed only male sex (p = 0.009) and lower PaCO2 at 48 hours (p = 0.04) to be independent predictors of CLD. We conclude that mechanical ventilation that results in PaCO2 levels above the physiologic range may decrease the risk of CLD in extremely low birth weight infants.

Importance of Early Neglect for Childhood Aggression

OBJECTIVE. The goal was to examine the association between early childhood neglect (birth to age 2 years) and later childhood aggression at ages 4, 6, and 8 years, compared with aggressions associations with early childhood abuse and later abuse and neglect. METHODS. A prospective cohort of 1318 predominantly at-risk children, recruited from 4 US cities and 1 southern state, were monitored from birth to 8 years of age. Maltreatment was determined through review of local child protective services records. A hierarchical, linear model approach, a special case of general, linear, mixed modeling, was used to predict aggressive behavior scores, as reported by the childs primary caregiver at ages 4, 6, and 8 years. RESULTS. Only early neglect significantly predicted aggression scores. Early abuse, later abuse, and later neglect were not significantly predictive in a controlled model with all 4 predictors. CONCLUSION. This longitudinal study suggests that child neglect in the first 2 years of life may be a more-important precursor of childhood aggression than later neglect or physical abuse at any age.

Impact of legal intervention on sexually abused children

OBJECTIVE Examining the psychologic risks of court and related interventions on child sexual abuse victims. DESIGN A prospective cohort study with follow-up at 5 months. SETTING Eleven county social service departments in central North Carolina. SUBJECTS 100 sexually abused children, ages 6 to 17 years, were recruited from consecutive referrals by social service departments; 75 completed the study. MEASUREMENTS AND RESULTS Using a structured psychiatric inventory, the Child Assessment Schedule, we found a high degree of distress at referral. The level of distress fell by 26% over the next 5 months (p less than 0.001). The 33 children not involved in criminal proceedings improved 30%, in comparison with a 17% improvement in the 22 children waiting for the proceedings (p = 0.042). The 12 children who had testified in juvenile court improved 42% on the Anxiety subscale, in comparison with a 17% improvement in all other subjects (p less than 0.01). With mathematical modeling that controlled for the factors of vaginal or anal penetration, the relationship to the perpetrator, an estimate of verbal IQ, duration of abuse, and whether counseling was received, it was estimated that children waiting for court proceedings at the follow-up examination were only one twelfth as likely to have improved by one standard deviation on the Depression subscale (p less than 0.05). A second model revealed that children who testified in juvenile court were 20.11 times more likely to improve by one standard deviation on the CAS Anxiety subscale (p less than 0.05). CONCLUSIONS Testimony in juvenile court may be beneficial for the child, whereas protracted criminal proceedings may have an adverse effect on the mental health of the victim.

ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C): Instrument development and multi-national pilot testing

OBJECTIVE To develop a child victimization survey among a diverse group of child protection experts and examine the performance of the instrument through a set of international pilot studies. METHODS The initial draft of the instrument was developed after input from scientists and practitioners representing 40 countries. Volunteers from the larger group of scientists participating in the Delphi review of the ICAST P and R reviewed the ICAST C by email in 2 rounds resulting in a final instrument. The ICAST C was then translated and back translated into six languages and field tested in four countries using a convenience sample of 571 children 12-17 years of age selected from schools and classrooms to which the investigators had easy access. RESULTS The final ICAST C Home has 38 items and the ICAST C Institution has 44 items. These items serve as screeners and positive endorsements are followed by queries for frequency and perpetrator. Half of respondents were boys (49%). Endorsement for various forms of victimization ranged from 0 to 51%. Many children report violence exposure (51%), physical victimization (55%), psychological victimization (66%), sexual victimization (18%), and neglect in their homes (37%) in the last year. High rates of physical victimization (57%), psychological victimization (59%), and sexual victimization (22%) were also reported in schools in the last year. Internal consistency was moderate to high (alpha between .685 and .855) and missing data low (less than 1.5% for all but one item). CONCLUSIONS In pilot testing, the ICAST C identifies high rates of child victimization in all domains. Rates of missing data are low, and internal consistency is moderate to high. Pilot testing demonstrated the feasibility of using child self-report as one strategy to assess child victimization. PRACTICE IMPLICATIONS The ICAST C is a multi-national, multi-lingual, consensus-based survey instrument. It is available in six languages for international research to estimate child victimization. Assessing the prevalence of child victimization is critical in understanding the scope of the problem, setting national and local priorities, and garnering support for program and policy development aimed at child protection.

Speak Softly—and Forget the Stick: Corporal Punishment and Child Physical Abuse

BACKGROUND Previous studies have shown an association between spanking and child physical abuse. However, the relationship between more frequent and severe corporal punishment and abuse remains unknown. The objective of this study was to examine the associations between reported spanking, spanking frequency, or spanking with an object and the odds of physical abuse in a representative sample of mothers from North and South Carolina. METHODS This study is a cross-sectional, anonymous telephone survey of adult mothers with children aged<18 years living in the Carolinas in 2002. The analysis was conducted in 2007. Survey responses were used to determine the association between corporal punishment (spanking, spanking frequency, and spanking with an object) and an index of harsh physical punishment consistent with physical abuse (beating, burning, kicking, hitting with an object somewhere other than the buttocks, or shaking a child aged<2 years). RESULTS Mothers who report that the child was spanked are 2.7 (95% CI=1.2, 6.3) times more likely to report abuse. Increases in the frequency of reported spanking in the last year are also associated with increased odds of abuse (OR=1.03, 95% CI=1.01, 1.06). Mothers reporting spanking with an object are at markedly increased odds of reporting abuse (OR=8.9, 95% CI=4.1, 19.6). CONCLUSIONS Although reported spanking increases the odds of reported physical abuse, the relationship between the reported hitting of a child with an object and reported abuse is much stronger. Reduction in this form of discipline through media, educational, and legislative efforts may reduce child physical abuse.

Social capital, family violence, and neglect

BACKGROUND. Social capital includes collective efficacy, psychological sense of community, neighborhood cohesion, and parental investment in the child. It has been shown to be associated with a variety of health and welfare outcomes and may be useful in understanding and preventing parenting behaviors on the continuum of child abuse and neglect. OBJECTIVE. The purpose of this research was to evaluate low social capital as a risk factor for harsh physical punishment, neglectful parenting, psychologically harsh parenting, and domestic violence. METHODS. This study is an analysis of cross-sectional telephone survey data of mothers in North and South Carolina (n = 1435). We constructed a 4-point social capital index reflecting survey responses to items ascertaining neighborhood characteristics, willingness to take personal action, the presence of 2 adults in the household, and regular religious service participation. We assessed the relationship of social capital to inventories of self-reported parenting behaviors and in-home violence. RESULTS. In adjusted analysis, we found that each 1 point increase in a 4-point social capital index was associated with a 30% reduction in the odds of neglectful parenting, psychologically harsh parenting, and domestic violence. There was no relationship between social capital and harsh physical punishment. CONCLUSIONS. This study demonstrates that increasing social capital decreases the odds of neglectful parenting, psychologically harsh parenting, and domestic violence but not harsh physical punishment. This supports further investigation into developing social capital as a resource for families.

Concordance Between Adolescent Reports of Childhood Abuse and Child Protective Service Determinations in an At-Risk Sample of Young Adolescents

This study examines the concordance between adolescent reports of abuse and abuse determinations from Child Protective Service (CPS) agencies. It also compares the utility of adolescent reports of abuse, relative to CPS determinations in predicting adolescent psychological adjustment. The sample included 350 early adolescents, ages 12 to 13 years, who were initially identified prior to age 2 years as being at elevated risk of maltreatment. An Audio-Computer Assisted Self Interview (A-CASI) was used to assess lifetime experiences of physical, sexual, and psychological abuse. The A-CASI interview elicited prevalence rates of abuse 4 to 6 times higher than those found in CPS records. However, 20 of 45 adolescents with CPS determinations of abuse failed to report abuse during the study interview. Adolescent psychological adjustment was more strongly associated with self-reports than with CPS determinations. The implications of these findings are discussed for validity of adolescent self-reports of childhood abuse and for the ongoing debate about disclosure patterns among victims of child sexual abuse.