Patricia Cohen

A Longitudinal Analysis of Risk Factors for Child Maltreatment: Findings of a 17-Year Prospective Study of Officially Recorded and Self-Reported Child Abuse and Neglect.

OBJECTIVEnTo identify demographic, family, parent, and child factors prospectively associated with risk for child abuse and neglect among families in the community, using data on child maltreatment obtained from both official records and youth self-reports.nnnMETHODnSurveys assessing demographic variables, family relationships, parental behavior, and characteristics of parents and children were administered to a representative sample of 644 families in upstate New York on four occasions between 1975 and 1992. Data on child abuse and neglect were obtained from New York State records and retrospective self-report instruments administered when youths were > or = 18 years old.nnnRESULTSnLogistic regression analyses indicated that different patterns of risk factors predicted the occurrence of physical abuse, sexual abuse, and neglect, although maternal youth and maternal sociopathy predicted the occurrence of all three forms of child maltreatment. In addition, the prevalence of child abuse or neglect increased from 3% when no risk factors were present to 24% when > or = 4 risk factors were present. State records and self-reports of child maltreatment did not correspond in most cases when maltreatment was reported through at least one data source, underlining the importance of obtaining data from both official records and self-reports.nnnCONCLUSIONSnAssessment of a number of risk factors may permit health professionals to identify parents and children who are at high risk for child maltreatment, facilitating appropriate implementation of prevention and treatment interventions.

Combining discrepant diagnostic information from multiple sources: Are complex algorithms better than simple ones?

Optimizing methods of combining discrepant diagnostic information from multiple sources is one of the more daunting tasks facing the field of child psychopathology. Several researchers have asserted that complex information-combining schemes, those in which certain information or sources of information are weighted differently from others, are preferable. This study provides theoretical and empirical evidence that simple information-combining schemes, those in which all information from all sources is weighted equally, will as a rule work as well as complex schemes and may even work better. The implications of these findings for diagnostic instrument and algorithm design are discussed. A two-step diagnostic procedure utilizing a simple information-combining scheme is presented.

A Longitudinal Investigation of Social Causation and Social Selection Processes Involved in the Association Between Socioeconomic Status and Psychiatric Disorders

Social causation theory and social selection theory have been put forth to explain the finding that low socioeconomic status (SES) is associated with risk for psychiatric disorders. The predictions of both theories were investigated using data from a community-based longitudinal study. Psychosocial interviews were administered to 736 families from 2 counties in New York State in 1975, 1983, 1985-1986, and 1991-1993. Results indicated that (a) low family SES was associated with risk for offspring anxiety, depressive, disruptive, and personality disorders after offspring IQ and parental psychopathology were controlled, and (b) offspring disruptive and substance use disorders were associated with risk for poor educational attainment after offspring IQ and parental psychopathology were controlled. These findings indicate that social causation and social selection processes vary in importance among different categories of psychiatric disorders.

Young Adult Drug Use and Delinquency: Childhood Antecedents and Adolescent Mediators

OBJECTIVEnThe aims of this study were (1) to examine the childhood, early adolescent, and late adolescent predictors of young adult drug use and delinquency; and (2) to explore the effects of drug use on delinquent behavior.nnnMETHODnData were gathered during the course of a 20-year longitudinal study of children representative of the Northeast. Data were gathered on childhood aggression, early and late adolescent drug use and delinquency, and young adult drug use and delinquency.nnnRESULTSnOverall, the results were consistent with our proposed model. Childhood aggression had an adverse effect on young adult drug use and female deviant behavior. Drug use and delinquency during early and late adolescence served as the mediator between childhood aggression and young adult drug use. Moreover, adolescent drug use was associated with later delinquency.nnnCONCLUSIONSnThe findings indicated that childhood aggression was related to both young adult drug use and delinquency. Second, there was stability of drug use and delinquency between early adolescence and young adulthood. Third, drug use during early adolescence had an impact on delinquency not only in early adolescence, but also in late adolescence and young adulthood.

Family Factors Related to the Persistence of Psychopathology in Childhood and Adolescence

DATA collected in a large prospective longitudinal study of an epidemiological sample of children were employed to identify family risk factors for future psychopathology. Three data analytic models were used to distinguish between variables with effects on the subsequent onset of disorders, those in which increase in risk factor was accompanied by increase in disorder, and those specifically related to the duration of disorders present in the earlier assessment. Power assertive punishment techniques were most consistently related to future problems of the child, and children in unstable families who exhibited behavior or affective disorders in early childhood were more likely to have continuing problems 8 years later than were children in stable families. The relevance of these findings for primary, secondary, and tertiary prevention efforts is discussed.

Early maternal separation and the trajectory of borderline personality disorder symptoms

Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems.

Maternal depression and mother–child interaction patterns: association with toddler problems and continuity of effects to late childhood

OBJECTIVEnIncreased behavior problems have been reported in offspring of mothers with depression. In-home observations link maternal depressive symptoms (MDS) and mother-child interaction patterns with toddler behavior problems and examine their persistence into late childhood.nnnMETHODnMaternal characteristics (N = 153) and behaviors of two-year-old offspring (N = 215) were assessed in families from a randomly selected population cohort. Maternal self-reported depressive symptoms and observed maternal-toddler interaction patterns were evaluated as risks for toddler problem behaviors. Follow-up CBCL assessments about a decade later assessed persistence of effects identified in the toddler data.nnnRESULTSnMaternal negativity toward her toddler was related to toddler problems, regardless of maternal depressive symptoms. MDS in combination with positive mother-toddler interaction showed only marginal ill effects on toddler offspring and no long-term effects. Depressive symptoms of less responsive/emotion teaching dyads were related to offspring tantrums and to mother and observer rated fearfulness, independent of family contextual risks. Analyses of Child Behavior Checklist (CBCL) problem scales obtained on these children in late childhood showed persistent effects similar to those shown at the younger age.nnnCONCLUSIONSnIn sum, these findings suggest that for mothers with high levels of depressive symptoms, demonstrations of affection and responsiveness to toddler offspring may mitigate both current and long-term consequences on offspring behavior.

A multiple-risk interaction model: Effects of temperament and divorce on psychiatric disorders in children

Effects of family status on the trajectory of problematic temperament-adjustment at 1 to 10 years of age and associated psychiatric disturbance 8 years later were examined in an epidemiological sample of 648 children. After adjusting for predivorce temperament-adjustment and background factors, logistic regression yielded independent effects of single custodial mother (SCM) family status for increased risk of disruptive and anxiety disorders, and of stepfamily status for increased risk of disruptive disorders. Increased risk of psychiatric disorders was more pervasive for SCM family boys versus intact family boys than for SCM family girls versus intact family girls, however only significantly more so for depression. No significant sex interaction was observed for stepfamily status. When girls and boys were treated independently, patterns of family status and outcomes of internalizing disorders varied. In stepfamilies, an elevated risk of depression and anxiety disorders was observed in girls but not boys, whereas in SCM families an elevated risk of depression was observed in boys but not girls. Within each family status group there was support for an altered risk of later psychiatric disorders given specific problematic predivorce temperament-adjustment characteristics. Implications for future research and treatment are discussed.

Using individual growth model to analyze the change in quality of life from adolescence to adulthood

BackgroundThe individual growth model is a relatively new statistical technique now widely used to examine the unique trajectories of individuals and groups in repeated measures data. This technique is increasingly used to analyze the changes over time in quality of life (QOL) data. This study examines the change from adolescence to adulthood in physical health as an aspect of QOL as an illustration of the use of this analytic method.MethodsEmploying data from the Children in the Community (CIC) study, a prospective longitudinal investigation, physical health was assessed at mean ages 16, 22, and 33 in 752 persons born between 1965 and 1975.ResultsThe analyses using individual growth models show a linear decline in average physical health from age 10 to age 40. Males reported better physical health and declined less per year on average. Time-varying psychiatric disorders accounted for 8.6% of the explained variation in mean physical health, and 6.7% of the explained variation in linear change in physical health. Those with such a disorder reported lower mean physical health and a more rapid decline with age than those without a current psychiatric disorder. The use of SAS PROC MIXED, including syntax and interpretation of output are provided. Applications of these models including statistical assumptions, centering issues and cohort effects are discussed.ConclusionThis paper highlights the usefulness of the individual growth model in modeling longitudinal change in QOL variables.

Duration of early maternal separation and prediction of schizotypal symptoms from early adolescence to midlife

Early childhood experiences influence the capacity for healthy social and emotional development. The present study uses longitudinal data to determine whether early maternal separation predicted the subsequent development of schizotypal personality disorder (SPD) symptoms assessed repeatedly from early adolescence over the following 20 years. Within this community sample (N=766), multilevel linear regression analyses revealed the duration of separation from mother in the first 2 years of life predicted elevated SPD symptoms. This relationship was specific to children with mother-reported early angry emotional behavior. These results provide support for the role of early childhood psychosocial risk factors in the development of subsequent schizophrenia spectrum symptoms in emotionally vulnerable children.