Robert T. Ammerman

Child abuse potential in parents with histories of substance use disorder.

OBJECTIVE To examine the relationship between parental history of substances use disorders (SUDs) and abuse potential. METHOD Milners (1986) Child Abuse Potential Inventory (CAPI) was administered to fathers and mothers (with and without histories of SUDs) of 10- to 12-year-old boys. RESULTS Fathers and mothers with lifetime histories of SUDs had higher Abuse Scale scores and were more likely to score in the Elevated range (as determined by clinically significant cutoff scores) than parents without such histories. No differences were found between parents with current diagnoses of SUD and those with past (but not current) histories of SUD. Fathers and mothers with a partner who had a history of SUD were more likely to score in the Elevated range, regardless of their own SUD histories. Separate regression models revealed that, for both fathers and mothers, emotional dysregulation (positive and negative affectivity) predicted Abuse Scale scores. Additional contributors to Abuse Scale scores were SUD status in fathers, and lack of involvement with the child in mothers. CONCLUSIONS History of SUDs in both fathers and mothers increases abuse potential. Contributors to abuse potential differed in fathers and mothers, underscoring the importance of examining parents separately in child maltreatment research.

Consequences of Physical Abuse and Neglect in Children

Abstract Research interest in the effects of abuse and neglect in children is relatively recent. Clinical case reports suggested pervasive deleterious physical and psychological consequences of maltreatment. Indeed, empirical efforts confirm these initial impressions. Abused and neglected children display deficits in intellectual and academic functioning. In addition, they exhibit a variety of internalizing and externalizing disorders, such as depression, anxiety, social withdrawal, aggressiveness, and conduct problems. Despite the above findings, a number of methodological shortcomings limit conclusions drawn from the literature. These include: (a) use of heterogeneous subject samples, (b) failure to match subjects on relevant variables, and (c) use of psychometrically weak assessment devices. This review examines functioning in abused and neglected children in four areas: (1) medical, (2) cognitive and intellectual, (3) emotional adjustment and psychopathology, and (4) social development. Several recommendations for future research are offered, including the need for increased: (a) descriptive information about abused and neglected populations, and (b) use of assessment instruments which delineate specific deficits in child functioning.

Etiological models of child maltreatment. A behavioral perspective

Child abuse and neglect are complex phenomena that require a multidisciplinary perspective. This article describes current etiological formulations of child maltreatment. Three models (ecological, transactional, and transitional) are described that delineate the multiple pathways leading to abuse and neglect. These approaches emphasize the interaction of causative factors in bringing about maltreatment and the importance of high and low-risk characteristics that differentially influence the development of maltreatment. Behavioral explanations of child maltreatment are also discussed. Particularly relevant here are observational learning, anger control, and coercive family processes. Finally, the implications of our understanding of etiology to assessment, treatment, and prevention are outlined and considered.

Abuse and Neglect in Psychiatrically Hospitalized Multihandicapped Children.

Medical charts of 150 consecutive admissions of multihandicapped children to a psychiatric hospital were examined to determine the extent and characteristics of abuse and neglect. Results indicated that 39% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent type of maltreatment, followed by neglect and sexual abuse. Maltreated multihandicapped patients admitted to the psychiatric unit were less likely to receive diagnoses of organic brain syndrome or profound mental retardation than nonmaltreated multihandicapped counterparts on the same unit. Moreover, data indicated that less severely impaired patients were more likely to be maltreated than were the more severely impaired. Particularly striking was the severity of maltreatment in this multihandicapped sample and the relatively high percentage (40%) of sexually abused patients who were assaulted by multiple perpetrators.

Case studies in family violence

Contributors. Preface. Part I: General Issues. 1. Family Violence: A Clinical Overview R.T. Ammerman, M. Hersen. 2. Social and Ecological Issues in Violence toward Children R.L. Burgess, et al. 3. The Ecology of Domestic Aggression toward adult Victims A. Rosenbaum, et al. 4. Legal Issues in Violence toward Children B.K. Mac Murray, B.A. Carson. 5. Legal Issues in Violence toward Adults L.G. Lerman, N.R. Cahn. 6. Medical Issues with Child Victims of Family Violence S.E. Briggs. 7. Medical Issues with Adult Victims of Family Violence R.L. Judd. Part II: Violence Toward Children. 8. Child Physical Abuse R.K. Oates, et al. 9. Child Neglect A.H. Green. 10. Child Sexual Abuse D.J. Kolko, E.J. Brown. 11. Incest J.A. Cohen, A.P. Mannarino. 12. Maltreatment of Children with Disabilities R.T. Ammerman, et al. 13. The Child Witness of Family Violence M.S. Rosenberg, et al. 14. Psychological and Emotional Abuse of Children M.R. Brassard, et al. Part III: Violence Toward Adults. 15. Wife Battering M.A. Dutton, et al. 16. Psychological Maltreatment of Partners A.H. Schwartz, et al. 17. Marital Rape H.S. Resnick, et al. 18. Intimate Partner Homicide D.G. Saunders, A. Browne. Index.

Handbook of prescriptive treatments for adults.

Introduction: Overview of the Issues in Prescriptive Treatments (R. Acierno et al.). Specific Disorders: Dementia (B.H. Mulsant, J.M. Rosen). Psychoactive Substance Use Disorders (K.S. Walitzer, G.J. Connors). Schizophrenia (S.A. Anderson et al.). Unipolar Depression (L.P. Rehm et al.). Bipolar Disorder (R. Philibert, G. Winokur). Panic Disorder (M.G. Craske, S.V. Waikar). Social Phobia (R.P. Mattick, G. Andrews). Simple Phobia (F.D. McGlynn). ObsessiveCompulsive Disorder (C. Duggan). Trichotillomania (G.A.H. Cristenson, T.B. Mackenzie). PostTraumatic Stress Disorder (T.M. Keane et al.). Generalized Anxiety Disorder (T.D. Borkovec, L. Roemer). Special Issues: Psychophysiological Disorders (D.A. Williamson, S.B. Sebastian). Pain Management (R.D. Kerns). The Violent Patient (G.T. Harris, M.E. Rice). Woman Battering (D.R. Follingstad, H. Breiter). 6 additional articles. Index.

Maltreatment of handicapped children: A critical review

Despite increased interest in child abuse and neglect in the past decade, little research attention has been focused on maltreatment in handicapped populations. This is surprising given that many handicapped children display characteristics (e.g., chronic and pervasive behavioral disturbances, decreased social initiations with caregivers) that are associated with high risk for assault and neglect in nonhandicapped children. Numerous investigations have found an overrepresentation of handicapped children in maltreated samples, and results of more recent efforts reveal a high incidence of abuse and neglect in handicapped populations. Although these data underscore the high risk for maltreatment in handicapped children, a number of important issues warrant further empirical examination. Moreover, generalizations and interpretations of findings from previous research have been obfuscated by methodological shortcomings. The present paper reviews the literature concerning abuse and neglect of handicapped children. Research strategies and issues are delineated and current problems in this field are discussed. Suggestions for directions future research might take are offered.

Changes in depressive symptoms in first time mothers in home visitation

OBJECTIVE The expansion of Home Visitation Programs for at-risk, first-time mothers and their young children has drawn attention to the potential impact of depression on program outcomes, yet little research has examined depression in the context of home visitation. The purpose of this study was to determine the prevalence of and changes in depressive symptoms in mothers enrolled in home visitation and identify predictors of change in symptoms over the first 9 months of service. METHODS Subjects consisted of 806 at-risk, first-time mothers enrolled in a Home Visitation Program. Self-reported depression was measured at enrollment and again 9 months later. Established clinical cutoffs were used to identify clinically elevated levels of depression. Additional measures were taken of interpersonal trauma history, concurrent intimate partner violence, and social support. RESULTS Results indicated that: (1) 45.3% of mothers had clinically elevated symptoms of depression at some point during the first 9 months of service, (2) 25.9% of mothers had elevated symptoms at both time points or at the 9-month assessment, and (3) 74.1% experienced an interpersonal trauma prior to enrollment. Lack of improvement or worsening of depressive symptoms from enrollment to 9 months was best predicted by pre-enrollment interpersonal trauma history, young maternal age, being African American, and symptoms severe enough to have led to mental health treatment. CONCLUSIONS Findings suggest that maternal depressive symptoms are a significant problem in home visitation. The role of interpersonal trauma in depressive symptoms, and how to best address these clinical issues in home visitation, warrants further examination. PRACTICE IMPLICATIONS Maternal depression is prevalent in Home Visitation Programs, and many mothers exhibit elevated symptoms at multiple time points over the first year of service. Interpersonal trauma history is also prevalent, and is predictive of increased depressive symptoms over time. Home Visitation Programs should note that mothers with interpersonal trauma history, young maternal age, and being African American have an increased likelihood of persistent depressive symptoms, which may in turn pose significant challenges to providing services.

A Clinical Trial of In-Home CBT for Depressed Mothers in Home Visitation

Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3months postpartum were randomized into IH-CBT and ongoing home visitation (n=47) or standard home visitation (SHV; n=46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs.

Intensive home visiting is associated with decreased risk of infant death

OBJECTIVE. The goal was to test the hypothesis that participation in a community-based home-visiting program is associated with a decreased risk of infant death. METHODS. A retrospective, case-control design was used to compare the risk of infant death among participants in Cincinnatis Every Child Succeeds program and control subjects matched for gestational age at birth, previous pregnancy loss, marital status, and maternal age. The likelihood of infant death, adjusted for level of prenatal care, maternal smoking, maternal education, race, and age, was determined with multivariate logistic regression. The interaction between race and program participation and the effect of home visiting on the risk of preterm birth were explored. RESULTS. Infants whose families did not receive home visiting (n = 4995) were 2.5 times more likely to die in infancy compared with infants whose families received home visiting (n = 1665). Black infants were at least as likely to benefit from home visiting as were nonblack infants. No effect of program participation on the risk of preterm birth was observed. CONCLUSION. The current study is consistent with the hypothesis that intensive home visiting reduces the risk of infant death.