Intergenerational Continuity in Child Maltreatment: Explicating Underlying Mechanisms

Abstract

The current study examined direct and indirect effects of a mother’s history of childhood physical and sexual abuse on her child’s officially reported victimization. This prospective, longitudinal study followed a community-based sample of 499 mothers and their children. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, and 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants’ target child between birth and age 3.5. Whereas both types of maternal maltreatment history doubled the child’s risk of child protective services investigation, mothers’ sexual abuse history conferred significantly greater risk. Pathways to child victimization varied by type of maternal maltreatment history. Mothers who had been physically abused later demonstrated interpersonal aggressive response biases, which mediated the path to child victimization. In contrast, the association between maternal history of sexual abuse and child victimization was mediated by mothers’ substance use problems. Study implications center on targeting child maltreatment prevention efforts according to the mother’s history and current problems.

Keywords

child maltreatment intergenerational social information processing substance use problems

Child maltreatment is a significant public health problem requiring targeted intervention and prevention efforts. Research on child maltreatment has identified key risk factors, such as family poverty (Putnam-Hornstein & Needell, 2011) and maternal trauma history (Banyard et al., 2003; Cohen et al., 2008). Above and beyond identifying such risk factors, explicating the mechanisms underlying the associations between documented risk factors and child maltreatment stands to increase the precision of both intervention and prevention efforts (Alink et al., 2019). In the current study, we pursued an overarching aim of improving child maltreatment prevention. We focused on the risk factor of maternal history of childhood abuse. We tested not only the direct associations between maternal abuse history and her child’s experience of being maltreated but also the extent to which several psychological processes mediated these associations.

A parent’s history of childhood maltreatment is a well-established risk factor for maltreatment of offspring (Madigan et al., 2019). The mechanisms underlying intergenerational continuities (cases in which both parent and offspring experience maltreatment) are not well understood, however prompting calls for studies of such mechanisms (Alink et al., 2019). For example, intergenerational continuity in maltreatment in a large cohort study was found to be mediated by maternal depression (Choi et al., 2019). In contrast, in another recent investigation that identified sociodemographic risks, intimate partner violence, and lack of family support as factors that distinguished mothers who broke versus perpetuated an intergenerational cycle of maltreatment, maternal psychological distress was not a significant mediator (St-Laurent et al., 2019). Other recent inquiries have yielded inconsistent findings concerning parental substance use as a mediator of intergenerational continuity in maltreatment (Augustyn et al., 2019; Capaldi et al., 2019). Two suggestions emerging from this literature pertain to (a) testing mothers’ prenatal characteristics as potential mediators, to maximize opportunities for prevention, and (b) considering the role of assessment timing. For example, Choi and colleagues’ (2019) study highlighted mothers’ postpartum depression as a mediator of the association between maternal and offspring maltreatment, but this effect appeared to have operated through mothers’ later depressive episodes when their children were 5 to 7 years old (i.e., postpartum depression was a more influential mechanism when mothers were also depressed later). Thus, repeated testing of mediated models may be especially informative. The current longitudinal study responds to these recent findings in two ways. First, we include prenatally assessed psychological mechanisms of intergenerational transmission. Second, we examine the extent to which there was continuity in mediation across two consecutive waves of maltreatment reports.

We conducted a prospective, community-based study of 499 mothers by interviewing them during pregnancy and following their children through child protective services record review. In a previous study, we found that the mother’s self-reported history of physical abuse or sexual abuse increased the likelihood of her child’s officially reported victimization by age 2 (experienced by 8% of this sample; Appleyard et al., 2011; Berlin, Appleyard, et al., 2011). Mothers’ self-reported aggressive response biases (aggressive tendencies) and social isolation during pregnancy mediated the association between their physical abuse histories and their infants’ victimization (Berlin et al., 2011); mothers’ substance use problems mediated the associations between their physical abuse and sexual abuse histories and their infants’ victimization (Appleyard et al., 2011). In the current study, we examined the extent to which these direct and indirect effects persisted through age 3.5 by testing aggressive response biases, social isolation, and maternal substance abuse problems as mediators of the associations between both types of maternal abuse history and child victimization.

Our focus on age 3.5 was motivated by the rapid and influential changes that characterize early childhood and by national data indicating that the highest rates of child victimization occur between birth and age 3 (U.S. Department of Health and Human Services, Administration on Children, Youth and Familie, 2019). We hypothesized that maternal history of maltreatment would continue to predict child victimization by age 3.5. Based on our previous findings and consistent associations in the literature between physical abuse and later aggression (e.g., Braga et al., 2017), we hypothesized that mothers’ aggressive tendencies (aggressive response biases) would mediate the association between their physical abuse histories and their child’s victimization. Based on our previous findings, we further hypothesized that mothers’ substance use problems would mediate the associations between both physical and sexual abuse histories and child victimization. Finally, given (a) evidence of both positive and negative influences of family support (e.g., St-Laurent et al., 2019), and (b) the availability of supportive services that target new mothers (e.g., Steele & Steele, 2018), we speculated that social isolation and its influence may have changed in the approximately 18 months between the previous and the current study. Thus, we anticipated that social isolation would no longer function as a mediator in the current analysis.

Method

Sample

All research methods were approved by the second author’s Institutional Review Board. Participants were 499 socioeconomically and racially diverse mothers and their children from a small southeastern community city and its surrounding county. Mothers were recruited during pregnancy in the waiting rooms of prenatal care providers. In addition, flyers were posted at these clinics and in other community locations. Potential participants were offered US$20 per interview. Of the 383 women approached, 351 (92%) agreed to participate. Another 148 were recruited after responding to the flyer.

Fifty-two percent of the mothers were first-time mothers. Mothers identified themselves as White (non-Latina) (35%), Black (non-Latina) (34%), Latina (23%), Asian (3%), bi- or multiracial (3%), or other (1%). Mothers ranged in age from 12 to 41 (M = 27.3, SD = 5.9). Twenty-eight percent of the mothers had not completed high school, 13% had completed high school or a GED, and 17% had completed some college or vocational training. Twenty-three percent of the mothers had graduated from college and 18% had completed a postgraduate degree. Family income ranged from US$0 to US$400,000, with a median of US$35,000. Comparison with population statistics for race, ethnicity, and education for mothers giving birth in the county during the year that study participants were interviewed indicated that the sample was representative of the county from which it was drawn.

Procedures and Measures

During the second half of pregnancy, participants completed an in-person psychosocial interview. As part of informed consent procedures, participants provided written consent for the research team to access to their child’s child protective service records for up to 7 years.

Maternal history of maltreatment during childhood

The Parent-Child Conflict Tactics Scale (PC-CTS; Straus et al., 1998) measured mothers’ childhood experiences of maltreatment. Thirty percent (n = 149) of the mothers experienced childhood physical abuse, sexual abuse, or both. Mothers were classified as physically abused if they reported that they were often hit on the bottom or on some other part of the body “with something like a belt, hairbrush, a stick, or some other hard object,” or if they reported that they were sometimes or often “beat up (hit over and over as hard as [their parent] could)” (n = 48; 9.6% of total). Mothers were classified as sexually abused if they reported that before age 18 they had ever been touched sexually against their will, been pressured to touch another person sexually, or been pressured to have sex by an older child or adult (n = 125; 25.1% of total). Five percent (n = 24) of the mothers experienced both types of maltreatment (physical and sexual abuse), representing 50% of the mothers who had been physically abused and 19% of the mothers who had been sexually abused.

Child victimization

County records of investigations and substantiations of child maltreatment were reviewed for the presence of participants’ target child. In accordance with county regulations, information about perpetrators was explicitly excluded from the records available to the research team. Records were reviewed through the child’s age of 43 months. We identified 51 children (10%) with at least one incident of investigated or substantiated abuse or neglect. There was a total of 96 incidents for these 51 children, with 20 (39%) of the children having more than one investigation or substantiation. Of these 96 incidents, 78 (81%) were investigations only, and 18 (19%) were substantiations. Of these 18 substantiations, 14 (78%) were substantiated for neglect, 3 (17%) were substantiated for abuse (physical, sexual, or emotional), and 1 (6%) was classified “in need of services.”

For analytic purposes, children were classified as victimized if they had at least one investigation or substantiation of abuse or neglect at or before age 43 months. As noted, 51 (10%) of the children met this criterion; 16 (31%) of these 51 children had at least one substantiated incident. Our analyses combined investigations and substantiations in light of findings that they are equally strong predictors of subsequent involvement with child protective services and related sequelae (Kohl et al., 2009) and because analyzing substantiated maltreatment only has been shown to result in limited representation, presumably from biases in the substantiation processes (Manly, 2005).

Psychological mediators

Maternal psychological mediators were assessed during the pregnancy interview. Aggressive response biases were assessed by presenting the pregnant woman with four vignettes in which she was asked to imagine a negative outcome caused by another adult with whose intentions were ambiguous. The mother then interpreted the other adult’s intentions and chose from a list of five increasingly aggressive behavioral responses. Responses were classified as aggressive or nonaggressive and averaged to create a single score indexing the proportion of total aggressive responses. Social isolation was assessed by asking the mother about the number of people to whom she could turn for help under each of four different scenarios. Responses to each scenario were coded on a 3-point scale (0–2) and averaged. Substance use problems were assessed with a brief 6-point index of substance use urges, interference of substance use with performance at home, school, or work, and experience of substance use treatment. (See Appleyard et al., 2011; Berlin, Appleyard, et al., 2011 for details.)

Analytic Approach

Simple direct effects of maternal maltreatment history on child victimization were tested via chi-square analyses with relative risk (RR) ratios to determine the proportions of child victimization attributable to maternal history of childhood physical abuse and sexual abuse, respectively. Direct and indirect effects of maternal maltreatment history on child victimization were tested via structural equation modeling (SEM) using Mplus v. 8 (Muthén & Muthén, 1998-2017) with Bayesian estimation of model fit to minimize potential biases for parameter estimates and to increase statistical power for testing indirect effects (Miočević et al., 2018). To examine unique effects of mothers’ histories of childhood physical abuse and sexual abuse, these variables were modeled simultaneously, with each controlling for the effects of the other. Standardized effect sizes (expressed as Cohen’s d’s) were calculated for the significant direct and indirect effects of maternal history of maltreatment. Models covaried maternal race ⁄ethnicity (White⁄non-Latina vs. non-White), socioeconomic status (SES; a latent variable composed of [standardized] maternal age and education and family income), and the pregnant woman’s mental health problems assessed using three questions adapted from the Composite International Diagnostic Interview Short Form (Kessler et al., 1998). Family income was missing in 13% and substance use problems were missing in 3.4% of the data due to nonresponse. For all other variables, between 99% and 100% of the data were present. Missing data were handled through full information maximum likelihood (FIML) estimation. Figure 1 illustrates the conceptual model.

Figure 1.

Conceptual model of direct and indirect effects of maternal history of childhood maltreatment on offspring victimization.

Results

Table 1 provides descriptive statistics and bivariate correlations for key study variables and covariates. Significant correlations were in predictable directions. Chi-square analyses revealed simple direct effects of maternal history of physical abuse and sexual abuse on child victimization. Of the 48 mothers who experienced childhood physical abuse, 18.8% (n = 9) had children who became victims of maltreatment by age 43 months, compared with 9.3% (n = 42) of the 451 mothers who did not experience childhood physical abuse, χ²(1) = 4.21, p = .04. Children of mothers with a history of physical abuse had 2.01 times the risk of victimization compared with children of mothers with no history of physical abuse (RR = 2.01, 95% confidence interval [CI] [1.05, 3.88]). Of the 125 mothers who experienced childhood sexual abuse, 17.6% (n = 22) had children who became victims of maltreatment by age 43 months, compared with 7.8% (n = 29) of the 373 mothers who did not experience childhood sexual abuse, χ²(1) = 9.83, p = .002. Children of mothers with a history of sexual abuse had 2.26 times the risk of victimization compared with children of mothers with no history of sexual abuse (RR = 2.26, 95% CI [1.35, 3.79]). The risk from sexual abuse was significantly greater than the risk to children of mothers with a history of physical abuse (z = −2.80, p = .01).

Table 1.

Descriptive Statistics and Bivariate Correlations for Key Study Variables and Covariates.

Variables	1	2	3	4	5	6	7	8	9	10	11
N	496	495	498	432	499	499	498	499	499	497	482
M (s)	N/A	27.3 (5.9)	4.36 (2.1)		0.85 (1.1)	N/A	N/A	N/A	0.07 (0.1)	0.40 (0.5)	0.12 (0.5)
Range	0-1	12-41	0-7	0-,400,000	0-3	0-1	0-1	0-1	0-1	0-2	0-5
Percent of yes responses	35%	n/a	n/a	n/a	n/a	9.6%	25.1%	10%	n/a	n/a	n/a
1. Maternal race/ethnicity (1 = White)	—
2. Maternal age	.34***	—
3. Maternal education^a	.53***	.54***	—
4. Family income^b	.46***	.43***	.56***	—
5. Maternal mental health problems	−.10*	−.13**	−.24***	−.22***	—
6. Maternal history of physical abuse	−.07	−.03	−.14**	−.12*	.17***	—
7. Maternal history of sexual abuse	.00	.02	−.01	−.05	.12**	.19***	—
8. Child victimization	−.11*	−.16***	−.22***	−.18***	.15**	.09*	.14**	—
9. Aggressive response biases	−.12*	−.15**	−.20***	−.08	.17***	.16***	.12**	.23***	—
10. Social isolation	−.37***	−.31***	−.57***	−.39***	.32***	.22***	.11*	.18***	.09*	—
11. Substance use problems	.00	.04	−.11*	−.11*	.18***	.14**	.20***	.24***	.14**	.08^†	—

Maternal education was rated on a scale of 0 (no formal schooling) to 7 (postgraduate degree). ^bMedian family income was US$35,000.

†

p < .10. *p < .05. **p < .01. ***p < .001.

Figure 2 summarizes the significant path coefficients for the SEM (the most relevant paths and coefficients are depicted in bold; nonsignificant paths are not depicted). Model fit was good (posterior predictive p-value [PPP] = .12). The model explained 34% of the variance in child victimization by age 3.5. Of note, maternal SES was a strong predictor of child victimization (β = −.45, p < .05). Above and beyond this and other covariates, the effect of maternal childhood physical abuse on child victimization was no longer significant, but the indirect effect was significant, indicating mediation via mothers’ aggressive response biases (ab = .07, 95% CI [.01, .17], d = 0.26). Neither social isolation (ab = −.01, 95% CI [−.11, .07]) nor substance use problems (ab = .04, 95% CI [−.01, .13]) was a significant mediator of the effect of maternal physical abuse. The direct effect of maternal history of childhood sexual abuse on child victimization remained significant (cʹ = .14, 95% CI [.01, .26], d = 0.33). In addition, the effect of maternal history of sexual abuse on child victimization was significantly mediated via maternal substance use problems (ab = .07, 95% CI [.02, .14]; d = 0.26) and marginally mediated by aggressive response biases (ab = .04, 95% CI [.00, .10]). Social isolation did not mediate this effect (ab = .00, 95% CI [−.05, .04]).

Figure 2.

Summary of structural equation model fitting associations among maternal history of maltreatment (physical abuse, sexual abuse), aggressive response biases, social isolation, substance use problems, and child victimization, controlling for maternal race/ethnicity, SES (age, education, family income), and maternal mental health problems.

Discussion

The current study added important information to the developing body of research addressing intergenerational continuity in childhood maltreatment and especially the mechanisms that may drive such continuities. In particular, in response to suggestions emerging from previous studies (e.g., Choi et al., 2019), we tested mothers’ prenatal characteristics as potential mediators and we examined the extent to which previously demonstrated indirect effects persisted in the context of maltreatment reports collected approximately 18 months later.

As predicted, we found an increase in official child victimization since our previous analysis: from 8% by child age 2 to 10% by child age 3.5, reflecting a 28% upturn. Consistent with existing literature (Madigan et al., 2019), we found that the mother’s experience of childhood physical or sexual abuse predicted her child’s victimization. Pathways to this outcome were unique to the mother’s type of abuse history. Both types of maternal maltreatment history doubled their child’s risk of victimization (compared with mothers without a history of maltreatment), but mothers’ sexual abuse history conferred statistically significantly greater risk than mothers’ physical abuse history. When tested in the multivariate SEM, the effect of maternal physical abuse operated indirectly through aggressive response biases, whereas the effect of maternal sexual abuse operated primarily through maternal substance abuse problems. Consistent with our hypotheses, social isolation reported during pregnancy did not function as a mediator. In all cases, standardized effect sizes were modest, between approximately one quarter and one third standard deviation.

The persistent effects seen in the current sample of both types of mothers’ maltreatment history, above and beyond several relevant covariates, including SES, attest to the robust nature of maternal maltreatment as a risk factor for their child’s victimization. The persistent effects of two mediating mechanisms help to explicate the observed intergenerational continuities. In particular, our findings suggest a trauma- and mental health-driven pathway for sexual abuse. Maternal history of sexual abuse may confer relatively greater risk because it operates through substance use problems, a notoriously difficult process to interrupt (McLellan et al., 2000). In contrast, our findings are consistent with a social learning pathway for physical abuse, wherein individuals who experience physical abuse develop maldaptive patterns of social congition, which in turn facilitate future aggression (Dodge et al., 1990). That is, mothers who were physically abused may repeat not only the perpetration of child maltreatment but also the same type of aggressive behavioral tendencies that had been inflicted on them. This speculation will require more precise child maltreatment data than were available for the current analysis. In particular, it is a limitation that information about perpetrators was not available for the current study. We recommend that future research include documentation not only of the official investigation of maltreatment but also of alleged perpetrators.

Another limitation to note concerns this study’s reliance on maternal report for both independent and mediating variables. This limitation is offset somewhat by our use of official records of maltreatment for the dependent variable. Future studies will benefit from a broader array of assessments, including observational assessments of parenting behaviors. Additional strengths of the current study include its prospective design, use of a representative community-based sample, and stringent analytic approach.

Although the focus of this study was on maternal maltreatment history, it is important to consider the role of maternal SES in her child’s maltreatment. Low income is a well-documented predictor of early maltreatment that strains basic parenting tasks such as securing family resources (e.g., housing, food, services) and managing parenting stress (Putnam-Hornstein & Needell, 2011; St-Laurent et al., 2019). The practical implications of the current findings should be viewed in the context of an overarching need for stronger anti-poverty policies and programs, such as the federal Early Head Start program for low-income families with young children and families.

Practical implications of the current study include prenatal screening for maltreatment history and further assessment of women who report histories of physical and/or sexual abuse, especially in the absence of therapeutic treatment. Findings also point to the need to address aggressive response biases through therapeutic services for women who have been physically abused as children. Applying cognitive behavioral therapy skills and techniques can contribute importanty to child maltreatment prevention and intervention (Azar et al., 2008), reducing child risk by changing parents’ maladaptive thinking patterns. Finally, findings also suggest that substance use prevention and treatment should be a priority for women who have been sexually abused. Some researchers have pointed out that some interventions (including substance use treatment) have shown limited efficacy with sexual abuse victims: modifications and adaptations may be needed for this vulnerable group (Trickett et al., 2011). Our findings suggest these tailored services may be especially important during pregnancy and the early parenting years when the demands for psychological resources, and related risk for offspring maltreatment, are particularly high.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Tiffany L. Martoccio

Elizabeth M. Aparicio

Author Biographies

Tiffany L. Martoccio, PhD, is a faculty research associate at the University of Maryland, College Park. Her community-based research focuses on evaluating evidence-based interventions within public health, human service, and educational systems serving at-risk young children. She is interested in integrating advanced statistical methods to synthesize and translate research into practice.

Lisa J. Berlin, PhD, is a professor at the University of Maryland School of Social Work. Her research program focuses on community-based interventions to support early child development in low-income, high-risk populations, especially through enhancing children’s earliest relationships. She is interested in integrating attachment theory, research, and attachment-based interventions with broad-based, publicly funded services for families with young children.

Elizabeth M. Aparicio, PhD, MSW, is an assistant professor in the Department of Behavioral and Community Health at the University of Maryland School of Public Health. Her research focuses on improving health equity through affecting individual and system-level change to improve youth and community well-being via informing and testing early childhood and adolescent interventions.

Karen Appleyard Carmody, PhD, serves as the director of Early Childhood Prevention Programs for the Center for Child & Family Health at the Duke University School of Medicine. Her clinical and research expertise is in infant mental health, child–parent attachment, early childhood trauma and maltreatment, and evidence-based practices to address these issues.

Kenneth A. Dodge, PhD, is the Pritzker Professor of Public Policy in the Sanford School of Public Policy at Duke University. He is a leading scholar in the development and prevention of aggressive and violent behaviors. His work provides a model for understanding how some young children grow up to engage in aggression and violence and provides a framework for intervening early to prevent the costly consequences of violence for children and their communities.

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