Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems

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Contents lists available at ScienceDirect

Child Abuse & Neglect

Research article

Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems Susan Yoon a,∗ , Julia M. Kobulsky a , Laura A. Voith b , Stacey Steigerwald a , Megan R. Holmes a a b

Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA Helen Bader School of Social Welfare, University of Wisconsin Milwaukee, USA

a r t i c l e

i n f o

Article history: Received 26 June 2015 Received in revised form 1 October 2015 Accepted 15 October 2015 Available online xxx Keywords: Violence exposure in the home Caregiver–child relationships Adolescents Behavior problems Gender difference

a b s t r a c t The main objectives of this study were to investigate (1) the relationship between mild, moderate, and severe violence exposure in the home and behavior problems in adolescents; (2) the caregiver–child relationship as a potential mediator in this relationship; and (3) gender differences. A series of path analyses were conducted using a sample drawn from the National Survey of Child and Adolescent Well-Being (NCSAW-I) of 848 adolescents (ages 11–15) who had been reported to Child Protective Services for maltreatment and who remained in their homes. Exposure to violence and the caregiver–child relationship were reported by adolescents. Both caregiver ratings and adolescent self-reports were used to assess adolescents’ behavior problems. Path analysis indicated that exposure to mild and severe violence was directly associated with higher levels of child-reported behavior problems. However, exposure to violence was not directly associated with caregiver ratings of adolescent behavior problems. The caregiver–child relationship mediated the relationship between mild and moderate violence on both caregiver and child-reported adolescent behavior problems. Gender differences also emerged; for girls, the caregiver–child relationship mediated the effects of mild and moderate violence, whereas for boys, it mediated the effects of severe violence on behavior problems. Study findings suggest caregiver–child relationships as a critical underlying mechanism in the association between violence exposure and adolescent behavior problems, highlighting the importance of adding the caregiver–child relationship factor to intervention efforts. © 2015 Elsevier Ltd. All rights reserved.

Introduction Research regarding the effects of adolescent exposure to violence has grown significantly within the past three decades. Existing research reveals links between various types of childhood victimization and child outcomes (Evans, Davies, & DiLillo, 2008; Finkelhor, Turner, Ormrod, & Hamby, 2009). Generally, outcomes associated with violence exposure include an

This document includes data from the National Survey on Child and Adolescent Well-Being, which was developed under contract with the Administration on Children, Youth, and Families, U.S. Department of Health and Human Services (ACYF/DHHS). The data were provided by the National Data Archive on Child Abuse and Neglect. ∗ Corresponding author at: Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-7164, USA. http://dx.doi.org/10.1016/j.chiabu.2015.10.012 0145-2134/© 2015 Elsevier Ltd. All rights reserved.

Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012

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array of internalizing and externalizing behaviors that can manifest from infancy into young adulthood (Evans et al., 2008), and those manifestations can have cascading effects on subsequent developmental domains (Begle et al., 2011; Holmes, Voith, & Gromoske, 2014). However, few studies have examined mediating pathways, namely, the role of caregiver–child relationships, explaining the relation between children’s violence exposure and behavior problems (e.g., Lieberman, Van Horn, & Ozer, 2005; Toth, Cicchetti, & Kim, 2002). Furthermore, little is known about possible gender differences that may exist in these relations. To address these limitations, the current study examined the relationship between violence exposure severity levels (i.e., mild, moderate, severe) and behavior problems in adolescents, the mediating role of caregiver–child relationships, and gender differences in these relations. Violence Exposure and Behavior Problems Adolescents’ exposure to violence in the home, defined as adolescents being a witness to or victim of acts which threaten or actually inflict physical harm in the home he or she lives in, is a widespread problem. According to McDonald, Jouriles, Ramisetty-Mikler, Caetano, and Green (2006), approximately 15.5 million (29.4%) children in the United States reside in homes in which intimate partner violence (IPV) occurred at least once in the previous year, and of those children, nearly half (13.3%) had been exposed to severe IPV. Likewise, according to the National Survey of Children’s Exposure to Violence (NatSCEV), approximately 20% of children and adolescents in the United States witness family assault such as intimate partner violence, and 9% experience physical abuse over their lifetime (Finkelhor et al., 2009). Although direct victimization (e.g., physical abuse) and witnessing family violence (e.g., exposure to IPV) represent distinct types of violence exposure in the home, research has revealed that these types of violence exposures frequently co-occur (Finkelhor et al., 2009). Negative outcomes commonly associated with violence exposure include aggressive or antisocial behavior, conduct problems, depression, anxiety, low self-esteem, posttraumatic stress, substance abuse, academic challenges, reduced social development, and poor physical health maintenance and somatization (Tailor, Stewart-Tufescu, & Piotrowski, 2015; Wolfe, Crooks, Lee, McIntyre-Smith, & Jaffe, 2003). In particular, many previous studies have found a significant link between exposure to violence in the home and behavior problems in adolescents (Evans et al., 2008; Moylan et al., 2010). In these studies, exposure to violence was significantly associated with higher levels of general behavior problems, which include externalizing behavior problems such as aggression and delinquency and internalizing behavior problems such as anxiety and depression. Studies that examined gender differences in the effects of violence exposure on behavior problems have yielded mixed findings, with some studies suggesting no significant gender difference (Fagan & Wright, 2011; Moylan et al., 2010; Sternberg, Lamb, Guterman, & Abbott, 2006) and others suggesting stronger effects of violence exposure on girls’ behavior problems (i.e., exposure to violence at home better predicted girls’ rather than boys’ behavior problems; Cummings, Pepler, & Moore, 1999; O’Keefe, 1994; Spano, Vazsonyi, & Bolland, 2009). Although numerous studies report a significant link between violence exposure and children’s behavior problems, many of these studies were limited by relying on one source of information, usually the child’s mother, to assess the child’s behavior problems. The elevated levels of behavior problems in violence exposed children should be understood with caution as these may reflect caregivers’ biased perceptions in reporting their children’s behavior problems. Many researchers argue that relying on one source of information about children’s behavior problems may be problematic (Kerr, Lunkenheimer, & Olson, 2007). Therefore, this study addresses this issue by utilizing multiple informants: caregiver-report and child self-report. Some researchers further discuss the issue of the validity of perpetrating caregivers’ reports of their children’s behavior problems. For example, Sternberg et al. (1993) indicate that the use of a single-informant is of a particular concern in studies focusing on the effects of violence exposure and child maltreatment because when caregivers are the perpetrators of violence, their ability to accurately measure and report their children’s behavior problems may be compromised. In fact, previous studies have found that abusive caregivers are likely to over-report externalizing behavior problems in their children compared to non-abusive caregivers (Bradley & Peters, 1991; Lau, Valeri, McCarty, & Weisz, 2006). The Role of Caregiver–Child Relationships In the literature examining the effects of violence exposure on behavior problems, some researchers have examined the role of caregiver–child relationships. Research on caregiver–child relationships in violent families indicates that caregiver–child relationships may be affected by the perpetrators’ identity. Physically abusive mothers were more likely to minimize their contribution in negative parent–child interactions as well as their children’s contribution in positive ones (Bradley & Peters, 1991). Similarly, physically abused children tended to have negative perceptions of their abusive parents (Sternberg et al., 1994). However, positive caregiver–child relationships have been found to weaken the effects of violence exposure on behavior problems in low-income adolescents (Hardaway, McLoyd, & Wood, 2012). Similarly, findings have suggested that a supportive caregiver can have ameliorating effects on violence-exposed children’s behavior problems (Margolin & Gordis, 2000; Sousa et al., 2011). For example, researchers found that IPV-exposed children with mothers rated high in maternal warmth exhibited lower levels of externalizing problem behaviors, compared with children with mothers reporting lower levels of warmth (Skopp, McDonald, Jouriles, & Rosenfield, 2007). In a study employing structural equation modeling, a significant pathway emerged between children’s IPV exposure, parental stress, and child internalizing problems in elementary-aged children (Renner & Boel-Studt, 2013). However, this pathway did not remain significant for adolescent-aged children (Renner & Boel-Studt, 2013), suggesting that the protective effects of parenting (i.e., caregiver–child Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012

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relationships) may diminish with the increasing autonomy of adolescence. Parental factors may be particularly salient during early adolescence, however, when children are just beginning to seek independence but still need a supportive caregiver relationship (Galambos, Barker, & Almeida, 2003). Although empirical studies suggest that caregiver–child relationships may play an important role in linking children’s traumatic life events and psychopathological outcomes (e.g., Kliewer et al., 2004; Toth et al., 2002), few studies to date have investigated the mediating effects of the caregiver–child relationship on behavior problems in violence-exposed children. Examining the effect of mother–child relationship quality on the relation between preschooler’s IPV exposure and behavior problems, Lieberman et al. (2005) found evidence of a mediating effect. However, the mediating effects of maternal PTSD were stronger, suggesting the importance of maternal psychological response for younger children. For school-age children, Toth et al. (2002) found that the mother-child relationship mediated the effect of child maltreatment on child-reported internalizing and externalizing behavior symptoms. In this study, maltreated children had less-positive perceptions of their mothers, which in turn led to greater behavior problems. Results from a national random household survey of adolescents in South America indicated a mediating effect of family cohesion, including parental support, on violence exposure and behavioral problems; notably, this relationship was stronger for girls (Kliewer, Murrelle, Mejia, Torres, & Angold, 2001). These findings suggest that positive caregiver–child relationships may have ameliorative mediating effects on the behavioral outcomes of violence-exposed children and adolescents, and gender differences may exist. However, no strong conclusions can be drawn without additional research. The Present Study This study is guided by developmental psychopathology (Sroufe & Rutter, 1984) and attachment theory (Bowlby, 1969). The developmental psychopathology perspective posits that adverse life experiences such as exposure to violence may affect children’s adaptation and functioning (Sroufe & Rutter, 1984). This perspective emphasizes that a child’s ultimate adaptation or maladaptation occurs as a result of interplay between the evolving individual and changing contextual factors (e.g., family environment), underlining the importance of mediating variables that may contribute to outcomes. Attachment theory suggests that parents in IPV relationships or abusive caregivers may fail to provide warm, reliable, and responsive care to their children, resulting in patterns of insecure attachment in the child, which may lead to poor relationships with caregivers (Ainsworth, Blehar, Waters, & Wall, 1978). Children with poor caregiver–child relationships are likely to develop negative representational models (Bowlby, 1982) of self and others, which in turn, may lead to maladaptive emotional and behavioral functioning. Using the developmental psychopathology and attachment framework, the current study aims to enhance knowledge of behavioral maladjustment among adolescents exposed to violence at home by examining (1) if exposure to mild, moderate, or severe violence is related to behavior problems in adolescents; (2) if the caregiver–child relationship mediates the relations between the three levels of violence exposure and behavior problems; and (3) if those relations differ by gender. Because previous research has identified a bias in which reliance on single report may lead to the overestimation of relationships because of problems of common method variance (Galambos et al., 2003), this study tests caregiver and adolescent reported behavioral problems. Based on the results of previous empirical research, it was hypothesized that exposure to mild, moderate, and severe violence would be associated with higher levels of behavior problems in adolescents. Additionally, it was hypothesized that higher violence exposure would be associated with poorer caregiver–child relationships and poorer caregiver–child relationships would be associated with higher adolescent behavioral problems. Finally, the models investigated gender differences across these relations; however, because of the relatively inconsistent examination of this moderator, specific hypotheses were not formulated. Method Study Sample A secondary data analysis was conducted using data from the National Survey of Child and Adolescent Well-Being (NSCAW-I), a nationally representative longitudinal study that investigated the outcomes of children and families involved with Child Protective Services (CPS). The full sample of the NSCAW-I includes 5,501 children, aged birth to 14 years at the time of sampling, who were the subjects of an abuse or neglect investigation conducted by CPS from October 1999 to December 2000. Data were collected using face-to-face interviews with children, current caregivers, teachers (for school-aged children), and child welfare workers at five time points: 2–6 months (Wave 1), 12 months (Wave 2), 18 months (Wave 3), 36 months (Wave 4), and 59–96 months (Wave 5) after the close of the investigation. Further information about the NSCAW-I study design and sampling method is described elsewhere (Dowd et al., 2008). The present study used data from the first wave of data collection. The study sample included 848 adolescents who were between the ages of 11 and 15 years and who remained in the home following investigation. The study sample was restricted to adolescent ages between 11 and 15 years at Wave 1 because the study focuses on early adolescents, and the child-report data for the key study variables were available only from adolescents who were at ages 11 years and older. Missing data were modeled using full-information maximum likelihood (FIML), which utilizes all available information from the observed data. Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012

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Measures Adolescent Behavior Problems. Adolescents’ behavior problems were measured using the Child Behavior Checklist for children aged 4–18 (CBCL 4–18; Achenbach, 1991a) and the Youth Self-Report (YSR). The CBCL is a 113-item caregiver rating of the child’s behaviors, designed to assess the child’s emotional, behavioral, and social problems in the past 6 months. Caregivers rated their child on the extent to which each item applied to their child, using the following response categories: 0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true. Higher scores on the scales indicate greater behavior problems. The age- and gender-standardized scores (T scores) for total behavior problems were used. The decision to focus on the total score was supported by preliminary analyses indicating no major gender differences in internalizing and externalizing scales in the study sample. The internal consistency reliability of the CBCL in the current sample was acceptable (Cronbach’s ˛ = .95). The YSR (Achenbach, 1991b) is a standardized, child self-report measure of emotional, behavioral, and social problems in the past 6 months. The YSR is almost identical to the CBCL in content and structure, with the YSR including additional items about positive behaviors. The majority of the YSR items are identical to and overlap substantially with the items on the CBCL, thus allowing for comparison between two sources of information (Achenbach, 1991b). Adolescents rated their own behavior, using the following response categories: 0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true. The age- and gender-standardized T scores for total behavior problems were used, with higher scores indicating more behavior problems. The internal consistency reliability of the YSR for the study sample was acceptable (Cronbach’s ˛ = .96). For both CBCL and YSR, T scores less than 60 are considered in the normal range, 60–63 represent borderline scores, and scores greater than 63 are in the clinical range (Achenbach, 1991a, 1991b). Exposure to Violence in the Home: Mild, Moderate and Severe. Violence exposure in the home environment was measured using the Violence Exposure Scale for children (VEX-R; Fox & Leavitt, 1995). The VEX-R is a child self-report measure in a cartoon format. Children were shown cards depicting violent and criminal acts and were asked to describe the frequency of their exposure to those acts, either as a victim or witness. While the full version of the VEX-R includes items measuring children’s exposure to violence in four different settings (i.e., home, school, neighborhood, and television viewing), the NSCAW-I only used items that specifically assess children’s exposure to violence in the home. The response categories included 0 = never, 1 = once, 2 = a few times and 3 = lots of times. A factor analysis (principal axis factor analysis with Varimax rotation) of VEX-R on the current study sample indicated three subscales that accounted for 42.71% of the variance. All items loaded satisfactory (>0.4) on their respective factors. Factor 1, which accounted for 15.36% of the variance, included four items indicating exposure to mild violence (e.g., yelling, spanking). Factor 2, which accounted for 14.30% of the variance, included six items indicating exposure to moderate violence (e.g., shoving really hard, slapping really hard), and factor 3, which accounted for 13.06% of the variance, included six items indicating exposure to severe violence (e.g., stabbing, shooting). Cronbach’s alphas for all three subscales were acceptable (mild: .76, moderate: .88, severe: .71). Caregiver–Child Relationship. The caregiver–child relationship was assessed using the 12-item short version of the Relatedness scale from the Research Assessment Package for Schools (RAPS-S: Wellborn & Connell, 1987), which asks for children’s feelings about their relationship with their primary caregiver (e.g., parental emotional security, involvement, autonomy support, structure). Items include questions about the child’s feelings (e.g., good, mad, happy) about the caregiver, the caregiver’s interest in the child, belief in the child’s abilities, time spent with the child, trust of the child, and the child’s understanding of what the caregiver wants. Children were asked to indicate how true each statement was (1 = not all true, 2 = not very true, 3 = sort of true, 4 = very true). Scores were summed to obtain a total relatedness score, with higher scores indicating a better relationship with the caregiver. Cronbach’s alpha for the total relatedness score was .82. Control Variables. Adolescent characteristics, including age and race/ethnicity, were used as control variables in this study. For race/ethnicity, the following race categories were used: White/Non-Hispanic, Black/Non-Hispanic, Hispanic, and Other. The Other category included Non-Hispanic American Indian, Native American, Asian, Pacific Islander, and multiracial individuals. Child’s gender was used as a moderating variable. Analysis Plan Path analyses were performed to examine the association between violence exposure (mild, moderate, and severe) and adolescent behavior problems as well as to assess caregiver–child relationships as a mediator in this association. A path analysis allows for simultaneous examination of the strength and direction of the interrelationships among multiple exogenous (i.e., independent variables) and endogenous (i.e., mediators and dependent variables) variables in a model, as well as an evaluation of the direct and indirect effects of variables (Kline, 2005). The hypothesized path model was tested using Mplus v.6.0 (Muthen & Muthen, 1998–2011). Standardized parameter estimates are presented for ease of interpretation. In order to test potential gender differences in the mediation path model, all paths were freely estimated across genders in the final model (i.e., multiple group analysis). In order to control for the adolescents’ demographics (i.e., age and race/ethnicity), the dependent variables were regressed on the control variables. Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012

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Table 1 Sample characteristics (N = 848). Boys

Girls

2

df

p

n

%

n

%

Adolescent’s race White/non-Hispanic Black/non-Hispanic Hispanic Other/multiracial

170 101 53 29

48.2 28.6 15.0 8.2

227 130 88 46

46.2 26.5 17.9 9.4

1.851

3

.604

Adolescent’s primary caregiver Biological mother Biological father Others

285 34 34

80.7 9.6 9.6

395 46 54

79.8 9.3 10.9

.372

2

.830

Boys

Adolescent’s age Exposure to mild violence Exposure to moderate violence Exposure to severe violence Caregiver–child relationship Caregiver-reported behavior problems Child-reported behavior problems

Girls

n

M

SD

Range

n

M

SD

Range

353 337 331 333 328 346 352

12.70 4.70 2.00 0.69 40.36 60.68 51.92

1.31 3.43 3.25 1.60 6.13 12.88 13.05

11–15 0–12 0–18 0–12 18–48 23–89 22–88

495 480 469 472 462 483 493

12.67 5.36 2.51 0.90 39.37 59.46 53.45

1.29 3.21 3.75 1.90 6.71 12.50 12.49

11–15 0–12 0–18 0–14 13–48 24–94 22–90

t

df

p

.335 −2.785 −2.057 −1.713 2.113 1.369 −1.724

846 815 765 779 788 827 843

.738 .005 .040 .087 .035 .171 .085

Note. Possible range for exposure to violence: mild: 0–12, moderate: 0–18, severe: 0–18; possible range for caregiver–child relationship score: 12–48; for both caregiver-reported and child-reported behavior problems, scores <60: normal range, 60–63: borderline, >63: clinical range.

To test the model fit to the data, three goodness-of-fit indices were used: Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), and the Standardized Root Mean Square Residual (SRMR). CFI above .95, RMSEA less than or equal to .05, and SRMR less than or equal to .06 indicate an acceptable fit (Hu & Bentler, 1999). The Chi-square index was less suitable in this study because of the large sample size (N = 848). Results Sample Description Sample demographics and descriptive statistics for study variables are presented in Table 1. Participants in this study were 848 adolescents between the ages of 11 and 15 years. Nearly half of the sample (41.6%) were male. The majority (80.2%) of adolescents reported the biological mother as their primary caregiver, 9.4% reported the biological father, and 10.4% reported others (e.g., grandmother, aunt, and other relatives) as their primary caregiver. There were no gender differences between reported categories of primary caregiver (2 =.372, p = .830). In terms of exposure to violence at home, female adolescents reported significantly greater exposure to mild and moderate levels of violence when compared with males. There was also a statistically significant gender difference in caregiver–child relationships, with males reporting significantly better relationships with their primary caregiver (M = 40.36, SD = 6.13) than females (M = 39.37, SD = 6.71). No significant gender differences were found in the mean scores of caregiver ratings (p = .171) and adolescent ratings (p = .085) of behavior problems. Pearson correlations using T scores from the CBCL (caregiver report) and YSR (child report) were computed to assess the consistency of informants’ responses. Caregiver-reported behavior problems were moderately correlated (r = .45, p < .001) with the adolescent-reported behavior problems. In general, the scores of caregiver-rated behavior problems (M = 59.97, SD = 12.67) were higher than the scores of adolescents’ self-reported behavior problems (M = 52.81, SD = 12.74), with the mean score of caregiver ratings representing clinically borderline behavior problems and the mean score of adolescent rating representing behavior in the normal range. Mediation Analysis: The Mediating Role of Caregiver–Child Relationships The mediation analysis addressed the direct and indirect pathways by which adolescents’ exposure to mild, moderate, or severe violence affected their behavior problems. The proposed mediation path model showed a good fit for the data, indicated by the CFI of .97, RMSEA of .06, and SRMR of .02. Table 2 presents the standardized path coefficients for the mediation model of violence exposure on behavior problems. The model explained approximately 11% of the variance in caregiver-child relationships, 8% of the variance in caregiver-reported behavior problems, and 24% of the variance in adolescent-reported behavior problems. Contradicting the hypothesis, higher levels of violence exposure were not directly associated with caregiver-rated adolescent behavior problems. However, exposure to mild or moderate violence had a significant indirect effect on behavior Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012

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Mild violence Direct effects Indirect effects

Boys ˇ (95% CI)

Child-reported behavior problems Girls ˇ (95% CI)

Total ˇ (95% CI) .19*** (.13–.26) .04* (.01–.06)

Boys ˇ (95% CI) .24*** (.14–.34) .02 (−.02 to .05)

Girls ˇ (95% CI) .14** (.06–.23) .06* (.02–.08)

.08 (.01–.15) .02* (.01–.04)

.09 (−.02 to .19) .01 (−.01 to .03)

.07 (−.03 to .16) .04* (.01–.07)

Moderate violence Direct effects Indirect effects

−.01 (−.09 to .08) .06*** (.03–.08)

.04 (−.08 to .17) .02 (.00–.05)

−.04 (−.16 to .09) .10*** (.05–.14)

−.07 (−.15 to .01) .09*** (.06–.13)

−.06 (−.18 to .06) .04 (.00–.09)

−.07 (−.18 to .04) .14* (.09–.19)

Severe violence Direct effects Indirect effects Relationship Age Sex White Hispanic

.00 (−.08 to .08) .00 (−.02 to .02) −.23*** (−.29 to −.17) .01 (−.04 to .07) −.07* (−.12 to −.01) .07 (.00–.13) .00 (−.07 to .06)

−.01 (−.11 to .10) −.03 (−.06 to .01) −.28*** (−.36 to −.20) .00 (−.08 to .07) – −.01 (−.10 to .08) −.05 (−.14 to .04)

.16*** (.09–.22) .00 (−.02 to .03) −.36*** (−.41 to −.31) .01 (−.04 to .06) .01 (−.04 to .06) .11** (.05–.16) .06 (.00–.12)

.14* (.03–.24) .04* (.01–.08) −.31*** (−.39 to −.22) −.04 (−.11 to .04) – .18** (.08–.27) .05 (−.04 to −.14)

.16** (.07–.26) −.04 (−.08 to .00) −.40*** (−.47 to −.33) .04 (−.02 to .11) – .05 (−.03 to .13) .06 (−.02 to .14)

Note. ˇ = standardized coefficient, CI = confidence interval. * p < .05. ** p < .01. *** p < .001.

.02 (−.10 to .13) .03* (.01–.05) −.16** (−.25 to −.07) .03 (−.05 to .12) – .16** (.06–.26) .05 (−.05 to .15)

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Table 2 Standardized coefficients for the mediational model of violence exposure on behavior problems (N = 848).

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F: - .13** (-.22 – -.04)

Caregiver-child Relationship

Exposure to Mild Violence

Exposure to Moderate Violence

Exposure to Severe Violence

7

M: - .16** (-.25 – -.07) F: - .28*** (-.36 – -.20)

Caregiver-reported Behavior Problems F: - .35*** (-.48 – -.35)

M: .24*** (.14 – .34) F: .14** (.06 – .23)

M: - .15** (-.26 – -.04)

M: - .31*** (-.41 – -.31) F: - .40*** (-.39 – -.22)

Child-reported Behavior Problems M= .14* (.03 – .24) F= .16 ** (.07 – .26)

Control Variables: Child’s age Child’s race/ethnicity Fig. 1. Standardized coefficients for the mediating path model of violence exposure, caregiver–child relationship, and behavior problems. Note. Dotted line represents a significant path for boys only, dashed lines represent significant paths for girls only, and bolded lines represent significant paths for both males and females. Standardized ˇ estimates and (95% confidence intervals) are presented for significant paths only. Standardized ˇ estimates for control variables and non-significant paths are not shown for clarity of the figure, but are presented in Table 2. For boys, R2 for caregiver–child relationship = .09, caregiverreported behavior problems = .08, and child-reported behavior problems = .24. For girls, R2 for caregiver–child relationship = .14, caregiver-reported behavior problems = .09, and child-reported behavior problems = .25. * p < .05, ** p < .01, *** p < .001.

problems through the caregiver–child relationship, supporting the hypothesis of the mediating role of the caregiver–child relationship between exposure to mild or moderate violence and behavior problems. More specifically, higher rates of exposure to mild or moderate violence at home were associated with a lower quality of caregiver–child relationship which, in turn, was related to greater adolescent behavior problems reported by caregivers. Both exposure to mild violence and exposure to severe violence had significant direct effects on adolescents’ self-rated behavior problems, partially supporting the hypothesis. Exposure to moderate violence had no direct effect on adolescent’s self-reported behavior problems (ˇ = −.07, p = .152). Similar to the above results from caregiver ratings, the results of the mediation tests indicated that exposure to mild or moderate violence had indirect effects on adolescents’ behavior problems via caregiver–child relationships. Gender Differences in the Mediation Pathways Gender differences also emerged, 2 (31) = 242.755, p < .001, suggesting that the mediation pathway via which violence exposure was linked to behavior problems differed as a function of adolescents’ gender. For girls, the caregiver–child relationship mediated the effects of mild and moderate violence, whereas for boys, it mediated the effects of severe violence on behavior problems. In the caregiver-report, the indirect effects of exposure to mild or moderate violence on behavior problems via caregiver–child relationships were significant (mild: ˇ = .04, 95% CI = .01–.07, p = .022; moderate: ˇ = .10, 95% CI = .05–.14, p < .001). Similarly, exposure to mild or moderate violence had indirect effects on behavior problems in girls in the adolescent self-report (mild: ˇ = .06, 95% CI = .02–.08, p = .016; moderate: ˇ = .14, 95% CI = .09–.19, p < .001). On the contrary, higher exposure to severe violence had indirect effects on self and caregiver-reported behavior problems in boys (caregiver: ˇ = .03, 95% CI = .01–.05, p = .048; self: ˇ = .04, 95% CI = .01–.08, p = .031). The standardized path coefficients and the significant paths across gender groups are presented in Fig. 1. Discussion In general, the findings of this study support the hypothesis for the mediating role of the caregiver–child relationship in the association between violence exposure at home and adolescents’ behavior problems. However, results varied by reporter, with stronger support for hypothesized relationships found for child-reported versus caregiver-reported behavior problems. According to the adolescent self-report, exposure to mild and severe violence was directly associated with higher Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012

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levels of behavior problems. According to the caregiver report, however, exposure to violence was not directly associated with adolescents’ behavior problems. For both the child and caregiver reports, indirect effects of violence exposure in the home on behavior problems were found. Specifically, higher frequency of exposure to mild and moderate violence had indirect effects on both caregiver- and child-reported behavior problems through caregiver–child relationship paths. Consistent with past research, violence exposure in the home was associated with poorer caregiver–child relationships (Sousa et al., 2011), and poorer caregiver–child relationships were associated with higher behavioral problems (Brennan, Le Brocque, & Hammen, 2003). In addition, these findings are consistent with developmental psychopathology and attachment theory. The results that exposure to violence in the home was related to the child’s negative perception of their caregiver, which in turn was related to their behavior problems, point to the importance of violence prevention efforts in the home. The significant indirect effect of violence exposure through caregiver–child relationship indicates that poor caregiver–child relationship act as an underlying mechanism for adolescents who are exposed to violence in the home. This suggests the importance of caregiver–child relationship enhancement as well as violence prevention interventions; strengthening caregiver–child relationships may reduce the behavior problems in violence-exposed adolescents, as caregivers may be able to provide their children with a sense of safety and security. The current study addresses concerns regarding single-reporter bias (Galambos et al., 2003) by assessing adolescent behavior problems through both caregiver and adolescent report. Consistent findings of indirect effects of mild and moderate violence through caregiver–child relationships on behavior problems, regardless of reporter, strengthen support for the study hypotheses. Complicating interpretation, however, is the lack of clarity as to why some study findings differ based on the rater. In addition to the possibility of single-reporter bias, past research has suggested that adolescents’ self-reports of behavior problems may be preferable in measuring outwardly unobservable (i.e., internalizing) behaviors (Verhulst & van der Ende, 1992). Thus, adolescents’ ability to report internal thoughts that caregivers are not privy to represent can be one potential source of inter-rater differences. Divergence between findings based on caregiver versus child reports of behavior problems may also be rooted in caregivers’ tendencies to attribute children’s behavior to characteristics of the child (i.e., temperament) versus children’s tendency to attribute their own behavior to external environmental conditions (De Los Reyes & Kazdin, 2005). Although the absence of a “gold standard” complicates giving preferences to either reporter, past research of child welfare samples correlating caregiver- and child-rated behavior problems with a third measure has provided evidence that caregivers’ over-reporting of children’s behavior problems may be a particular concern (Handwerk, Larzelere, Soper, & Friman, 1999). These phenomena could explain differences in the support for hypotheses based on caregiver- and child-reported behavior problems, particularly the lack of direct violence exposure effects on caregiver-reported behavior problems. Exploratory analyses regarding gender differences indicated that for girls, the caregiver–child relationship was a significant mediator for exposure to mild and moderate violence, but for boys it was a significant mediator for exposure to severe violence. As indicated in Fig. 1, exposure to mild and moderate violence was associated with poorer caregiver–child relationships for girls, whereas exposure to severe violence was associated with poorer caregiver–child relationships for boys. The relationship between the caregiver–child relationship and behavior problems and direct effects of violence exposure in the home on behavior problems did not vary by gender. These findings suggest greater sensitivity to the effects of milder forms of violence exposure on caregiver–child relationships in girls. For girls, higher exposure to mild and moderate forms of violence were associated with poorer caregiver–child relationships, with no apparent additional risk found for higher levels of severe violence exposure. However, for boys, only severe forms of violence exposure were related to poorer caregiver–child relationships. These findings support theories suggesting that girls have different susceptibilities to adverse reactions to stress because of a biological or social vulnerability (Zahn-Waxler, Shirtcliff, & Marceau, 2008). For example, girls’ social awareness may make them particularly sensitive to perceived relational harm associated with violence (Zahn-Waxler et al., 2008). Girls tend to be more vulnerable than boys to the disruptions in the home environment (i.e., violent and abusive home; Cummings et al., 1999; Loeber & Stouthamer-Loeber, 1986; Sternberg, Lamb, & Dawud-Noursi, 1998) and show difficulties in establishing positive intimate/interpersonal relationships (e.g., attachment to parents) under such conditions (Leadbeater, Kuperminc, Blatt, & Hertzog, 1999). Often, girls are more sensitive than boys to even minor cues of violence in the home, such as family conflict (Fagan, Van Horn, Antaramian, & Hawkins, 2011) and negative parenting (Griffin, Botvin, Scheier, Diaz, & Miller, 2000). Research on gender as it relates to antisocial behavior posits two pathways by which boys may be more vulnerable to severe violence exposure. First, previous research has shown that boys are more likely than girls to engage in antisocial behavior (aggressive and nonaggressive) (Keenan, Loeber, & Green, 1999). Studies show boys are more likely to have delayed communication skill development and lower levels of empathy which interferes with socialization and contributes to increased levels of antisocial behavior (Lahey, Waldman, & McBurnett, 1999), and subsequently, may deemphasize the caregiver–child relationship compared to girls who may rely more heavily on this relationship. As a result, the caregiver–child relationship with boys may not be as severely affected by mild or moderate forms of violence exposure. Second, researchers posit that parental behavior contributes to gender differences. During adolescence, for example, boys are less heavily supervised compared to girls (Svensson, 2003) and parents are more permissive of evocative temperament in boys compared to girls (Keenan et al., 1999); as a result of these leniencies, caregiver–child conflicts with boys may be more extreme.

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The developmental psychopathology perspective emphasizes the timing of the experience (Sroufe & Rutter, 1984), thus this perspective would posit that violence exposure will have different effects for an individual depending on the developmental period in which it is experienced. This study’s focus on early adolescence therefore enhances the unique contribution of this article and adds knowledge about a developmentally specific time period. However, it should be noted that within the developmental span examined (i.e., 11–15 years), fundamental differences may exist within this population in terms of how they perceive, experience, and respond to violence exposure. Early adolescence is associated with a gradual decline in parental influences and the corresponding increase in prominence of peers (Windle et al., 2008). This suggests that potential age-related nuances in the mediated role of parental relationships within the 11–15 year old period should be examined in further studies. The 11–15 year age range is further associated with pubertal development, physical brain changes, cognitive development, all of which are associated with increased gender dimorphism and divergence, with changes generally occurring earlier in girls (Ge, Brody, Conger, Simons, & Murry, 2002; Hazen, Schlozman, & Beresin, 2008; Windle et al., 2008; Zahn-Waxler et al., 2008). For example, girls enter puberty earlier than boys, with puberty normally beginning around 10 years of age in girls and 12 years of age in boys (Ge et al., 2002; Hazen et al., 2008). The advanced pubertal maturation in girls may help explain the findings of relatively stronger effects of violence exposure and caregiver–child relationships on behavior problems in girls. However, more research is needed in order to thoroughly examine the interplays among age, gender, and puberty in explaining the relationships of violence exposure, caregiver–child relationships, and behavior problems. The changes of early adolescence are also connected to the modal onset of many mental health disorders (e.g., mood disorders, psychosis, and substance use disorders) during this time period as well as gender differences (Paus, Keshavan, & Giedd, 2008; Zahn-Waxler et al., 2008). Furthermore, it is hypothesized that gender differences in the onset of mental health disorders is tied to differences in the responses to victimization during the time period (Hayward & Sanborn, 2002; Zahn-Waxler et al., 2008). Gender differences suggested by this study in the mediated paths between violence exposure, parent–child relationships, and behavioral problems may be a function of the maturation process that occurs over the course of adolescence. More research is needed to understand how these gender differences may vary with development. Strengths and Limitations The current study has several distinct strengths that enhance its contribution to the literature. It used a mediation analysis, allowing for an in-depth examination of the interrelationships among violence exposure in the home, caregiver–child relationships, and behavior problems. The use of path analysis allowed for the simultaneous estimation of relationships among various endogenous and exogenous variables. The subscales of violence exposure in the sample were supported by factor analysis. Additionally, the use of both caregiver- and adolescent-reported behavior problems is also a distinct strength of the study, enhancing the validity of consistent findings of the indirect effects of mild and moderate violence exposure on behavior problems through caregiver relationships across raters. Finally, this study focuses on child-welfare-involved adolescents who are at a heightened risk for exposure to violence and behavioral maladjustment (Burns et al., 2004). Children who are involved with CPS are of interest because they represent an identifiable population for whom specialized interventions can be developed. The utilization of NSCAW-I data, a large national dataset on a readily identifiable service population, enhances the external validity and clinical implications of these findings. There were several limitations to the study. First, the cross sectional data utilized in the study are limited in their ability to support theorized direction of relationships among violence exposure, caregiver–child relationships and behavior problems. The current study focuses on younger adolescents, who may be less independent and therefore more amenable to caregiverchild relationship factors than their older counterparts (Galambos et al., 2003). Because of the desire to focus on this distinct developmental period, a cross-sectional analysis was deemed the most amenable analytic strategy to address research questions. Caregiver–child relationships were collected only on youths 11 and older; longitudinal analyses would have required examining behavior problems at an older age. Past longitudinal research focusing on the causal direction has supported the direction of relationships tested here (Sousa et al., 2011). However, causal directions in the opposite direction and bidirectional relationships are possible (i.e., behavior problems may negatively affect caregiver–child relationships, poor caregiver–child relationships and behavior problems may increase adolescent vulnerability to violence exposure). Future research should examine these relationships longitudinally. Second, as mentioned earlier, the caregiver–child relationship data in this study do not provide information about whether the caregiver was a perpetrating caregiver (e.g., perpetrator of IPV or child physical abuse) or a non-offending caregiver (e.g., victim of IPV). Future research may benefit from examining how the mediating effects of caregiver-child relationships may vary by perpetrating versus non-offending caregivers. Third, the generalizability of study findings is limited. The sample in this study consisted of children referred to CPS for abuse and neglect, thus the study findings may not be generalizable to normative populations. Lastly, findings of the study should be interpreted with caution as there were several methodological limitations of the data used in this study. It should be noted that the data were collected from children and families soon after (i.e., 2–6 months) the investigation for alleged child abuse and neglect was terminated. Given that the investigation by CPS can be intimidating and stressful experience for both the child and the caregiver, it is possible that the timing of the data collection may have affected their responses. For example, some children may have under-reported their exposure to violence in the home from the fear that they may be reported to CPS and separated from their caregivers if their responses indicate ongoing child abuse or family violence. In a similar vein, they may have failed to accurately describe their relationship with the caregiver. The fact that the majority (89.6%) of adolescents reported their biological mother (80.4%) or biological father (9.2%) as their primary caregiver adds to the Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012

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plausibility of the response bias. Another caveat is that the data did not provide information about whether or not the child’s exposure to violence was perpetrated by the caregiver. The lack of information concerning whether the identified primary caregiver was a perpetrating caregiver or a non-offending caregiver may degrade the interpretability of the findings. Research Implications This study’s findings provide a distinct contribution to existing research by demonstrating gender differences in the protective, mediating role of caregiver–child relationships in violence exposure in the home-adolescent behavior problems relationship. The findings of this study corroborate past studies finding gender differences in the relationship between violence exposure and behavior problems (Cummings et al., 1999; O’Keefe, 1994; Spano et al., 2009) and identifying caregiver–child relationships as a potential protective factor (Hardaway et al., 2012; Kliewer et al., 2004; Margolin & Gordis, 2000; Skopp et al., 2007; Sousa et al., 2011; Toth et al., 2002). This study also adds to the current literature by demonstrating the unique and distinct effects of violence exposure severity (i.e., mild, moderate, severe) on caregiver–child relationships and behavior problems, addressing the shortcomings of the dichotomous violence exposure variable used in previous studies. The developmental psychopathology perspective stresses the importance of the nature the experience (Sroufe & Rutter, 1984). This perspective would suggest that the forms as well as the severity of violence exposure would matter. While this study addresses severity levels of violence exposure, it does not consider different forms of exposure, such as witnessing violence versus experiencing victimization. Furthermore, co-occurring forms of violence exposure not included in this study, such as sexual maltreatment, may explain apparent relationships, particularly in regard to gender differences. Future research is warranted to explore how these various forms of violence may be differently related to caregiver–child relationship or behavior problems in early adolescence. In contrast to past studies that focused primarily on young children (e.g., pre-school: Howell, Graham-Bermann, Czyz, & Lilly, 2010; school-aged: Renner & Boel-Studt, 2013), this study indicates the salience of parental protective factors for early adolescents. Future research is needed to understand how various types of parental/caregiver factors (i.e., caregiver-child relationships, caregiver stress, caregiver monitoring) may mediate the relationships between violence exposure in the home and behavior problems and to examine the mediation of caregiver–child relationships at different phases in adolescence. Clinical and Policy Implications The findings of the current study suggest the importance of violence prevention for children and families involved with the child welfare system and the need for gender-specific intervention strategies. For both boys and girls, interventions should address the connections between violence exposure at home, caregiver–child relationships, and behavior problems. 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Please cite this article in press as: Yoon, S., et al. Gender differences in caregiver–child relationship mediation of the association between violence exposure severity and adolescent behavior problems. Child Abuse & Neglect (2015), http://dx.doi.org/10.1016/j.chiabu.2015.10.012