Identification of adolescent abuse and future intervention prospects

Jounmi ofAdolescet:ce ~987, !0, t - t o

I d e n t i f i c a t i o n of a d o l e s c e n t a b u s e a n d future intervention prospects CYNTHIA J. SCHELLENBACH* AND LOUISE IL GUERNEY~ Recent research indicates that the incidence rate for adolescent abuse equals or exceeds that of all other age groups, because ado|eseent abuse is underreponed to protective service agencies, it is less likely to be identified a,~d served, ldet~tifying ado|escem abuse and u,ldcrstanding the dynamics of fami|y interaction are important problems for researchers and service "~roviders.. Analysis of a sample of 62 two-parent families containing an adolescent highlights facto,, on the Adolescent Abuse Inventory (Sebes, ~983) and other characteristics of the family system and individuals which discriminated high-risk from low-risk family systems. The second part of the paper describes the procedures of an intervention project based on this classification system. I N'YRODUCTION Much research has a t t e m p t e d to identify predictors of child m a l t r e a t m e n t on the i~tdividual, familial, and c o m m u n i t y levels of analysis. On the individual level, recent research suggests that abusive parents tend to exhibit specific personality characteristics such as low self-esteem, fears of threat and control, and highly unrealistic expectations of children (Spinetta and Rigler, I97z; Milner and W i m b e r l y , i98o ). O n the familial level, there exist structural characteristics which are correlated with abuse. Abusive families tend to be larger in size, having children more closely spaced. Although not all abusive families are of lower socioeconomic status, a larger n u m b e r of children m a y tend to place a greater strain on limited family resources (BmNess, Anderson and ScheIlenbach, t 9 8 I ) . On the c o m m u n i t y level, abusive families tend to be characterized by social isolation and a lack of s u p p o r t in their n e i g h b o r h o o d s ( G a r b a r i n o and S h e r m a n , I98o). T h e family system is also e m b e d d e d in a society in which violence towards children is an acceptable cultural paltern (Gelles, I978 ). In fact, the family may have characteris,.ics which make it a likely setting for abuse (Burgess, I979)Several models have been advanced to account for tile d e v e l o p m e n t and * Research rep~ ~ed here was e(mducted m~der a grant from the National Center on Child Abuse a+~d Neglect, I)ep;~rtment +~f Health and I--himan Services, grant ~m+ 9 ° CA 8351o~ to James Garbarinc~, Donald F~rd, and L~mise Guerney~ * Reprl,tt requests to Cy~thia SeheI|eM~cb, |~d~vidua| and Family Developme~l Program, i)epartment ~f Psychology, U~iversity of Notre Dame, Notre Dame, Indiana 46556, U.S.A. t The Pennsylva~ia State University~ o~4c~J97~/87~'o~ + ~a $o3.~o

~ ~987The As~iatlon for the Ps~.ehiatde S~udyo[ Adol~eenu

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C. J, SCHELLENBACH

A N D L. F, G U E R N E Y

maintenance of abuse within the family system. Two models have examined the interaction of ecological and social familial factors (Burgess et aL, i981) and the cognmv~Dena loral factors (Twentyman, Rohrbeck and Amish, x985), The social interactional model of abuse focuses on four causal levels of analysis (Tinbergen, i95i ). First, the model describes the development of abusive behavior through the cycle of coercion in the family. Second, the proximal and distal antecedents of~zehavior are identified~ That is, the events which may prompt aggression in the family are listed. Third, the adaptive significance of aggression within me family is examined. Finally, the model addresses the role of aggression in the larger cultural setting. This type of model combines biological, socmloglca, and familial levels of analysis in examining the development of abusive behavior. Although the broad view ' model, it tends to ignore cognitive factors which represents a strength of t hls may lead to abuse. For example, abusive parents may tend to show negative attributions of their children's behavior. One ~odel which accounts for internal cognitions of abusive parent~ in the development of abusive behavior has been advanced by "! wen ym~l~ et aL (i985). The model includes four postulates which have precipitated empirical research aimed at understanding the developme:}t of abus~ive behavior in a family setting. First, the abusive parent holds in~{rpropriate expectations for the child's behavior. This postulate is supported by evidence that abusive mothers tend to be unrealistie regarding appropriate behaviors of their children either in the direction of expecting too little (restricting the level of development) or expe tmgtoo much (having expecta " - t"ions which ~re too high for the age of the child) (Twentyman and Plotkin, i98z ). Second, the ehldi will disconfirm the expectations of the parent. If the parental expectations are too high or too low, normal child behavior is likely to disappoint the parent. Third, the parent attributes the behavior to a negative, internal characteristic of the child. Indeed, two studies reported that abusive mothers tended to attribute child behavior to internal, stable personality characteristics, or that children were misbehaving simply to annoy the mother (Twentyman and Ptotkin, i982; Larrance and Twentyman, i983). Finally, the parent behaves aggressively toward the child, as in evidence which indicates that mothers tend to apply more severe punishments than control mothers. Although there is some evidence to Support parts of the model, no single model has been effective in predicting abuse. Moreover, the model fails to specify the causal sequence of the steps leading to abuse. The model also fails to specify the effects of different situations or variability in ages of children involved in the abusive incident. Just as there is variability in the type of maltreatment from emotional abuse * i on in eonstellations of to physical abuse, so there seems to be wide varmt actors which precipitate different types of abuse (Cicchetti and Rizley, *

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IDENTIFICATION OF ADOLESCENTABUSE 3 I98I). A complementary parallel finding reveals hete hefty in the effects of abuse which vary with type of abuse (emotional, physical, sexual) and age of the child. [There is a need for conceptual efforts which const~ct a nosoiogy of maltreatment related to consequent effects of abuse on children.] If we could begin to asse~ factors which would be predictive of different types of maltreatment on a continuum, we would be in a better position to recommend effective interventions. Since abuse is a dysfunction of the parent~hild relationship, we need to attend to all participants in the relationship in any thorough search for predictive factors. The developmental approach has been productive in identifying different types of abuse within the parent-child relationship (Cicchetti and Riztey, I98i; Garbarino, Sebes and Schel!enbach, I984). Parenting an infant or a preschooler is very different from parenting an adolescent. Different, also, are the consequences of maltreatment for the young child in comparison to the adolescent. An infant can do virtually nothing to protect herself from abuse and is totally defenseless against neglect. A blow delivered to an infant can cause mortal harm. The same blow delivered to an adolescent will probably lead to less severe physical consequences. The adolescent may be a prime target for abuse. Furthermore, the a~-appropriate behaviors of the normal adolescent--such as self-assertion, incre peer interaction, higher level of cognitive ability--require a change or adaptation within the family system. Family rules and parenting techniques which proved effective with young child~n will undoubtedly have to be modified with adolescents. Parental expectations must be modified in view of the adolescent's growing circle of signifieant'bthers outside the family. In general, the quality of the parent-child relationship is linked to a realistic match between parental expectations, discipline techniques, and adolescent behavior. Parenting adolescents may well have more to do with the interaction between parents and adolescent than with the behavior of parents or adolescent individually. Existing models have been developed to understand the development of child abuse, not adolescent abuse. Given recent research on the high incidence of adolescent maltreatment (Burgdorf, I98o), there is a need to develop models which would be appropriate to the dynamics of parent-adolescent relationships. The high incidence of adolescent abuse underscores this need. On the basis of incidence studies of adolescent abuse, we know that the incidence of adolescent maltreatment is high. The National Incidence Study indicated that over 65o,ooo cases of adolescent abuse could be projected annually. Despite public, professional and empirical emphasis on child abuse and neglect, adolescent maltreatment accounts for sOme 47 per cent of known cases of maltreatment (Burgdorf, 198o). In another study, Olsen andHolmes (I98z) found that adolescent abuse accounted for some 42 per cent of all cases of maltreatment even after all cases of unsubstantiated abuse were removed

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C.J. SCHELLENBACH AND L. F. GUERNEY

from the sample. This finding is especially surprising given that adolescents account for only 38 per cent of children under the age of t8. T h a t is, adolescents are over-represented in the maltreated sample. This overrepresentation exists despite cultural myths which encourage greater concern and focus on study of victims of child maltreatment. T h e discrepancy between these widespread beliefs, research, and actual incidence of abuse may be related to ~ m p l i n g error. Much of the current res e arch is based on samples obtained from hospital and protective service agencies. Evidence indicates that adolescents are least likely to be reported to public service providers. Rather, adolescents are likely to be known by school counsellors, school nurses, youth group leaders, clergy, or sports coaches who tend not to report cases to public service providers. In contrast to children, adolescents who are experiencing abuse are likely to be labelled as problematic in some way---as a behavioral problem, learning disability, substance abuse, truancy case, or as a school adjustment problem. T o date, very little research has addressed the needs of the maltreated adolescent within the family. Lourie (I977) was one of the first to study family functioning in cases of ~ families, Lourie suggested adolescent abuse. In his clinical ~nabs' i "s of 2 ~8 that over 9o per cent of these families initiated abusive patterns of behavior a~ the onset of adolescence. In fact, he suggested a model of family functioning which included three descriptions of behavior which developed into abusive behavio~~during adolescence. T h e first was that families continued destructive patterns of parenting behavior begun in childhood. The second was that families escalated from patterns of harsh discipline to abusive behavior with ~ the onset of adolescence. T h e third was that parental beha V mr which was normal during childhood became abusive in response to adolescent demands. Another study (Pelcovitz, Kaplan, Samit, Krieger and Cornelius, 1984)also suggested dysfunction in family functioning during adolescence was related to adolescent abuse. I n this study two types of family discipline were related to adolescent abuse, the authoritarian family and the indulgent family. T h e authoritarian family showed paternalistic, harsh demands asserted within a rigid set of rules in the household. Adolescent behavior was kept in check by force and denial of needs. In contrast, an excessively indulgent parental style was also assoc atea with abuse. Using this type of parental control, few demands and few limits were placed on the adolescent as guidelines for behavior. Yet, controls were placed on adolescents with excessive use of force by parents when limits were broken. Both of these types of families also experienced a number of stressful events within the family system, such as marival problems. Similarly, the ' : e stress and present adolescents in these families were also likely to expenenc behavioral problems to their parents. In one study of the behavioral

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characteristics of abused adolescents, Pelcovitz et aL (i984) reported high frequencies of severe depression, alienation, and a~ressive acting out disorders. Only a handful of stud ies have examined the general characteristics of abusive families having adolescents. In order to identify characteristics of parents, adolescents, and families involved in destructive patterns of parent--child interaction, a more complete study of the interactive factors was conducted (Garbarino el aL, z983). A sample of 6~ two-parent families containing an adolescent highlighted factors on a criterion measure (the ~ Adolescent Abuse Inventory, Sebes, I983) and other chara C tenst~cs of~the amfly system which discriminated high-risk and low.risk families. Parents in the high-risk category tended to show greater use of discipline and less support as measured by the Cornetl Parent Behavior Description (Devereux, Bronfenbrenner and Rogers, I969). Families in the high-risk group were characterized by either excessively rigid styles of interaction which provided few boundaries for individuals within the family, or excessively chaotic styles in which few rules or demands were provided for structure within the family. In contrast, low-risk parents tended to be characterized by flexible, open modes of communication with clear boundaries to protect the individuality of family members. Adolescents tended to show a greater number of behavioral problems as measured by the Achenbac . h Child Behavior Checklist (Achenbach, I978; Achenbach and Edelbrock, I979) compared to the low-risk group of adolescents. The differences between the two groups were found in both classes of developmental behavior problems, anternaI ~ izing "° and externalizing. In addition, the adolescents reported a higher number of stressful events in their recent pasts (during the last twelve months prior to the'mtervle " w ). The high-risk adolescents reported a larger number of significant life changes, " alcohol or substance abuse incidents, and a larger n U moer of stressful incidents in the twelve months prior to the study. Ira summary, the empirical factors which were salient for the development of an intervention program included three trends: (i) family communication patterns involving excessive authority or excessive permissiveness enforced by abusive punishment; (z) a high level of recent conflict within the family system; (3) adolescents who present behavioral challenges to parents; (4) adolescents who are themselves experiencing a greater number of recent stressful events, especially those related to alcohol and substance abuse; (5) parents who respond with a higher level of discipline and a lower level of support to the high-risk adolescents. The following prospects for a~n intervention program were designed on the basis of these empirical findings from research on adolescent maltreatment and destructive parem-adolescent

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C.J. SCHELLENBACH AND L. F. GUERNEY FAMILY INTERACTION PROJECT (FIP)

Educational approaches seem most appropriate when the group of parents are at-r isk for maltreatment as opposed to being actually abusive. When low-risk parents are also to be included in an intervention plan, the treatment goal is enrichment rather than remediation. The emphasis more approprtat ' e ly should be on information and skills that would be of value to both groups of parents. Both high and Iow-risk parents can benefit from programming for the enrichment of parent-adolescent relationships and positive adolescent management alternatives. For the F I P intervention pilot program, both high and low-risk families were of interest. Our approach was to offer the opportunity for parent education to all parents at the time of their participation in the research interviews. For reasons to be explained later in this section, there appeared to be advantages to including both high and low-risk families in the same program. T h e program goal was to increase use of positive discipline techniques as opposed to negative techniques such as physical punishment behaviors by parents and children. Such a goal is applicable to parents " functioning at all levels. Enhancement goa ls should be appropriate regardless of the risk level identified.

Rec±-aitment All 6z participating families in the research project were invited to join the parent class, regardless of risk level. Assistance in recruitment, generally required for assembling parent education groups, was offered by research teams. As they interviewed families, they presented the opportunity for future classes and tried to motivate interest. However, because of the time gap between the data collection and class offering, no assumptions were made about the willingn~s of parents to follow-up by attending a class. Letters, phone calls, and invitations were issued to include children in a children's group, primarily to relieve parents of concern about leaving children to attend a class. Secondly, the prospect of offering a program for the children was also a motivating factor. Nineteen parents from eleven different families, agreed to attend. Eight couples were included. Eight families planned to bring one or more children to the child en s program. In reality, logistics of conducting several different groups mitigated against ~parating parents, even if it had been our desire to do so. However, this programmer (the second author) does not believe or generally practice homogenous grouping when conducting parent education. T h e rationale is that process considerations are more critical than content issues in trying to teach parents new behaviors. T h a t is, learning the processes required to be

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empathic or to set appropriate limits and consequences, for example, must be accorded hi gher consideration than the specific contents relevant to d i fferent types of parents or ehildren. For example, parents of asthmatic children and parents of children with " " ~ t"ion specific to therr ' children's hm,t" i ng cardiac condition do need mtorma problems and treatment. In addition, they share in common the problems of knowinghow to decide and enforce appropriate limitations on their ehl*ldren s behavior. Except for special limitations related to the different health ' cond itlons, however, when and how to deal with limits is the same task faced by all parents, even those with healthy children. Another factor supports this v i e w ~ n e gleaned from support and therapy ~oups. The phenomenon of higher-functioning group members facilitating lower-functioning members has been documented for many years (e.g. Riessman, 965, Ki!lilea, I976), Thus, in a group of parents with different problems and degrees of aptitude in learning to solve them, it can be expected that the more skilled parents will provide support, modelling and motivation for the others. In order not to be influenced by classification of risk, the program leader was blind to the risk classification of parents. It was found later that high and tow-risk parents did in fact relate to each other as predicted. Attendance Because attendance at parent education classes is notoriously poor, it was decided that an incentive system should be employed to overcome the problems frequently encountered (Rosenberg, Reppueci and Linney, I979). The scheme worked out was the awarding of attendance p r i z e ~ o n e attendance certificate each night per parent. At the last class, the winning certificate was drawn for the attendance prize of $75.00. Apparently, the prize did serve as an incentive since attendance was at 85 per cent, compared to reports of far lower percentages in other classes (Abidin, i98o ). ~ilot intervention program content The Family Interaction Project (FIP) Parenting course was designed to address the major needs identified in the study that related to parent-child functioning. Specifieatiy, the program was aimed at providing information to parents on the kinds of parenting challenges which they could expect during adolescence, provide tramt g in skills for enhancing communication during adolescence, and provide discipline alternatives to physical punishment appropriate to the developmental level of adolescents. Two separate but complementary dimensions of the parent-adolescent relationship were addressed: (i) the affective dimension or the ability to develop empathy or a genuine unde~tanding of the changing needs of the adolescent; (2) the

8 C.J. SCHELLENBACH AND L. F. GUERNEY control dimension or the conflict-resolution dimension between parents and ~" r matlon on adolescent developadolescents. T h e program contained lnIo ment, skills training ~n effective communication between parents and • adolescents, and training in conflict resolution, ve~ i rst, two inforrnation lessons were included to cover realistic expectations for adolescents ~and " i p issues between parents and adolescents. Next, the skills common relattonsh of listening and appropriate self-expression were taught, he concluding part of the course focused on dlsclpl ne with the goal of increasing the n u m b e r of alternatives which parents used to deal with conflict situations. An outline of the content of the program is displayed in Table i. Table 1. Outh)~e of the/~TP parenting p~gram Session I

Session 1V

~What to expect of your adolescent Adolescent-Parent Relations ~What are the issues? Listening and Speaking to Increase Communication ~Praetiee in the use of communication skills Strategies for Problem-Solving

Se~ion V Se~ion V] Session VII

~Reinforcement Setting Limits an Deciding Consequences Cooperative Problem-Solving and Contracts Putting it all together~How each lemon builds from the last

Session I I Session I I I

T h e sequencing of the content is important for appropriate skill acquisition. T h e acquisition of the skills should be eumulative~ For example, it is essential to teach appropriate expectations for adolescents as a foundation for the communiation skills which follow. Listening and expressive skills are essential prerequisites to effective problem-solving between parents and adolescents. Moreover, the emphasis in this program was on teaching empathic skills to enhance the affective dimension of the parent-adolescent relationship. "F hese skills are particularly important to abusive or at*risk parents who may be accustomed to using force or control tactics as an initial method of d~scIpl ne. By introducing positive skills first, there is greater emphasis on acceptance and empathy as opposed to power tactics. TW:s sequence illustrates the importance of balancing freedom (i.e. encouraging expression and negotiation) with limits (i.e. setting rules or boundaries for appropriate behavior) in the practice of parenting in daily situations. Empathy was stressed as a basic communication skill, because parents must be able to accept the new feelings and abilities associated with their

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adolesc e nts' emerging capabilities. The skills presented in the pilot intervention program were adapted for the special needs of adolescents and their parents from a book called Parenting: A Skills Tt~ining ram developed by Guerney (I98o). The second session complemented the first in that content focused on the conflicts which may arise as a result of newly emergent adolescent changes. It is particularly helpful for parents to anticipate and unde~tand developmental changes in their adolescents. Having a knowledge base is not enough, however. The second session was devoted to a discussion of relevance of the skills to personal situations of the participants. If parents are able to see how the skills will be important in their own lives, they are likely to show greater commitment and motivation in learning the skills. The third se~ion covered empathic communication skills including empathic responding and personal messages. Empathic responding is a special way of responding to others which promotes effective two-way communication and conveys understanding and acceptance. The importance of communicating empathic responses for adolescent development and promotion of the parent-adolescent relationship~ and problem solving is stressed, Examples, role-plays, homework assignments and demonstrations help to promote understanding and competence of this method of positive interaction. Also included in this lesson was the personal mes~ge, a ~ l l which allows parents to communicate their own feelings without being judgmental. Personal messages include a reason for the feeling and an opportunity for the person to change their actions. This type of statement allows parents of adolescents an opportunity to take responsibility for their actions. Th e next section of the program described two positive skills called " s~r u cturmg ~ . and u tel~ n forcement " . Structuring is a positive approach to pr~blem-solving which can minimize conflict. The procedure involves four steps: (~) deciding what the goals are for the parent and for the adolescent (this may require a period of n got,atlon with adolescent), (z) anticipating what could happen to interfere with these goa 1s," (3) deciding on ways to avoid problems and listing positive procedures; (4) communicating clearly to achieve these goals. The use of reinforcement was then taught to encourage positive behaviors on the part of the adolescent. Content underscores the limitations of punishment in fostering behavior change and positive learning. For parents of adolescents, the greatest limitation is that physical power is less influential with adolescents. The following two sessions were designed to teach parents discipline alternatives which are not based on physical power and control. These two sessions focused on establishing rules and consequences and constructing

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C.J. SCHELLENBACH AND L. F. GUERNEY

behavioral contracts. Rules are positively stated guidelines that specify expectations for appropriate child behavior which are enforced by consequences when the rule is broken. For adolescents, communications skills (reviewed earlier) are the key to success in establishing effective limits. When rules are broken, consequences should be age and situation appropriate. The next session focused on more elaborate techniques for promoting problem-solving in parent-adolescent relationships. Contracting is a particularly effective method for behavioral change among a ssive and delinquent adolescents (Patterson, Reid, Jones and Congner, I975). In this session parents were taught principles of negotiation and contracting which address problem behaviors of their adolescents which were noted in the Achenbach Child Behavior Checklist metioned earlier. Adolescent competencies were also underscored. In this way, both strengths and problems could be considered in working out an effective contract. The final session, "Putting it all together", was an integrative lesson designed to teach discrimination of skill use. This lesson emphasizes short-term versus long-term gain, relationship issues, and sequential use of skills.

Participant feedback Since this was a pilot effort, evaluation was limited to formative approaches. A self-report questionnaire was administered to parents in the last session and filled out anonymously. Parents were asked to answer openended questions about the following: relevance of the content, interest value, contribution of other group members, lengths of individual sessions and the whole course; what was best liked, least liked; most useful, least useful; contributions of the instructor; what should be changed, and finally, "Would you reco end this course to a friend if it were offered again?" Everyone agreed that they'd recommend the course; the majority thought it should be longer; the majority would have liked more time to hear other parents' experiences. All liked the instructor, the choice of skills and the personalizing of the skills to their situations. Most would like to have had more time on

DISCUSSION

The FIP program yeas a preliminary pilot effort to offer a parenting p am that would: (I) be appropriate for parents of "mixed risk" for adolescent abuse, (z) address issues identified through FIP research as associated with high-risk for abuse; (3) be attended through iw¢itation as opposed to spontaneous expression of interest by the parents. While the program was not evaluated empirically because of its prelimi-

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n a ~ nature, a n o n y m o u s self-reports solicited from participants, feedback from graduate student observers, and leader judgement indicate that the program content was appropriate for the needs of the parents attending the group and that the taxi of high and low ri~k parents was in no way disadvantageous. Based on this pilot effort, one could expect that . e p h c a t m of the program with a similar population would yield similarly positive results. Empirical p r ~ p o s t , control/comparison studies will be required of future offerings of the p r o g r a m to determine its full potential and

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Milner, J. S. and Wimberly, R. C. 0980)° Prediction and explanation of child abuse. Journal of Clinical log3, 36, 875484. Olsen, L. and Holmes, W. 0983). Youth at :A nts and/vLaltreatment. Boston: MA: Center for Applied Social R~arch. Patterson, G. R., Reid, J. B , Jones, R. R. and Conger, R. E. (z975)~ l~amilies with ire Ch . Eugene, OR.: Castalia. Pelcovitz, D., Kaplan, S., Samit, C., Krieger, R. and Cornelius, P. (~984). Adolescent abuse: Family structure and implications for treatmenL Jountal of Child P~,chiatD, ~ , 85-<)0. Riessman, F. 0965). The "helper" therapy principle, Social Work 10, 27-32. Rosenberg, M. S., Reppucci and Linney, J o (I979)~ Problems of implementation: parent education for high-risk families. Paper presented at the annual meeting of the American Psychological Association, New York. Sebest J. M. (I983). Determining risk for abuse in families with adolescents: The development of a criterion measure. Unpublished doctoral dissertation, The Pennsylvania State Unive~ity. Spinetta, J. and Rigler, D. (I972). The child-abusing parent: A psychological review. Psycholo~cal Bulletin 77, o4. Tinbergen, N. (~95I). The Study of Instinct. London: Oxford University Press. Twentyman, C. T. and Plotkin, R. C. (I982). Unrealistic epectations of parents who maltreat their children: An educational deficit that pertains to devclopment.Jtmmal of Chnical Psy 38, 497-503 • Twentyman, C. T., Rohrbeck, C. A. and Amish, P. L. (I985). A cognitive-behavioral modal of child abuse. In Violent ht als and Families: A Practitioner's 11a , Saunder, S. (Ed.). Springfield: C. Thomas.