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Preliminary results of a prospective study of the antecedents of child abuse 1
Child Abuse and Neglect, Vol. 3, pp. 269 - 278. 0 Pergamon PressLtd.,1979.Printedin Great Britain.
PRELIMINARY
RESULTS
OF A PROSPECTIVE
STUDY OF THE ANTECEDENTS
OF CHILD ABUSE '
Byron Egeland University
of Minnesota,
n548 Elliott Hall, Minneapolis,
Minnesota
55455
An analysis of the existing child abuse literature suggests the presence of three broad quasicharacteristics of the parents, environmental and sociological stress, independent factors: and characteristics of the child. The majority of the investigations have focused on the contributory role of the parent, Results of this research have portrayed the abusive parent as a member of a multi-problem family whose deficits and liabilities encompass the entire spectrum of personal and social pathology (Parke and Collmer, 1976; Sameroff and Chandler, 1975). Specifically, research has attempted to show that abusive parents possess a unique constellation of personality traits or characteristics which presumably increase the likelihood that they will engage in abusive behavior. However, studies aiming to delineate personality characteristics of abusive parents have yielded no consistent findings, but instead have implicated a wide array of disparate, sometimes contradictory, traits (Gelles, 1973; Parke and Collmer, 1976; Spinetta and Rigler, 1972). Many authors also assert that abusing parents share some common misunderstanding with regard to the nature of child rearing and tend to look to the child for satisfaction of their own parental emotional needs. The personal histories of these parents include evidence that they were themselves abused, neglected, or emotionally deprived as children and consequently lack parenting skills and adequate understanding of appropriate child rearing practices (Smith and Hansen, 1975). In addition, it is argued that abusing parents lack knowledge of child rearing and have unrealistic expectations of normal child development (Smith and Hansen, 1975). A number of investigators have also suggested that environmental and sociological stress factors impinging on the family are prepotentelicitors of child abuse (Justice and Justice, 1976). A basic tenet of this prospective is that hardship and stress create frustration which leads to aggression, often exhibited towards children, primarily because they do net pose a threat of retaliation. It follows from this assumption that populations exposed to the greatest amount of environmental stress would exhibit the greatest incidence of child abuse. This is particularly applicable to low socioeconomic status populations where people are faced with the problems of simply providing the basic necessities of life for their families. Families in general, and low socioeconomic families in particular, are subject to a variety of stresses that threaten the integrity of the individual members and the family functioning and interaction as a whole. Poverty, unemployment, poor and crowded living conditions, illness, death, desertion, social isolation, and marital conflict all serve to heighten frustration, increasing the possibility of aggressive outbursts (Egeland, Cicchetti, and Taraldson, 1976). While research has suggested that in a large majority of the reported cases of child abuse the perpetrator was of low socioeconomic status, nonetheless there are studies which maintain that child abusers are made up of a cross-section of individuals of different socioeconomic status and education (Blumberg, 1976) and that social, economic, and demographic factors are irrelavant to the act of child beating (Steele and Pollack, 1968). Even though it may be true that child abusing families are experiencing a great deal of stress, it is clear that every family undergoing an equal amount of stress does not abuse their children, Since the majority of parents from lower socioeconomic backgrounds do not abuse their children, it is obvious that
1) This research was funded by a grant from the.Administration for Children, Youth and Families, National Center for Child Abuse and Neglect, U.S. Dept. of Health, Education and Welfare 269
B. &eland
270
environmental
stress
alone
is not a sufficient
explanation
for the occurrence
of abuse.
Only recently has any consideration been given to the behavior of the child and how these behaviors may tend to elicit abuse or neglect from the parents. It is possible that the reason some parents abuse their children, while others displaying the same personality characteristics and inundated by the same stress do not, is that certain characteristics of the child may lead to some parents taking out their frustrations by abusing and neglecting the child. The child may be the major source of the parents' hostility and aggressiveness, not just the outlet for those already existing characteristics, Gelles (1973) and Parke and Collmer (1976) have suggested that certain traits, characteristics, or behaviors may render a child particularly unrewarding and difficult to care for or tolerate and therefore increase the probability of abuse. Terr (1970) found that many children in his sample were mentally retarded or hyperactive. Kemp (1971) found the adopted child, premature baby, and the precocious child to be high risk for abuse. Infant characteristics alone do not offer a viable etiology for child abuse since the majority of premature babies and children showing other problems are not abused. However, it would appear that the deviancies and caretaking behavior which characterize the parents of abused children can only be understood if the nature of the child's contribution to the disordered relationship is also taken into consideration. There is evidence in the child development literature which suggests that the child does affect the caretaker (cf. Lewis and Rosenblum, 1974). Prom the diversity of findings of previous research in the area of child abuse, it is inThus, evitable that any search for a single simple etiologicai factor is doomed to failure. it is imperative that we examine the interactions of the parents, environmental and socioloAll three factors occur within the context of the family in gical stress, and the child. conjunction with each other, so that the effects and significance of any one must be explored One factor by itself may mean with respect to its relationship with the other factors. nothing, but in combination with specific others may create a particular malignant situation. It should also be noted that the approach used in the vast majority of child abtise research Retrospective research attempts to identify factors that differentiate is retrospective. As pointed out earlier, the abusing from nonabusing parents after the abuse has occurred. conclusions drawn from such retrospective research are that environmental stress, poverty, and certain parental personality characteristics are among the causes of child abuse. A most important question remains unanswered: Why do some parents abuse or neglect their or under the same while others, displaying the same personality characteristics children We need to identify the precipitating factors that differentiate the family stress, do not? that abuses a child from the similar family that does not; an at-risk model of research is the best design for this task. This investigation studies the interaction of a wide but carefully chosen set of variables in the lives of a group of high-risk mothers who are being followed throughout their children's In the research reported here, characteristics of the mothers, infant first year of life. temperament and the organization of neonatal behavior, environmental stress factors , and the interaction of the caretaker and infant are examined in an attempt to identify differences between mothers who mistreat their children and those who do not. It is hoped that by studying the relationship between mother and infant during the first year of life we can gain a better understanding of the causes of child abuse, neglect, and more mild forms of The following specific factors are looked at in terms mistreatment for a high-risk sample. of how well they differentiate a group of mothers who eventually mistreated their children during the last trimester and three months after from a group who provided adequate care: the baby is born, parental personality characteristics, anxiety, locus of control, and feelings, perceptions and expectations regarding pregnancy, delivery, and the baby are assessed; interaction are infant temperament is assessed at birth and 3 months; and mother-infant The results reported in this paper are preliminary observed at three and six months of age. in that only the data collected prenatally, at birth, and at three and six months are used in the analyses. METHOD Lelection
of the - Sample
A sample of 275 primiparous women receiving prenatal care at the Maternal and Infant Care Clinics, Minneapolis Health Department, were enrolled in the investigation during the last The families are from lower socioeconomic backgrounds (the majority trimester of pregnancy.
Prospective Study of the Antecedents of Child Abuse
271
were on welfare), which for this investigation defines the at-risk nature of the sample. The base rate for abuse and neglect in the public Health Clinic population is approximately 1 to 2%, which is considerably higher than for the state in general. Even though every attempt has been made to enroll fathers, only 29% agreed to participate. Sixty percent of the mothers were unwed at the time of delivery. During the past 20 months, 26 infants have been identified as not receiving proper care in that the caretaker is to some extent irresponsible in managing the day-to-day childcare activities. While the problems are not as severe as those found in children referred to Child Protection (six from the total of 26 are or have been active Child Protection cases), there is reason to expect some adverse psychological impact on the child. According to the results obtained from the Child Care Rating Scale, the care these children receive is similar to the care received by the children from our sample who have been referred to Child Protection. At each visit to the mother's home, the Child Care Rating Scale, which involves ratings of any evidence of violence in the household, particularly toward the child, poor physical care, bad living conditions, neglect, and failure to thrive, is completed. Actual physical abuse was noted in five cases; failure to thrive in four (medically diagnosed), neglect and abuse in three cases, and severe neglect in 14 cases. The Child Care Rating Scale was filled out by the tester after each scheduled visit to the home. The items on the scale represent specific incidents of abuse or obvious examples of neglect and mistreatment which in no way overlapped with mother-infant interaction observed during feeding. A group of 25 good mothers offering high-quality care to their children was identified, based on observations and results from the Child Care Rating Scales. These mothers all cared for their children well in terms of feeding, providing health care, protecting the child from possible dangerous situations in the home, not leaving the baby alone or with unknown babysitters, and in general caring for the child adequately. Comparisons were made on a number of variables between the group offering high-quality mothering and the group offering lowquality mothering.
Data Gathering Procedures At approximately 36 weeks of pregnancy, a battery of tests was given to assess personality characteristics-- aggression, defendence, impulsivity, and succorance (Jackson, 1967), dependency and depression (Schaefer and Manheimer, 1960), anxiety (Cattel.1and Scheier, 1963), locus of control (Egeland, Hunt, and Hardt, 1970; Rotter, X966), and parents' feelings and perceptions of pregnancy, delivery, and their expected child (Cohler, Weiss, and Grunebaum, 1970; Schaefer and Manheimer, 1960). Specifically, these latter tests measure such characteristics as fear for self and baby, lack of desire for pregnancy, appropriate vs. inappropriate control of child's aggression, encouragement of reciprocity, feelings of competence in meeting baby's needs, etc. The battery of tests given to the parents prenatally was administered again when the infant was three months old. At birth and at three months an attempt was made to characterize the temperament of the infant using three different approaches: direct assessment of the neonate using the Brazelton Neonatal Assessment Scale (1973); naturalistic observation, for which nurses in the newborn nursery rated the child on such factors as irritability, activity level, soothability, etc., and maternal assessment of the infant at three months using the Carey Infant Temperament Questionnaire (1970). A detailed analysis of the three infant measures of temperament (Taraldson, Brunnquell, Deinard, and Egeland, 1977) showed that interrater reliability on the Nurse's Rating Scale and the Braselton was very good. However, the stability of the baby's behavior across the four days in the newborn nursery was moderate, and the correlations of Brazelton scores from day seven to day ten were quite low. In order to improve reliability, the Brazelton scores used in the analyses consisted of a combination of scores obtained when the baby was in an optimal state. At three and six months mother-infant interaction is observed in a feeding situation in the home, and at six months mother and infant are observed in play. Some of the behaviors observed include quality of verbalization, expressiveness,quality of physical contact, facility in caretaklng, sensitivity, cooperation, responsiveness to baby's initiation of interactions, and positive and negative regard. Twenty-four different variables are rated, and the observations are recorded using a nine-point rating scale based on Ainsworth, Staton, and Bell's work (1969) and extensive pilot work (cf. Egeland, Taraldson, and Brunnquell, 1977). Interrater reliabilities for the 24 feeding variables were quite good, with high ratings on such
272
B. Egeland
items as quality of physical contact (.78); facility in caretaking (.84); and general sensitivity (.82). The range for 24 items was .43 to .86 and the Lawlis-Lu measure of interrater agreement for all items was highly significant.
RESULTS One problem with using the at-risk approach in the area of child abuse is that the number of actual cases will not be large enough to study in any systematic fashion. The incidence figure typically quoted is approximately .09% (Nagi, 1976) and the figure reported for the Minneapolis Public Health population is l-2%. This means that the projected occurrence of abuse in our sample of 275 would be five cases. Our findings of 26 abused, neglected, and mistreated children suggests that the incidence is considerably higher than the figures typically reported. It appears that by going into the home and getting to know the families, considerably more abuse and neglect is discovered than typically comes to the attention of local hospitalsand other social agencies. All of the 26 mothers in the inadequate group are receiving some sort of social service by way of a public health nurse, social worker, and six families are under child protection. Our first analysis was an attempt to determine if the severity of maltreatment differed between the six inadequate mothers under child protection compared to the 20 who were not. According to the results, there were no differences between the two groups on the number of items checked on The Child Care Rating Scale, nor were there any differences on the type of item checked (e.g. physical violence vs. inadequate living conditions). As the 20 children not under child protection get older, there is little doubt that an increasing number of them will be placed under child protection. The results reported in the remainder of the paper involve comparisons between the 25 good mothers and the total group of 26 inadequate mothers.
Demographic
and Medical
Characteristics
Data regarding demographic characteristics and social and medical histories of the good and inadequate mothers were obtained from the prenatal clinic and the hospital delivery files. To summarize the results which were reported in an earlier paper (Egeland and Brunnquell, in press), there were basically no differences between the two groups regarding the sex of the baby, prematurity (approximately 10% of the babies in each group were premature), infant abnormalities, Apgar scores at one and five minutes, gestational age, and type of delivery. However, pregnancy complications were reported for 45% of the good mothers and 58% of the inadequate mothers, and delivery complications for 45% and 68% of the good and inadequate (These differences only approached significance, p < .lO). mothers, respectively. Perhaps the most significant factor distinguishing the two groups is the mother's age. The mean ages at delivery were 24.5 years for the good mothers and 19.3 years for the inadequate The difference is certainly related to mothers ’ differing abilities in preparing mothers. for and meeting the demands of pregnancy, delivery, and childrearing. The factors which do seem to distinguish between the two groups of mothers fall into two general categories: first, environmental support for the mother, and second, general education and specific preparation for the baby by the mother. General support is seen in the striking difference in Only 32X of the good mothers were single at the time marital status between the two groups. of delivery, while 74% of the inadequate mothers were single (x2 = 15.10, p < .009). Supportiveness of the alleged father and the mother's family was reported to be 75% and lOO%, respectively, for the good mothers and only 37% and 45% for the inadequate group. Interestingly the reported supportiveness of the mother's friends was approximately the same for the two groups, which suggests that friends, in many instances, do not provide significant and adequate support to the mother, particularly in the absence of more stable support from a partner or family member. There are striking differences in education and preparation for caring for the baby. Onehundred percent of the good mothers have completed at least 12 years in school, compared to only 30% of the irresponsible mothers. Given this findin8, it is not surprising that large differences in specific preparation for.the baby exist. For example, 100% of the good mothers attended child birth classes whereas 30% of the inadequate mothers attended.
Prospective
Discriminant
Study of the Antecedents
of Child Abuse
273
Analyses
Given the large amount of data collected on the mother-infant pairs, the most appropriate way to contrast the two groups is through the technique of discriminant function analysis. The actual program used was the Discriminant from the Statistical Package for the Social Scientist (Tatsuoka, 1971). This technique, similar to regression, obtains the optimal prediction of predetermined group membership (criterion groups) using a given set of variables. In this case, the good and inadequate groups were criterion groups, and the various sets of test scores and observations data were used to estimate how well that set of variables difThe results are reported in terms of percentage ferentiates the two preselected groups. Since the sample size for the two groups of mothers was relatively correct classification. small, it was not possible to use the separate test scores or observation ratings in the disInstead, factor scores derived from each of the factors reported criminant function analysis. These factor scores are based on separate factor analyses of the 17 in Table 1 were used. pre- and postnatal parent measures, the 27 Brazelton items, 17 nurses' ratings; and the 24 feeding ratings for the entire sample of 275 mothers and infants. The factors resulting from the principle axes factors analysis (varimax rotations) are presented in Table I.. The results from the first set of discriminant function analyses were used to determine to what extent certain infant characteristics influence the quality of care he or she receives. Using the ratings done by nurses during the child's stay in the nursery after delivery, an overall correct classification rate of 60.8% was found (E < .13). Using the Brazelton Neonatal Inventory, the correct classification rose to 70.5% (2 < .007), with most errors resulting from predicting that babies would fall into the good mother group when actually they were in the inadequate group. Factor I, Orientation, and Factor II, Irritability, contributed These findings suggest that the infant plays only a moderate role in most to the prediction. causing his or her own mistreatment. Regarding the question of the relationship between the pattern of mother-infant interaction and later quality of care, the results clearly indicate that deviant patterns of interaction observed in a feeding situation at three and six months and in a play situation at six months were highly predictive of maltreatment and neglect later on. The prediction based on the three-month feeding observation achieved an overall correct classification rate of 81.8% Factors I (mother's caretaking skill), II (mother's affect towards baby), and (E < .OOOl). III (baby's social behavior) all contribute to the predictions, with Factor I by far the most important. The discriminant analysis using six-month feeding and play observation resulted in a higher correct classification rate and when the three-month mother personality and child care scores were added to six-month mother-infant observations, the percent of mothers correctly classified rose to 95.8%. Only one mother in each group was incorrectly classified. Based on the personality testing of the mothers in their 36th week of pregnancy, the correct classification rate was 84.0% (2 < .OOOl) with Mother Factor III, which measures the mother's ability to deal with the psychological complexity of childrearing, contributing by far the largest portion of the prediction. The good mothers had a better understanding of the psychological complexity of childrearing, that is, they seemed to be more aware of the difficulties and demands involved in being a parent and to be able to accept in an appropriate manner the ambivalent feelings which accompany healthy mothering. Factors I and IV, which focus primarily on aspects of mother's personality such as aggression and impulsivity, contribute little to predicting group membership. The same tests repeated at three months after delivery yielded a 79.5% correct classification While the factor structure of this set of tests differs slightly from that of (E < .OOOl). the prenatal testing, the psychological complexity factor again clearly emerges as the largest contributor to the prediction and the second most important predictor was Factor V, Low Desire for Motherhood. In an attempt to maximize correct prediction of group membership, nine variables were selected from the data presented above. Due to sample size limitation, nine was the maximum number of variables which could be included in the analysis. These variables were selected on the basis of: a) the amount of variance accounted for by each factor in its own data set, or b) rational expectation of relation to prediction of group membership. The variables selected were Brazelton I, II, and V, Mother's Prenatal I, II, and III, and three-month feeding with a direct discriminant function analysis. A set-wise solution using Wilks Lambda as criterion entered the variables in the following order: three-month feeding I and II; Brazelton I;
274
B. Egeland
Feeding III; Mother Prenatal III; Brazelton solution also achieved an 85% final correct
Cluster
II; Mother Prenatal I and II; Brazelton classification rate.
V.
This
Analysis
This analysis seeks to statistically define groups or clusters within the 51 mother-child pairs used for the discriminant function analysis. In other words, are there subgroups of If so, mothers which display different personality characteristics or interaction patterns? are the subgroups related to the severity or type of maltreatment and do they represent difrent etiological patterns? The cluster analysis, which has as its goal identifying groups of subjects more similar to each other than to other subjects within the same general group, was performed using the same measures as described above and the 51 mothers in the good and inadequate groups. The statistical process (Dixon, 1975) begins by "clustering" the two cases with the shortest distance between them; these cases are then amalgamated and treated as one case, then joined with the other clusters (which may be individual cases or actual clusters of two or more cases); this continues until all cases are joined into one cluster. The distance calculation is done by a sum of squares procedure using the square root of sums of squares as a distance measure; the amalgamation is a weighted average of values where the weight is the number of cases in a cluster (Dixon, 1975). To carry out this procedure the set of 51 mothers was reduced to 29 on whom a complete set of These included 14 good mothers prenatal, neonatal, and postnatal measurements had been made. In order to have a sufficient, though minimal, number of subjects and 15 inadequate mothers. per variable for this analysis, the set of variables was reduced to six. All of these had been used in the discriminant analysis, and were chosen on a rational basis as most likely to The variables are factor scores as in the discriminant provide an adequate clustering. three month Feeding Factors I, II, and III, Brazelton Factor I, analyses and consist of: Nurses Factor II, and Mother's Prenatal Factor III. From the results of the cluster analysis four subgroups emerge. Most striking is the first large subgroup, A ,which includes thirteen of the 29 cases in the analysis. This sub-cluster Among the includes all of the good mothers except one and none of the inadequate mothers. remaining 15 cases, three groups clearly emerge, all of which contain mothers from the inadequate group (Subgroup B, N = 6; Subgroup C, N = 5; Subgroup D, N = 4). The results are extremely interesting in that the subgroups formed by the clustering procedure clearly break down into a subgroup comprising the good mothers and three subgroups comprising the inadequate The fact that the groups clustered in this way indicates that the psychological and mothers. The meaobservational factors used here are a major contributor to group differentiation. sures used account for the formation of meaningful groups rather than random effects or observer-related error variance. The fact that three subgroups of mothers from the inadequate group clustered indicates that there are three distinct patterns of mother-infant characteristics which certainly supports the notion of multiple etiologies. A most interesting examination of this clustered data involves looking at the subgroups within the inadequate mothers group to discover characteristics which may indicate differences This was done in two ways, first by comparing between groups and similarity within groups. This the clusters to a rational grouping according to reported severity of the problem. comparison for the 15 inadequate mothers used in the cluster analysis indicates that there is little relation between the clusters here and the severity of the abuse and neglect known to Secondly, a look at the case histories of the mothers in the different our investigators. subgroups of inadequate mothers, does yield interesting differences. The information about each of the sub-clusters is taken from the observers' notes on conditions and events in the homes on the various visits made to each mother-child pair. There seemed to be an equal frequency of comments regarding the unsanitary conditions in all three The sub-clusters also seemed similar in regard to generally rough handling or subgroups. One notable difference was the frequency of other people caring generally ignoring the child. for the child much of the time in sub-clusters C and D but notfor those in sub-cluster B. This seems to be related to a larger number of mothers in sub-clusters C and D who are teenagers and who are described as lacking skill in caring for their child and managing their own lives. On the other hand, reports of physical violence by boyfriend or husband to the mother occurred in 5 of 6 cases in sub-cluster B but not at all in sub-clusters C and D. This was accompanied by frequent change of residence in 4 of 6 cases in sub-cluster B but again not at all in sub-clusters C and D.
Prospective
Study of the Antecedents
of Child Abuse
275
The results based on the cluster analyses are tentative and difficult to interpret at the present time. However, by running additional cluster analyses with different combinations of life stress, interactional, parental, and child variables and by using more of a descriptive case study approach in attempting to characterize the mother-infant pairs in each cluster; there is no doubt that we will be better able to understand the complex phenomena The results presented here suggest that the prospective, multiof child abuse and neglect. variate approach offers appropriate methodology and statistical techniques for the study of child abuse and neglect.
DISCUSSION This investigation represents a first attempt at differentiating good from inadequate mothers based on data collected before any specific abuse or neglect has occurred. Before discussing the results and their implications, it should be pointed out that the findings reported in By including data collected at nine and 12 months and beyond, this paper are preliminary. the relative importance of certain prenatal, birth, and three-month variables for predicting It is also the case that the good and inadequate group membership may change significantly. As more information becomes available additional mothers will mothers groups are changing. be added to the two groups and in some cases mothers already in the groups will be removed. Separate discriminant function analyses were performed using the mother, infant, and motherinfant interaction variables in an attempt to differentiate between the good and inadequate The two measures based primarily on assessment of the infants were least mother groups. It seems that the condition of the baby cannot effective in differentiation when used alone. in itself predict abuse or neglect within a mother-child pair, although the trends indicate The importance of baby's behavior in determining the qualithat baby variables are involved. ty of care he/she receives is noted in the results of the discriminant analysis involving the combination of mother, infant and interaction variables when it was found that Brazelton Factor I, baby's orientation is the third best predictor of group membership. There are three additional aspects of the results that will be discussed in some detail: the failure to find personality differences between the two groups of mothers; the importance of the interactional data; and the significance of the mother's understanding of the psychological complexity of the infant and her relationship with the infant. Basically, the two groups of mothers did not differ on the personality measures. The Impulsive/Anxious and the Hostile/Suspicious factors did not differentiate the two groups which suggests that anxiety and the traits of aggression, impulsivity, and suspiciousness are not predictive of the quality of care the mother provides. These results support the notion that there is no particular abusing personality. The implications for treatment suggest that a psychiatric approach which has as its goal themodification of basic personality traits is not the most effective intervention strategy. Helping a hostile, anxious, or suspicious mother gain insight and understanding of these behaviors will probably have little effect on how she relates to her child. The generalizability of the conclusion that personality variables are relatively unimportant as an etiology of child abuse may only apply to a young, relatively uneducated, lower socioeconomic sample similar to the mothers in this investigation. It is quite possible that the psychiatric model is appropriate for abusers with different educational and socioeconomic backgrounds. One characteristic the inadequate mothers have in common is that they misunderstand their child and the nature of child rearing. The inadequate mothers obtained lower scores on the psychological complexity factor which is based on three scales from Cohler, Weiss, and Grunebaum's (1970) Maternal Attitude Scale. The three scales measure: the appropriateness of the mother's attitude toward the child's aggression; the appropriateness of her attitude toward encouraging reciprocity, and her appropriate acceptance of the ambivalent feelings that of necessity accompany pregnancy and mothering. On the prenatal testing these three elements are accompanied by a higher than average score (for our sample) on a vocabulary test, indicating that intellectual ability is related to these three scales. This seems to be a factor related more to interpersonal understanding and empathy than to a broad personality style. Mothers scoring high on this test are more aware of the difficulties and demands involved in being a parent and are able to accept in an appropriate manner the ambivalent feelings which accompany healthy mothering. They are able to see themselves as autonomous and separate from their infants, but, on the other hand, they recognize the need to provide an environment that supports the development of a strong attachment between mother and
B. Egeland
276
infant. Some of the inadequate mothers seem to have difficulty maintaining their own identity or autonomy within this close mother-infant relationship while others were frightened of or did not see the need for promoting this close emotional tie. These findings suggest that intervention must focus on the mother child relationship, particularly the mother's feelings about various aspects of this relationship and her understanding of the need to promote a She must also recognize that as the child gets older she must encourage secure attachment. This can only be done in an atmosphere where the mother feels separation and individuation. a close emotional tie to the child but yet can function as a separate, autonomous person. The importance of an adequate reciprocal relationship between mother and infant is most clearIn the step-wise discriminant ly seen in the results of the feeding and play observations. function analysis using the nine selected variables, the feeding observation factors, mother's caretaking skills and mother's affective behavior were the first two variables entered, that is, those which contributed most to the prediction of group membership. In the feeding end play situations, the inadequate mothers were less sensitive to the child's They were more apt to interfere with baby's activities and were less cues and signals. These mothers paid little attention to likely to "cooperate" with the baby during feeding. baby's needs and activities, and during feeding they would often interrupt the baby's ongoing activity rather than gearing feeding in both timing and quality to the baby's state, mood, For many of the inadequate mothers, feeding was something they did to their and interests. infants, and it was done in a highly mechanical. way, which precluded any reciprocal interThe babies would attempt to engage the mothers in social interaction, but generally action. the inadequate mothers were either insensitive to the baby's social cues or chose not to respond to them. It should be pointed out that these analyses and the conclusions are an initial attempt at The results are relating certain factors to good and poor outcomes with a high-risk sample. Applied to another preliminary and there is a need for further analyses and replication. However, the degree of significance in differensample the results may be quite different. tiating the good and inadequte mother groups based on the interaction and psychological variables indicates that a powerful effect is being tapped.
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Egeland, B., Taraldson, B., and Brunnquell, D. Observation of Waiting Room and Feeding Situation: Technical Report, U. of Minnesota, Minneapolis (1977). Gelles, R.J. Child abuse as psychopathology: a sociological critique and reformulation, American J. of Orthopsychiatry 43, 611-621 (1973). Jackson, D.N. (1967) Personality Research Form Manual, Research Psychologists Press, N.Y. Justice, B. and Justice, R. (1976) The Abusing Family, Human Sciences Press, N.Y. Kempe, C.H. Pediatric implications of the battered baby syndrome, Archives of Disease in Childhood 46, 28-37 (1971). Lewis, M. and Rosenblum, L.A. (1974) The Effect of the Infant on its Caregiver, Wiley, N.Y. Nagi, S.Z. Child abuse and neglect programs: a national overview, Children Today 4, 13-17 (1975). Parke, R.D. and Collmer, C.W. Child abuse: an interdisciplinaryanalysis, In. E.M. Hetherington, Ed., Review of Child Development Research 5, 509-590, University of Chicago Press, Chicago (1976). Rotter, J.B. Generalized expectancies for internal versus external control of reinforcement, Psychological Monographs ,80 (1966). Sameroff, A.J. and Chandler, M.J. Reproductive risk and the continuum of caretaking casualty, In F.D. Horowitz, E.M. Hetherington, S. Starr-Salapatek,and G.M. Siegel, Eds,, Review of Child Development Research 4, 187-244, U. of Chicago Press, Chicago (1975). Schaefer, M.S. and Manheimer, H. Dimensions of perinatal adjustment. Paper presented to Eastern Psychological Assocation, New York (1960). Smith, S.M. and Hansen, R. Interpersonalrelationships and child-rearing practices in 214 parents of battered children, Brit. J. of Psychiatry 127, 513-525 (1975). Spinetta, J.J. and Rigler, D. The child-abusing parent: a psychological review, Psychological Bulletin 77, 296-304 (1972). Steele, B.F. and Pollock, C.B. A psychiatric study of parents who abuse infants and small children, In R.B. Helfer and C.H. Kempe, Eds., The Battered Child, 103-147, U. of Chicago Press, Chicago (1968). Taraldson, B., Brunnquell, D., Deinard, A., and Egeland, B. Psychometric and theoretical credibility of three measures of infant temperament, Society for Research in Child Development, New Orleans, Louisiana (1977). Tatsuoka, M. (1971) Multivariate Analyses, Wiley, N.Y. Terr, L.
A family study of child abuse, American J. of Psychiatry 127, 665-671 (1970).
B. Egeland
278
TABLE
Mother's
1
Prenatal
Factors Resulting from Factor Infant Interaction Variables
Nurses'
Testing
of Mother,
Impulsive/Anxious
II
Negative
III
Psychological
IV
Hostile/Suspicious
Reactions
to Pregnancy
Complexity
Baby's Alertness/Activity
II
Mother's
III
Baby's
IV
Ease of Care for Baby
Mother's
Factors
Factors
Interest
Contentment
Three-Month
Testing
I
Orientation
I
Hostile/Suspicious
II
Irritability
II
Negative
III
Motor Maturity
III
Psychological
IV
Physical
V
Consolability
Three-Month
Ability/Body
Feeding
Tonus
to Pregnancy
Complexity
IV
Impulsive/Anxious
V
Low Desire
VI
Dependence
Six-Month
I
Mother's
Caretaking
II
Mother's
Affective
Skills Behavior
for Motherhood
Mother's
Caretaking
Mother's
Affective
Baby's
Baby's
Social Behavior
IV
Muscle
Tone/Cuddling
III
Play Interaction
Support
and Cooperation
II
Baby's Activity
III
Amount
of Reciprocal
and Coordination
IV
Baby's
Satisfaction
Play
Interaction
I
III
Factors
Feeding
Factors
II
Mother's
Reactions
Interaction
Factors
I
and Mother-
Ratings
I
Brazelton
Six-Month
Infant,
Factors
Factors I
Analyses
Skills Behavior
Social Behavior
PRELIMINARY
RESULTS
OF A PROSPECTIVE
STUDY OF THE ANTECEDENTS
OF CHILD ABUSE '
Byron Egeland University
of Minnesota,
n548 Elliott Hall, Minneapolis,
Minnesota
55455
An analysis of the existing child abuse literature suggests the presence of three broad quasicharacteristics of the parents, environmental and sociological stress, independent factors: and characteristics of the child. The majority of the investigations have focused on the contributory role of the parent, Results of this research have portrayed the abusive parent as a member of a multi-problem family whose deficits and liabilities encompass the entire spectrum of personal and social pathology (Parke and Collmer, 1976; Sameroff and Chandler, 1975). Specifically, research has attempted to show that abusive parents possess a unique constellation of personality traits or characteristics which presumably increase the likelihood that they will engage in abusive behavior. However, studies aiming to delineate personality characteristics of abusive parents have yielded no consistent findings, but instead have implicated a wide array of disparate, sometimes contradictory, traits (Gelles, 1973; Parke and Collmer, 1976; Spinetta and Rigler, 1972). Many authors also assert that abusing parents share some common misunderstanding with regard to the nature of child rearing and tend to look to the child for satisfaction of their own parental emotional needs. The personal histories of these parents include evidence that they were themselves abused, neglected, or emotionally deprived as children and consequently lack parenting skills and adequate understanding of appropriate child rearing practices (Smith and Hansen, 1975). In addition, it is argued that abusing parents lack knowledge of child rearing and have unrealistic expectations of normal child development (Smith and Hansen, 1975). A number of investigators have also suggested that environmental and sociological stress factors impinging on the family are prepotentelicitors of child abuse (Justice and Justice, 1976). A basic tenet of this prospective is that hardship and stress create frustration which leads to aggression, often exhibited towards children, primarily because they do net pose a threat of retaliation. It follows from this assumption that populations exposed to the greatest amount of environmental stress would exhibit the greatest incidence of child abuse. This is particularly applicable to low socioeconomic status populations where people are faced with the problems of simply providing the basic necessities of life for their families. Families in general, and low socioeconomic families in particular, are subject to a variety of stresses that threaten the integrity of the individual members and the family functioning and interaction as a whole. Poverty, unemployment, poor and crowded living conditions, illness, death, desertion, social isolation, and marital conflict all serve to heighten frustration, increasing the possibility of aggressive outbursts (Egeland, Cicchetti, and Taraldson, 1976). While research has suggested that in a large majority of the reported cases of child abuse the perpetrator was of low socioeconomic status, nonetheless there are studies which maintain that child abusers are made up of a cross-section of individuals of different socioeconomic status and education (Blumberg, 1976) and that social, economic, and demographic factors are irrelavant to the act of child beating (Steele and Pollack, 1968). Even though it may be true that child abusing families are experiencing a great deal of stress, it is clear that every family undergoing an equal amount of stress does not abuse their children, Since the majority of parents from lower socioeconomic backgrounds do not abuse their children, it is obvious that
1) This research was funded by a grant from the.Administration for Children, Youth and Families, National Center for Child Abuse and Neglect, U.S. Dept. of Health, Education and Welfare 269
B. &eland
270
environmental
stress
alone
is not a sufficient
explanation
for the occurrence
of abuse.
Only recently has any consideration been given to the behavior of the child and how these behaviors may tend to elicit abuse or neglect from the parents. It is possible that the reason some parents abuse their children, while others displaying the same personality characteristics and inundated by the same stress do not, is that certain characteristics of the child may lead to some parents taking out their frustrations by abusing and neglecting the child. The child may be the major source of the parents' hostility and aggressiveness, not just the outlet for those already existing characteristics, Gelles (1973) and Parke and Collmer (1976) have suggested that certain traits, characteristics, or behaviors may render a child particularly unrewarding and difficult to care for or tolerate and therefore increase the probability of abuse. Terr (1970) found that many children in his sample were mentally retarded or hyperactive. Kemp (1971) found the adopted child, premature baby, and the precocious child to be high risk for abuse. Infant characteristics alone do not offer a viable etiology for child abuse since the majority of premature babies and children showing other problems are not abused. However, it would appear that the deviancies and caretaking behavior which characterize the parents of abused children can only be understood if the nature of the child's contribution to the disordered relationship is also taken into consideration. There is evidence in the child development literature which suggests that the child does affect the caretaker (cf. Lewis and Rosenblum, 1974). Prom the diversity of findings of previous research in the area of child abuse, it is inThus, evitable that any search for a single simple etiologicai factor is doomed to failure. it is imperative that we examine the interactions of the parents, environmental and socioloAll three factors occur within the context of the family in gical stress, and the child. conjunction with each other, so that the effects and significance of any one must be explored One factor by itself may mean with respect to its relationship with the other factors. nothing, but in combination with specific others may create a particular malignant situation. It should also be noted that the approach used in the vast majority of child abtise research Retrospective research attempts to identify factors that differentiate is retrospective. As pointed out earlier, the abusing from nonabusing parents after the abuse has occurred. conclusions drawn from such retrospective research are that environmental stress, poverty, and certain parental personality characteristics are among the causes of child abuse. A most important question remains unanswered: Why do some parents abuse or neglect their or under the same while others, displaying the same personality characteristics children We need to identify the precipitating factors that differentiate the family stress, do not? that abuses a child from the similar family that does not; an at-risk model of research is the best design for this task. This investigation studies the interaction of a wide but carefully chosen set of variables in the lives of a group of high-risk mothers who are being followed throughout their children's In the research reported here, characteristics of the mothers, infant first year of life. temperament and the organization of neonatal behavior, environmental stress factors , and the interaction of the caretaker and infant are examined in an attempt to identify differences between mothers who mistreat their children and those who do not. It is hoped that by studying the relationship between mother and infant during the first year of life we can gain a better understanding of the causes of child abuse, neglect, and more mild forms of The following specific factors are looked at in terms mistreatment for a high-risk sample. of how well they differentiate a group of mothers who eventually mistreated their children during the last trimester and three months after from a group who provided adequate care: the baby is born, parental personality characteristics, anxiety, locus of control, and feelings, perceptions and expectations regarding pregnancy, delivery, and the baby are assessed; interaction are infant temperament is assessed at birth and 3 months; and mother-infant The results reported in this paper are preliminary observed at three and six months of age. in that only the data collected prenatally, at birth, and at three and six months are used in the analyses. METHOD Lelection
of the - Sample
A sample of 275 primiparous women receiving prenatal care at the Maternal and Infant Care Clinics, Minneapolis Health Department, were enrolled in the investigation during the last The families are from lower socioeconomic backgrounds (the majority trimester of pregnancy.
Prospective Study of the Antecedents of Child Abuse
271
were on welfare), which for this investigation defines the at-risk nature of the sample. The base rate for abuse and neglect in the public Health Clinic population is approximately 1 to 2%, which is considerably higher than for the state in general. Even though every attempt has been made to enroll fathers, only 29% agreed to participate. Sixty percent of the mothers were unwed at the time of delivery. During the past 20 months, 26 infants have been identified as not receiving proper care in that the caretaker is to some extent irresponsible in managing the day-to-day childcare activities. While the problems are not as severe as those found in children referred to Child Protection (six from the total of 26 are or have been active Child Protection cases), there is reason to expect some adverse psychological impact on the child. According to the results obtained from the Child Care Rating Scale, the care these children receive is similar to the care received by the children from our sample who have been referred to Child Protection. At each visit to the mother's home, the Child Care Rating Scale, which involves ratings of any evidence of violence in the household, particularly toward the child, poor physical care, bad living conditions, neglect, and failure to thrive, is completed. Actual physical abuse was noted in five cases; failure to thrive in four (medically diagnosed), neglect and abuse in three cases, and severe neglect in 14 cases. The Child Care Rating Scale was filled out by the tester after each scheduled visit to the home. The items on the scale represent specific incidents of abuse or obvious examples of neglect and mistreatment which in no way overlapped with mother-infant interaction observed during feeding. A group of 25 good mothers offering high-quality care to their children was identified, based on observations and results from the Child Care Rating Scales. These mothers all cared for their children well in terms of feeding, providing health care, protecting the child from possible dangerous situations in the home, not leaving the baby alone or with unknown babysitters, and in general caring for the child adequately. Comparisons were made on a number of variables between the group offering high-quality mothering and the group offering lowquality mothering.
Data Gathering Procedures At approximately 36 weeks of pregnancy, a battery of tests was given to assess personality characteristics-- aggression, defendence, impulsivity, and succorance (Jackson, 1967), dependency and depression (Schaefer and Manheimer, 1960), anxiety (Cattel.1and Scheier, 1963), locus of control (Egeland, Hunt, and Hardt, 1970; Rotter, X966), and parents' feelings and perceptions of pregnancy, delivery, and their expected child (Cohler, Weiss, and Grunebaum, 1970; Schaefer and Manheimer, 1960). Specifically, these latter tests measure such characteristics as fear for self and baby, lack of desire for pregnancy, appropriate vs. inappropriate control of child's aggression, encouragement of reciprocity, feelings of competence in meeting baby's needs, etc. The battery of tests given to the parents prenatally was administered again when the infant was three months old. At birth and at three months an attempt was made to characterize the temperament of the infant using three different approaches: direct assessment of the neonate using the Brazelton Neonatal Assessment Scale (1973); naturalistic observation, for which nurses in the newborn nursery rated the child on such factors as irritability, activity level, soothability, etc., and maternal assessment of the infant at three months using the Carey Infant Temperament Questionnaire (1970). A detailed analysis of the three infant measures of temperament (Taraldson, Brunnquell, Deinard, and Egeland, 1977) showed that interrater reliability on the Nurse's Rating Scale and the Braselton was very good. However, the stability of the baby's behavior across the four days in the newborn nursery was moderate, and the correlations of Brazelton scores from day seven to day ten were quite low. In order to improve reliability, the Brazelton scores used in the analyses consisted of a combination of scores obtained when the baby was in an optimal state. At three and six months mother-infant interaction is observed in a feeding situation in the home, and at six months mother and infant are observed in play. Some of the behaviors observed include quality of verbalization, expressiveness,quality of physical contact, facility in caretaklng, sensitivity, cooperation, responsiveness to baby's initiation of interactions, and positive and negative regard. Twenty-four different variables are rated, and the observations are recorded using a nine-point rating scale based on Ainsworth, Staton, and Bell's work (1969) and extensive pilot work (cf. Egeland, Taraldson, and Brunnquell, 1977). Interrater reliabilities for the 24 feeding variables were quite good, with high ratings on such
272
B. Egeland
items as quality of physical contact (.78); facility in caretaking (.84); and general sensitivity (.82). The range for 24 items was .43 to .86 and the Lawlis-Lu measure of interrater agreement for all items was highly significant.
RESULTS One problem with using the at-risk approach in the area of child abuse is that the number of actual cases will not be large enough to study in any systematic fashion. The incidence figure typically quoted is approximately .09% (Nagi, 1976) and the figure reported for the Minneapolis Public Health population is l-2%. This means that the projected occurrence of abuse in our sample of 275 would be five cases. Our findings of 26 abused, neglected, and mistreated children suggests that the incidence is considerably higher than the figures typically reported. It appears that by going into the home and getting to know the families, considerably more abuse and neglect is discovered than typically comes to the attention of local hospitalsand other social agencies. All of the 26 mothers in the inadequate group are receiving some sort of social service by way of a public health nurse, social worker, and six families are under child protection. Our first analysis was an attempt to determine if the severity of maltreatment differed between the six inadequate mothers under child protection compared to the 20 who were not. According to the results, there were no differences between the two groups on the number of items checked on The Child Care Rating Scale, nor were there any differences on the type of item checked (e.g. physical violence vs. inadequate living conditions). As the 20 children not under child protection get older, there is little doubt that an increasing number of them will be placed under child protection. The results reported in the remainder of the paper involve comparisons between the 25 good mothers and the total group of 26 inadequate mothers.
Demographic
and Medical
Characteristics
Data regarding demographic characteristics and social and medical histories of the good and inadequate mothers were obtained from the prenatal clinic and the hospital delivery files. To summarize the results which were reported in an earlier paper (Egeland and Brunnquell, in press), there were basically no differences between the two groups regarding the sex of the baby, prematurity (approximately 10% of the babies in each group were premature), infant abnormalities, Apgar scores at one and five minutes, gestational age, and type of delivery. However, pregnancy complications were reported for 45% of the good mothers and 58% of the inadequate mothers, and delivery complications for 45% and 68% of the good and inadequate (These differences only approached significance, p < .lO). mothers, respectively. Perhaps the most significant factor distinguishing the two groups is the mother's age. The mean ages at delivery were 24.5 years for the good mothers and 19.3 years for the inadequate The difference is certainly related to mothers ’ differing abilities in preparing mothers. for and meeting the demands of pregnancy, delivery, and childrearing. The factors which do seem to distinguish between the two groups of mothers fall into two general categories: first, environmental support for the mother, and second, general education and specific preparation for the baby by the mother. General support is seen in the striking difference in Only 32X of the good mothers were single at the time marital status between the two groups. of delivery, while 74% of the inadequate mothers were single (x2 = 15.10, p < .009). Supportiveness of the alleged father and the mother's family was reported to be 75% and lOO%, respectively, for the good mothers and only 37% and 45% for the inadequate group. Interestingly the reported supportiveness of the mother's friends was approximately the same for the two groups, which suggests that friends, in many instances, do not provide significant and adequate support to the mother, particularly in the absence of more stable support from a partner or family member. There are striking differences in education and preparation for caring for the baby. Onehundred percent of the good mothers have completed at least 12 years in school, compared to only 30% of the irresponsible mothers. Given this findin8, it is not surprising that large differences in specific preparation for.the baby exist. For example, 100% of the good mothers attended child birth classes whereas 30% of the inadequate mothers attended.
Prospective
Discriminant
Study of the Antecedents
of Child Abuse
273
Analyses
Given the large amount of data collected on the mother-infant pairs, the most appropriate way to contrast the two groups is through the technique of discriminant function analysis. The actual program used was the Discriminant from the Statistical Package for the Social Scientist (Tatsuoka, 1971). This technique, similar to regression, obtains the optimal prediction of predetermined group membership (criterion groups) using a given set of variables. In this case, the good and inadequate groups were criterion groups, and the various sets of test scores and observations data were used to estimate how well that set of variables difThe results are reported in terms of percentage ferentiates the two preselected groups. Since the sample size for the two groups of mothers was relatively correct classification. small, it was not possible to use the separate test scores or observation ratings in the disInstead, factor scores derived from each of the factors reported criminant function analysis. These factor scores are based on separate factor analyses of the 17 in Table 1 were used. pre- and postnatal parent measures, the 27 Brazelton items, 17 nurses' ratings; and the 24 feeding ratings for the entire sample of 275 mothers and infants. The factors resulting from the principle axes factors analysis (varimax rotations) are presented in Table I.. The results from the first set of discriminant function analyses were used to determine to what extent certain infant characteristics influence the quality of care he or she receives. Using the ratings done by nurses during the child's stay in the nursery after delivery, an overall correct classification rate of 60.8% was found (E < .13). Using the Brazelton Neonatal Inventory, the correct classification rose to 70.5% (2 < .007), with most errors resulting from predicting that babies would fall into the good mother group when actually they were in the inadequate group. Factor I, Orientation, and Factor II, Irritability, contributed These findings suggest that the infant plays only a moderate role in most to the prediction. causing his or her own mistreatment. Regarding the question of the relationship between the pattern of mother-infant interaction and later quality of care, the results clearly indicate that deviant patterns of interaction observed in a feeding situation at three and six months and in a play situation at six months were highly predictive of maltreatment and neglect later on. The prediction based on the three-month feeding observation achieved an overall correct classification rate of 81.8% Factors I (mother's caretaking skill), II (mother's affect towards baby), and (E < .OOOl). III (baby's social behavior) all contribute to the predictions, with Factor I by far the most important. The discriminant analysis using six-month feeding and play observation resulted in a higher correct classification rate and when the three-month mother personality and child care scores were added to six-month mother-infant observations, the percent of mothers correctly classified rose to 95.8%. Only one mother in each group was incorrectly classified. Based on the personality testing of the mothers in their 36th week of pregnancy, the correct classification rate was 84.0% (2 < .OOOl) with Mother Factor III, which measures the mother's ability to deal with the psychological complexity of childrearing, contributing by far the largest portion of the prediction. The good mothers had a better understanding of the psychological complexity of childrearing, that is, they seemed to be more aware of the difficulties and demands involved in being a parent and to be able to accept in an appropriate manner the ambivalent feelings which accompany healthy mothering. Factors I and IV, which focus primarily on aspects of mother's personality such as aggression and impulsivity, contribute little to predicting group membership. The same tests repeated at three months after delivery yielded a 79.5% correct classification While the factor structure of this set of tests differs slightly from that of (E < .OOOl). the prenatal testing, the psychological complexity factor again clearly emerges as the largest contributor to the prediction and the second most important predictor was Factor V, Low Desire for Motherhood. In an attempt to maximize correct prediction of group membership, nine variables were selected from the data presented above. Due to sample size limitation, nine was the maximum number of variables which could be included in the analysis. These variables were selected on the basis of: a) the amount of variance accounted for by each factor in its own data set, or b) rational expectation of relation to prediction of group membership. The variables selected were Brazelton I, II, and V, Mother's Prenatal I, II, and III, and three-month feeding with a direct discriminant function analysis. A set-wise solution using Wilks Lambda as criterion entered the variables in the following order: three-month feeding I and II; Brazelton I;
274
B. Egeland
Feeding III; Mother Prenatal III; Brazelton solution also achieved an 85% final correct
Cluster
II; Mother Prenatal I and II; Brazelton classification rate.
V.
This
Analysis
This analysis seeks to statistically define groups or clusters within the 51 mother-child pairs used for the discriminant function analysis. In other words, are there subgroups of If so, mothers which display different personality characteristics or interaction patterns? are the subgroups related to the severity or type of maltreatment and do they represent difrent etiological patterns? The cluster analysis, which has as its goal identifying groups of subjects more similar to each other than to other subjects within the same general group, was performed using the same measures as described above and the 51 mothers in the good and inadequate groups. The statistical process (Dixon, 1975) begins by "clustering" the two cases with the shortest distance between them; these cases are then amalgamated and treated as one case, then joined with the other clusters (which may be individual cases or actual clusters of two or more cases); this continues until all cases are joined into one cluster. The distance calculation is done by a sum of squares procedure using the square root of sums of squares as a distance measure; the amalgamation is a weighted average of values where the weight is the number of cases in a cluster (Dixon, 1975). To carry out this procedure the set of 51 mothers was reduced to 29 on whom a complete set of These included 14 good mothers prenatal, neonatal, and postnatal measurements had been made. In order to have a sufficient, though minimal, number of subjects and 15 inadequate mothers. per variable for this analysis, the set of variables was reduced to six. All of these had been used in the discriminant analysis, and were chosen on a rational basis as most likely to The variables are factor scores as in the discriminant provide an adequate clustering. three month Feeding Factors I, II, and III, Brazelton Factor I, analyses and consist of: Nurses Factor II, and Mother's Prenatal Factor III. From the results of the cluster analysis four subgroups emerge. Most striking is the first large subgroup, A ,which includes thirteen of the 29 cases in the analysis. This sub-cluster Among the includes all of the good mothers except one and none of the inadequate mothers. remaining 15 cases, three groups clearly emerge, all of which contain mothers from the inadequate group (Subgroup B, N = 6; Subgroup C, N = 5; Subgroup D, N = 4). The results are extremely interesting in that the subgroups formed by the clustering procedure clearly break down into a subgroup comprising the good mothers and three subgroups comprising the inadequate The fact that the groups clustered in this way indicates that the psychological and mothers. The meaobservational factors used here are a major contributor to group differentiation. sures used account for the formation of meaningful groups rather than random effects or observer-related error variance. The fact that three subgroups of mothers from the inadequate group clustered indicates that there are three distinct patterns of mother-infant characteristics which certainly supports the notion of multiple etiologies. A most interesting examination of this clustered data involves looking at the subgroups within the inadequate mothers group to discover characteristics which may indicate differences This was done in two ways, first by comparing between groups and similarity within groups. This the clusters to a rational grouping according to reported severity of the problem. comparison for the 15 inadequate mothers used in the cluster analysis indicates that there is little relation between the clusters here and the severity of the abuse and neglect known to Secondly, a look at the case histories of the mothers in the different our investigators. subgroups of inadequate mothers, does yield interesting differences. The information about each of the sub-clusters is taken from the observers' notes on conditions and events in the homes on the various visits made to each mother-child pair. There seemed to be an equal frequency of comments regarding the unsanitary conditions in all three The sub-clusters also seemed similar in regard to generally rough handling or subgroups. One notable difference was the frequency of other people caring generally ignoring the child. for the child much of the time in sub-clusters C and D but notfor those in sub-cluster B. This seems to be related to a larger number of mothers in sub-clusters C and D who are teenagers and who are described as lacking skill in caring for their child and managing their own lives. On the other hand, reports of physical violence by boyfriend or husband to the mother occurred in 5 of 6 cases in sub-cluster B but not at all in sub-clusters C and D. This was accompanied by frequent change of residence in 4 of 6 cases in sub-cluster B but again not at all in sub-clusters C and D.
Prospective
Study of the Antecedents
of Child Abuse
275
The results based on the cluster analyses are tentative and difficult to interpret at the present time. However, by running additional cluster analyses with different combinations of life stress, interactional, parental, and child variables and by using more of a descriptive case study approach in attempting to characterize the mother-infant pairs in each cluster; there is no doubt that we will be better able to understand the complex phenomena The results presented here suggest that the prospective, multiof child abuse and neglect. variate approach offers appropriate methodology and statistical techniques for the study of child abuse and neglect.
DISCUSSION This investigation represents a first attempt at differentiating good from inadequate mothers based on data collected before any specific abuse or neglect has occurred. Before discussing the results and their implications, it should be pointed out that the findings reported in By including data collected at nine and 12 months and beyond, this paper are preliminary. the relative importance of certain prenatal, birth, and three-month variables for predicting It is also the case that the good and inadequate group membership may change significantly. As more information becomes available additional mothers will mothers groups are changing. be added to the two groups and in some cases mothers already in the groups will be removed. Separate discriminant function analyses were performed using the mother, infant, and motherinfant interaction variables in an attempt to differentiate between the good and inadequate The two measures based primarily on assessment of the infants were least mother groups. It seems that the condition of the baby cannot effective in differentiation when used alone. in itself predict abuse or neglect within a mother-child pair, although the trends indicate The importance of baby's behavior in determining the qualithat baby variables are involved. ty of care he/she receives is noted in the results of the discriminant analysis involving the combination of mother, infant and interaction variables when it was found that Brazelton Factor I, baby's orientation is the third best predictor of group membership. There are three additional aspects of the results that will be discussed in some detail: the failure to find personality differences between the two groups of mothers; the importance of the interactional data; and the significance of the mother's understanding of the psychological complexity of the infant and her relationship with the infant. Basically, the two groups of mothers did not differ on the personality measures. The Impulsive/Anxious and the Hostile/Suspicious factors did not differentiate the two groups which suggests that anxiety and the traits of aggression, impulsivity, and suspiciousness are not predictive of the quality of care the mother provides. These results support the notion that there is no particular abusing personality. The implications for treatment suggest that a psychiatric approach which has as its goal themodification of basic personality traits is not the most effective intervention strategy. Helping a hostile, anxious, or suspicious mother gain insight and understanding of these behaviors will probably have little effect on how she relates to her child. The generalizability of the conclusion that personality variables are relatively unimportant as an etiology of child abuse may only apply to a young, relatively uneducated, lower socioeconomic sample similar to the mothers in this investigation. It is quite possible that the psychiatric model is appropriate for abusers with different educational and socioeconomic backgrounds. One characteristic the inadequate mothers have in common is that they misunderstand their child and the nature of child rearing. The inadequate mothers obtained lower scores on the psychological complexity factor which is based on three scales from Cohler, Weiss, and Grunebaum's (1970) Maternal Attitude Scale. The three scales measure: the appropriateness of the mother's attitude toward the child's aggression; the appropriateness of her attitude toward encouraging reciprocity, and her appropriate acceptance of the ambivalent feelings that of necessity accompany pregnancy and mothering. On the prenatal testing these three elements are accompanied by a higher than average score (for our sample) on a vocabulary test, indicating that intellectual ability is related to these three scales. This seems to be a factor related more to interpersonal understanding and empathy than to a broad personality style. Mothers scoring high on this test are more aware of the difficulties and demands involved in being a parent and are able to accept in an appropriate manner the ambivalent feelings which accompany healthy mothering. They are able to see themselves as autonomous and separate from their infants, but, on the other hand, they recognize the need to provide an environment that supports the development of a strong attachment between mother and
B. Egeland
276
infant. Some of the inadequate mothers seem to have difficulty maintaining their own identity or autonomy within this close mother-infant relationship while others were frightened of or did not see the need for promoting this close emotional tie. These findings suggest that intervention must focus on the mother child relationship, particularly the mother's feelings about various aspects of this relationship and her understanding of the need to promote a She must also recognize that as the child gets older she must encourage secure attachment. This can only be done in an atmosphere where the mother feels separation and individuation. a close emotional tie to the child but yet can function as a separate, autonomous person. The importance of an adequate reciprocal relationship between mother and infant is most clearIn the step-wise discriminant ly seen in the results of the feeding and play observations. function analysis using the nine selected variables, the feeding observation factors, mother's caretaking skills and mother's affective behavior were the first two variables entered, that is, those which contributed most to the prediction of group membership. In the feeding end play situations, the inadequate mothers were less sensitive to the child's They were more apt to interfere with baby's activities and were less cues and signals. These mothers paid little attention to likely to "cooperate" with the baby during feeding. baby's needs and activities, and during feeding they would often interrupt the baby's ongoing activity rather than gearing feeding in both timing and quality to the baby's state, mood, For many of the inadequate mothers, feeding was something they did to their and interests. infants, and it was done in a highly mechanical. way, which precluded any reciprocal interThe babies would attempt to engage the mothers in social interaction, but generally action. the inadequate mothers were either insensitive to the baby's social cues or chose not to respond to them. It should be pointed out that these analyses and the conclusions are an initial attempt at The results are relating certain factors to good and poor outcomes with a high-risk sample. Applied to another preliminary and there is a need for further analyses and replication. However, the degree of significance in differensample the results may be quite different. tiating the good and inadequte mother groups based on the interaction and psychological variables indicates that a powerful effect is being tapped.
Ainsworth, M., Staton, M., and Bell, action in the feeding situation. Academic Press, London (1969).
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B. Egeland
278
TABLE
Mother's
1
Prenatal
Factors Resulting from Factor Infant Interaction Variables
Nurses'
Testing
of Mother,
Impulsive/Anxious
II
Negative
III
Psychological
IV
Hostile/Suspicious
Reactions
to Pregnancy
Complexity
Baby's Alertness/Activity
II
Mother's
III
Baby's
IV
Ease of Care for Baby
Mother's
Factors
Factors
Interest
Contentment
Three-Month
Testing
I
Orientation
I
Hostile/Suspicious
II
Irritability
II
Negative
III
Motor Maturity
III
Psychological
IV
Physical
V
Consolability
Three-Month
Ability/Body
Feeding
Tonus
to Pregnancy
Complexity
IV
Impulsive/Anxious
V
Low Desire
VI
Dependence
Six-Month
I
Mother's
Caretaking
II
Mother's
Affective
Skills Behavior
for Motherhood
Mother's
Caretaking
Mother's
Affective
Baby's
Baby's
Social Behavior
IV
Muscle
Tone/Cuddling
III
Play Interaction
Support
and Cooperation
II
Baby's Activity
III
Amount
of Reciprocal
and Coordination
IV
Baby's
Satisfaction
Play
Interaction
I
III
Factors
Feeding
Factors
II
Mother's
Reactions
Interaction
Factors
I
and Mother-
Ratings
I
Brazelton
Six-Month
Infant,
Factors
Factors I
Analyses
Skills Behavior
Social Behavior