The psychological maltreatment rating scales

Child Abuse & Neglect, Vol. 17,pp. 715-729,1993 Printed in the U.S.A. All rights reserved.

0145-2134/93 $6.00 +.00 Copyright © 1993 Pergamon Press Ltd.

THE PSYCHOLOGICAL MALTREATMENT RATING SCALES MARLA

R.

BRASSARD

School and Counseling Psychology Program, University of Massachusetts, Amherst, MA, USA

STUART N. HART Indiana University, Purdue University at Indianapolis, IN, USA

DAVIDB. HARDY University of Massachusetts, Amherst, MA, USA

Abstract-Psychological maltreatment is gaining recognition as one of the core concepts in child welfare, however, its utility has been limited by definitional problems and the absence of operationalized and validated instruments. These Psychological Maltreatment Rating Scales (PMRS) were developed for assessing psychological maltreatment in mother-child interaction, and were used to rate the videotaped interaction of 49 high-risk mother-child dyads and make predictions of child protective service involvement with the dyads. These predictions are compared with predictions based upon mothers' personal resources and social support. Results show that the PMRS is a moderately reliable and valid measure of psychologically maltreating and prosocial parental behavior that can discriminate between maltreating and comparison parents, and is a more effective predictor than maternal measures. Three factors of parenting emerged from an exploratory factor analysis: emotional abuse, and two factors of positive parenting. Psychological abuse was the presence of hostile behavior, and psychological neglect the absence of positive parenting.

Key Words-Psychological maltreatment, Child welfare instrument, Abuse, Neglect, Children.

INTRODUCTION PSYCHOLOGICAL MALTREATMENT HAS been gaining increasing attention from researchers [see topical issues of the American Psychologist, 1987,42(2); School Psychology Review, 1987,16(2); Developmental and Psychopathology, 1991,3(1)] because it is seen as the concept that unifies and connects the cognitive, affective, and interpersonal problems that are related to sexual abuse, physical abuse, and all forms of neglect (Brassard, Germain, & Hart, 1987; Hart & Brassard, 1987). While a variety of definitions of psychological maltreatment have been suggested, essentially it is a repeated pattern of behavior that conveys to children that they are worthless, unloved, unwanted, or only of value in meeting another's needs. This research was supported by the National Center on Child Abuse and Neglect, Grant IDI 90CA 1216HAR T. Received for publication June 22, 1992; final revision received October 5, 1992; accepted October 10, 1992. Requests for reprints should be sent to Marla R. Brassard, PhD., School and Counseling Psychology Program, University of Massachusetts, Amherst, MA 01003, 715

716

M. R. Brassard, S. N. Hart, and D. B. Hardy

The destructive power ofpsychological maltreatment is apparent in the mounting evidence that it is the psychological concomitants, more than the severity of the acts themselves, that constitute the real trauma and are responsible for the damaging consequences of physical (Claussen & Crittenden, 1991; Vissing, Strauss, Gelles, & Harrop, 1991) and sexual abuse (Brassard & McNeill, 1987). In cases of neglect, it is not simply the parent's failure to provide adequate care, but the pervasive psychological unavailability and the lost opportunities for healthy interpersonal involvement and intellectual stimulation that place a child at risk for severe developmental disorders (Farber & Egeland, 1987; Polansky, Chalmers, Williams, & Buttenwieser, 1981). A small, yet compelling body of research has been developing that ties psychological maltreatment to deficits in child competence and that supports claims for its preeminence and centrality as the core element in all forms of abuse and neglect. In their longitudinal study of high-risk, first-time mothers, Egeland and Sroufe (Egeland & Erickson, 1987, Erickson & Egeland, 1987; Egeland, Sroufe, & Erickson, 1983) found that other than physical injury leading to death, psychological unavailability may be the most destructive form of child maltreatment, especially in the first year of life. Children of psychologically neglectful mothers, often unreported to Child Protective Services (CPS), were the most developmentally delayed and, like all the maltreated children in their sample, were showing signs of serious problems by preschool and kindergarten. In a study of the type and severity of psychological maltreatment in a sample of 175 physically maltreated and neglected children, 176 normative children and 39 clinic-referred children, Claussen and Crittenden (1991) found that although psychological maltreatment does occur alone, it co-occurs in almost all cases of physical abuse. Even when the degree of physical injury is considered, psychological maltreatment accounts for most of the negative developmental outcomes. Vissing, Strauss, Gelles, and Harrop (1991) analyzed the telephone interview data of a nationally representative sample of 3,346 American parents with a child under 18 living at home. They found that children who experience frequent verbal aggression from parents had higher rates of physical aggression, delinquency, and interpersonal problems than other children. The effects were consistent across all age groups and segments of the population. The findings showed that the effect of verbal aggression was independent of physical aggression. Verbally-aggressive parents tended to have aggressive children whether or not the parents were physically aggressive. Other studies have also provided some suggestive findings. Cross-cultural studies of rejection, using the Human Area Relations Files (Rohner & Rohner, 1980), have found that this form of psychological hostility and neglect were related to adverse developmental outcomes in children in every culture studied. Parental psychological rejection was consistently related to deficits of self-esteem, emotional instability, and excessive aggression in children. Main and Goldwyn (1984) found that within the first 3 years of life, children who were rejected by their mothers developed three behavioral characteristics possessed by most abusing parents: difficulty controlling aggression, inappropriate responses to distress in others, and self-isolating tendencies. This was true not only in a sample ofphysically abused children, but for a sample of nonabused children as well. Furthermore, this research established an empirical link between the mothers' experiences of maternal rejection when they were children, systematic distortions of their own cognitive representations of relationships, and the rejection of their infants. DeLozier (1982) examined the childhood histories of 18 working-class mothers who had physically assaulted their children and 18 controls. She gave them the Hansburg Separation Anxiety Test, which depicts either a child leaving his parents, or parents leaving the child. The abusive mothers were sensitive to any type of separation depicted on the test, even common-

Psychological maltreatment rating scales

717

place forms, and they responded with high levels of anxiety or anger in their stories. Their responses indicated a yearning for care, but an expectation of rejection of any attempts to solicit it. DeLozier thought she would find a high incidence of separation from parents in the abusive women's childhoods, or high levels of actual violence from parents. Instead of actual abandonment and violence, she found that abusive mothers had experienced significantly more repeated threats of abandonment, beating, maiming, or killing from caregivers and more uncertainty as to the availability of caregivers. Only 7 of 18 abusive mothers reported that they could turn to their own mothers for help when in distress, whereas all of the control mothers reported that they could turn to their mothers for help. Accurate estimates of the incidence of psychological maltreatment are extremely difficult, if not impossible to obtain. The American Humane Society (AHS) collates data gathered by each state according to their own criteria. According to AHS records, psychological maltreatment was recognized as the primary abuse in approximately 11% of the 2,000,000 cases of child maltreatment reported in the years 1986 and 1987 (AHS, 1988, 1989). The National Incidence Study from the National Center on Child Abuse and Neglect (NCCAN) (1988) collected data concerning cases ofchild maltreatment recognized and reported by community professionals in a national study of 29 counties throughout the United States. There were 211,100 cases of emotional abuse and 223,100 cases of emotional neglect reported in 1986. No racial or gender differences were identified, but emotional abuse and neglect was four to five times more frequent for the lower-income families than the higher-income families. It is generally accepted that a small percentage of the actual number of cases of child maltreatment are reported (Holder, Newberger, & Loken, 1983). We believe this to be particularly true for cases of psychological maltreatment, a position supported by research findings that indicate high levels ofpsychological maltreatment in nonreported populations (Claussen & Crittenden, 1991). Additionally, anecdotal reports and discussions with state local welfare officials indicate that, with the exception ofextreme conditions, discrete forms of psychological maltreatment are likely to be screened out of processing by CPS, and that psychological maltreatment cases are less likely than others to go to court or to receive serious intervention. Our review of the literature suggests that it is the psychological concomitants of abuse, not the physical trauma of the acts themselves (unless extreme, see Vissing, et al., 1991) that lead to developmental disorders. Because psychological maltreatment (a) leaves no physical evidence, (b) exists in acts of omission as well as acts of commission, (c) co-occurs with most other maltreatment, (d) occurs alone, and (e) usually represents a pattern of behavior rather than a single episode, and thus it must consequently be assessed over time, psychological maltreatment generates definitional problems. While psychological maltreatment is gaining increasing attention, and there exists a growing recognition of its important developmental sequelae, it is these definitional problems that have frustrated attempts at both scientific investigation and clinical intervention.

RATIONALE OF THE STUDY The study presented here is part of a larger research project to develop valid, operationalized measures of psychological maltreatment. The study was funded by NCCAN because the definitions produced so far have been inadequate. Other researchers have used a variety of measurement formats. These include parental report (Vissing et al., 1991); clinician ratings and judgments (Claussen & Crittenden, 1991; Egeland, 1991; McGee & Wolfe, 1991); protective service records (Barnett, Manly, & Cicchetti, 1991); projectives (DeLozier, 1982); and ethnographic specimen records (Rohner & Rohner, 1980) to determine the presence and degree of psychological maltreatment This study is an attempt to validate global rating scales

718

M. R. Brassard, S. N. Hart, and D. B. Hardy

of actual parent-child interaction relevant to psychological maltreatment. The instrument contains four scales that assess psychological abuse and neglect (spurning, terrorizing, corrupting/exploiting, denying emotional responsiveness) and nine scales that assess prosocial parenting. In developing the Psychological Maltreatment Rating Scales (PMRS) we focused on live interaction for three major reasons. First, maltreating mothers are known to often lack the emotional and cognitive resources to self-reflect, or they respond with socially desirable responses to self-report instruments or interviews. Young children were similarly limited in their reports. Second, analyses of mother/child interactions have proven to have such powerful predictive validity in other developmental research (e.g., Ainsworth, Blehar, Waters, & Wall, 1978; Bakeman & Brown, 1980; Patterson, 1982) and have been used so productively in the investigation of relationship disorders or other forms ofless than optimal caregiving (e.g., Crittenden, 1988; Egeland & Erickson, 1987; Malatesta, Culver, Tesman, & Shepard, 1989; Sroufe, Jacobavitz, Mangelsdorf, DeAngelo, & Ward, 1985), that such analyses seemed wellsuited for the study of maltreatment. Lastly, live interaction provides clinically relevant material that can facilitate interventions with these families. The PMRS were developed to identify psychological maltreatment. To establish the validity of the instrument we investigated the following questions: 1. Can the PMRS discriminate between a sample of lower socioeconomic maltreating mother-child dyads and demographically matched comparisons selected from the children's classrooms? If so, maltreating mothers should be significantly higher on the scales assessing psychologically maltreating behavior (e.g., terrorizing) and significantly lower on the scales assessing positive aspects of parenting (e.g., mutual pleasure). Similarly, a discriminant analysis should be able to accurately classify mother-child dyads by maltreatment status using the PMRS. Our maltreatment sample consisted of mothers who were substantiated for physical abuse or neglect. We did not use an emotional maltreatment sample because so few families were identified by CPS for psychological maltreatment alone. Instead, we independently confirmed the presence ofemotional abuse and neglect in our maltreatment sample using criteria by the National Center on Child Abuse and Neglect (1988). Emotional abuse included close confinement, verbal or emotional assault, and other or unknown abuse not included under the other two categories (e.g., attempted or potential physical or sexual assault, deliberately witholding food, shelter, or sleep). Emotional neglect included inadequate nurturance/affection, chronic/extreme spouse abuse, permitted maladaptive behavior, refusal of psychological care, delay in psychological care, permitted drug and alcohol abuse, and other emotional neglect (e.g., markedly overprotective restrictions that foster immaturity or emotional overdependence). See Hart and Brassard (1990b), for a description of the logical relationships between the subtypes of maltreatment presented here and the NCCAN criteria. 2. Is there a coherent, meaningful factor structure to the PMRS? If the instrument is tapping critical aspects ofparenting and maltreatment, then (a) psychological abuse and psychological neglect should load on separate factors and (b) scales addressing positive aspects of parenting should be distinguishable from those assessing maltreatment. 3. Do the PMRS measures of interaction do a better job of predicting maltreatment status than measures of maternal personal resources and social support (see Table 1). Belsky (1984) has identified both mother resources and social support as two of the critical determinants of the quality of parenting. While we assume that a mother's personal resources and her social support are related to the extent to which she is psychological maltreating,

Psychological maltreatment rating scales

719

Table l. Psychometric Measures Administered to Mothers Construct Personal Resources Intelligence Social Judgement

Psychopathology Quality of Relationship in Family-of-Origin Social Support Marital Satisfaction and Support Environmental and Social Stress

Measure

Source of Information

Peabody Picture Vocab. Test-Revised, Dunn & Dunn (1981) Wechsler Adult Intelligence ScaleRevised , Comprehension, Wechsler (1981 ) Beck Depression Inventory, Beck (1970 ) Reynolds & Gould (1981) Family-of-Origin Stru ctured Interview, Staff and Epstein (undated)

Mother's Performance on Test

Locke Wallace Marital Adjustment Test , Kimmel & van der Veen (1974) Life Stress Scale, Cochrane & Robertson (1973) , Egeland, Breitenbucher & Rosenberg (1980)

Mother's Performance on Test

Mother Self Report Mother Self Report

Mother Self Report Mother Self Report

direct measures of parent-child interaction should be able to provide a more accurate measure of maltreatment status and one of greater clinical utility.

METHODS

Subjects Participants were 49 preschool/school-aged children and their mothers who were part of a larger sample of 110 dyads that included infants and toddlers. Of this larger group , half of the children were from families with substantiated histories of maltreatment while the other half had no known history of maltreatment. Half of the maltreated children were identified through a child protective service (CPS) unit of a state department of social services in the northeastern United States; the other half identified though a family support center in a large midwestern city. Mothers were perpetrators of at least one or more confirmed reports of physical abuse and/or neglect for each of the 25 children. After CPS recruited a case, a staff member used NCCAN (1988) definitions of emotional abuse and neglect to determine whether or not one or more of these forms of maltreatment had occurred in addition to the physical abuse and neglect. Only one of the recruited cases did not qualify as an emotional maltreatment case and it was excluded. For each maltreated child, a comparison child was selected, matched as completely as possible for educational setting (same classroom), gender, grade/age , race, and socioeconomic status (SES;Hollingshead, 1975). All dyads were from the lowest social class. Children ranged in age from 4 years 0 months to 8 years 11 months with a mean age of 6 years 8 months. Gender distribution was 55% male and 45% female. The subjects were 41% Black, 13% English-speaking Hispanic, and 46% Caucasian.

PROCEDURES

Home Visit Each of the families was visited in their home by a team of two research assistants (one male and one female), who were blind to maltreatment status of the families prior to interaction.

720

M. R. Brassard, S. N. Hart, and D. B. Hardy

The mother and child were videotaped for 15 minutes as they participated in an age-appropriate child teaching task. Following the teaching task, psychometric instruments were administered to the mother (see Table 1).

INSTRUMENTS

Psychological Maltreatment Rating Scales (PMRS) In an attempt to establish an adequately operationalized definition of psychological maltreatment, we used a combination ofcategories ofpsychological abuse and neglect conceptualized by ourselves and other researchers (Baily & Baily, 1986; Brassard et aI., 1987;Garbarino, Guttman, & Seeley, 1986; NCCAN, 1988). We subsequently identified and articulated five distinct subtypes of psychological maltreatment through multidimensional scaling by experts and lay persons. The development of the observation scales for measuring parent-child interactions that are relevant to psychological maltreatment is described in Hart and Brassard (1990). The scales were used to rate IS-minute videotapes of mother-child interaction tasks during a child teaching task. Prior to videotaping, the mother was instructed to teach the child the task and if necessary help the child perform the task correctly. For the preschool children the task consisted ofa board game and for the school-age children the task was a simple paper construction project. The PMRS are composed of four scales assessing psychological maltreatment (the fifth scale, isolating, was dropped because it was a weaker measure of denying emotional responsiveness, and our task was structured in such a way as to minimize its occurrence): 1. Spurning, a type of verbal battering that is a combination of rejection and hostile degradation. Concrete examples ranged from the mild example of a mother asking "are you tired/frustrated already?" to the extreme form ofa mother admonishing, "keep your hands off-you'll screw it up." 2. Terrorizing, threatening to physically hurt, kill, or abandon the child. This also includes exposing a child to violence, threats directed toward loved ones or objects, and leaving a young child unattended under threatening circumstances. Concrete examples ranged from the mild form, "you'd better behave," said in a harsh voice, to the extreme form of a mother shaking her fist and threatening physical punishment. 3. Exploiting/Corrupting involves modeling antisocial acts and unrealistic roles or encouraging and condoning deviant behaviors, standards, or beliefs. Examples ofmaternal behavior of this type ranged from the mild comment, "It doesn't matter how we do this-just so we get it done," to the severe comment, "this is stupid-let's get it over." 4. Denying Emotional Responsiveness includes ignoring a child's attempts to interact and reacting to a child in a mechanistic way that is devoid of affectionate touch, kisses, and talk. Examples ranged from the mild form in which a mother failed to orient to the child with eye contact and body posture, to the extreme form in which the mother ignored direct requests for help from her child. 5. Isolating includes confining a child physically or socially, including unreasonable restrictions of movement within the child's environment, such as locking a child in a closet or confining him to a chair for long periods of time. It also includes placing unreasonable limits on the child's opportunities for normal social contact with others. In addition to scales measuring psychological maltreatment, nine scales assessed the prosocial aspects of the parent-child relationship. These included three rating scales developed by the Minnesota Maternal-Child Interaction Research Project (Egeland & Sroufe, undated)-

Psychological maltreatment rating scales

721

Mother's Quality of Instruction, Mother's Supportive Presence, and Mother's Respect for Child's Autonomy (see Pinata, Smith, & Reeve, 1991 for a review of validity data). Mother's Quality of Instruction rates how well the mother structures the situation so that the child knows what the task objectives are and receives hints or corrections while solving problems that are: (a) timely to his/her current focus, (b) paced at a rate that allows comprehension of and use of each hint, (c) graded in logical steps that the child can understand, and (d) stated clearly without unnecessary digressions. Mother's Supportive Presence assesses the degree to which a mother expresses positive regard and emotional support to the child. This may occur by acknowledging the child's accomplishments with the task, encouraging the child with positive emotional regard (e.g., "You're really good at this.") and other various ways ofletting the child know that he/she is supported in their performance of the task. Mother's Respect for Child's Autonomy reflects the degree to which the mother acted in a way that recognized and respected the validity of the child's individuality, motives, and perspectives in the session. Four scales that focused on maternal behavior were developed by our staff: 1. Mother's Strategies for Maintaining Task Involvement includes mother's interpretation of the task and the degree to which she can take into consideration the demands of the task, her child's needs, and her own needs. 2. Mother's Emotional Response to Task is a scale that measures the mother's affective orientation to the task. It ranges from the mother's participating with clear enjoyment and enthusiasm, to an overt negative response such as boredom, irritability, or impatience. 3. Mother's Mental Status is a rating of whether mother exhibits clear signs of psychopathology-depression, extreme hyperactivity, psychotic behavior. 4. Touching (intentional) ranges from affection (no seductive overtones), touching to encourage or appropriately prompt, touching to control (hold down, direct), seductive touch, hostile touch (pinching, hitting, slapping, punching) and no touching. A final two scales,also developed by the staff, assessed aspects ofdyadic interaction; Mutual Pleasure and Body Harmonics. 1. Experience of Mutual Pleasure is a rating of the extent to which mutual pleasure (laughing together, mutual enjoyment of task completion or winning of a game, etc.) occurred, ranging from none observed to the couple thoroughly enjoying the task and each other. 2. Body Harmonics rates the predominant orientation of the couple to one another ranging from mutual orientation with harmonious interaction to the other extreme of body postures that are not oriented to each other or in synchronous interaction. Two graduate students in school psychology received 14 hours of training until they reached the criterion of 80% agreement or better on the training tapes. All of the tapes were rated by one student and the other student rated a random 20% of the tapes to provide interrater reliability data. Interrater reliability for the scales, computed using Pearson Product Moment Correlations, ranged from .72 to .94. To assess test-retest reliability, a middle-class sample (technical class or better on the Hollingshead Scale, 1975) of 10 mothers and their infant/toddlers and 10 mothers and their school-aged child were videotaped 2 weeks apart. The test-retest ratings on the maltreatment scales of the PMRS were as follows: spurning60% exact agreement and 87% ± 1 agreement, terrorizing-100% exact agreement, isolating -80% exact and 100% ± 1 agreement, corrupting/exploiting-87% exact and 93% ± 1 agreement, and denying emotional responsiveness-46% exact and 80% ± 1 agreement. These data are probably an overestimation of reliability since the majority of cells had a rating of 0 maltreatment.

722

M. R. Brassard, S. N. Hart, and D. B. Hardy Table 2. Structure Matrix for Three Factor Solution of the PMRS Variable Quality of Emotional Support Response to task Mutual pleasure Denied emotional response Body harmonics Mental status Supportive presence Psychological Abuse Corrupting/exploiting Spurning Terrorizing Touching Facilitation of Social and Cognitive Development Control strategies Respect for autonomy Quality of instruction

Factor I

Factor 2

Factor 3

.77 .76

-.68 .67 .58 .58

.56

.87 .79 .73

- .53 .89 .81

.68

Note. Only loadings of .50 or greater have been shown.

Measures Given to Mothers Instruments were selected for their psychometric properties and their capacity to tap a mother's personal resources and the amount and type of social support and stress in her life (see Table 1). These conditions are known to mediate individuals' quality of parenting (Belsky, 1984). The Beck Depression Inventory (BDI) scores were coded by level of severity ofdepression: I is equal to 1-10 points indicating no depression, 2 is equal to 11-16 points for mild depression, 3 is equal to 17-20 points indicating borderline clinical depression, 4 is equal to 21-30 points indicating moderate depression, and 5 is equal to 0 and above 30 indicating severe depression. Scores of 0 were scored as severe because research suggests that mothers who report no depressive symptoms present as much as or greater risk to their infants than mothers who do not report such symptoms (see Field, Morrow, Healy, Foster, Adlestein, & Goldstein, 1991). The Family of Origin Scale (Faa) is an interview form designed to collect information on the mother's family composition, demographics, and histories of substance abuse, criminality, and mental illness. It also assesses the nature of the mother's close attachments, both in her family of origin and in her current relationships. We modified the Mother-Father-Peer Scale (Epstein, undated) and incorporated 43 of its items into the 62-item Faa. For this section the subject rates on a five-point scale the degree to which mother, father, or peers exhibited certain behaviors during childhood (e.g., mother "hit me with her hand or other objects").

RESULTS In order to understand what aspects of caregiver behavior the PMRS was tapping we conducted several exploratory factor analyses (exploratory because of the small sample sizes). After examining various rotational solutions we selected a three-factor varimax solution (see Table 2). The results of the factor analyses are reported prior to the data on prediction of maltreatment since factor scores were used to determine group differences. All factors had at

Psychological ma ltreatment rating scales

723

Table 3. Psychological Maltreatment Rating Scales Factor Scores Maltreated (n = 25)

Factor I: Quality of Emot ional Support Response to task Mutual pleasure Denied emotio nal respon se Body harm onics Mental status Supportive presence Factor 2: Psychological Abuse Corrupting/exploiting Spuming Terrorizing Tou ching Factor 3: Facilitation of Social and Cognitive Develop ment Control strategies Respect for autonomy Quality of instruction

*p

Comparison (n = 24)

Mean

SD

Mean

SD

z-Value

- .11 .24 .36 2.24 1.04 .16 .23

.92

.12 .7 1 .63 1.58 1.21 .2 1 .7 1

1.08 .62 .7 1 1.14 .93

-.79 -3.06 - 1.44 2.36* - .63

AD IA4 1.56 1.12 .00 - .19 .12 .12 .24

A3 .56

.77 .94 .37

043

A2

- 043 - 3.06* 3.15* 2.85* 1.10* 2.82* - 3. 14*

.90 1.12 1.08 .97 .00

- A2 .58 .96 .37 .58

.62 .93 .97 .90 .87 .93

.66 .33

.20

1.24

A2

.77

A4 A3

.33 .63

.57 .71

-

l AO 1.75* 1048 2.30*

< .05.

least three variables with loadings in excess of .55 and had fewer variables with loadings in excess of .50 in more than one factor. The 3-factor solution expla ined 65 percent of the variance in the PMRS scores. We replicated this factor solution with a sample of 10 pairs of maltreating and control mothers and their infant/toddlers despite expected age differences (see Hart & Brassard, I990a) . l. Factor 1, labeled Facilitation of Social and Cognitive De velopment, includes the mother's quality of instruction, her ability to keep the child on task , her ability to allow the child age-appropriate autonomy, and the mother's supportive presence; all ofwhich load significantly (greater than .50) on this factor. 2. Factor 2, labeled Psychological Abuse , includes terrorizing, corrupting/exploiting, spurning, and touch. This last variable ranges from affection ate touch to hostile, controlling touch. It is the negative end of the touch continuum th at clusters with the other emotional abuse factors . Emotional unavailability did not load on this factor. Instead, it significantly and negatively loaded on the other two factors suggesting that this scale measures the absence of positive maternal presence or what is generally considered to be emotional neglect. 3. Factor 3, labeled Quality of Emotion al Support, includes dyadi c attunem ent (motherchild bod y harmonics, existence of mutual pleasure), as well as measures of mother's emotional availability and support (m other's mental status, emotional una vailability, emotional response to task , and supportive presence, which loaded strongly on Factor 1 as well).

PREDICTION OF MALTREATMENT STATUS As noted in Table 3, significant differences were obtained on the PMRS between maltreat ed and comparison groups in the predicted direct ion on the Psychological Abuse Factor, but not

M. R. Brassard, S. N. Hart, and D. B. Hardy

724

Table 4. Discriminant Function Analyses of Psychological Maltreatment Rating Scales: Groups Defined by Maltreatment Status Structure Matrix

Discriminant Function Analysis -.60

Touching Mother support Corrupting/exploiting Terrorizing Denied emotional responsiveness Quality of instruction Spuming Control strategies Respect for autonomy Mutual pleasure Response to task Body harmonics Mental status

-.59 .55 .54

046 -044 AI - .34 - .29 - .28 - .27 - .12 -.08

Classification Analysis Predicted Group Actual group Maltreated Comparison

Comparison

n

Maltreated

25

23 (92.0%) 2 (8.0%) 7 (29.2%) 17 (70.8%) Percent correctly classified 81.63%

24

the Quality of Emotional Support Factor. The Facilitation of Social and Cognitive Development Factor approached significance in the predicted direction. On the individual scales, the comparison mothers had higher ratings on all of the scales loading on the factor of Quality of Emotional Support (they were significantly higher on two of the six scales and approached significance on an additional three) and on the factor Facilitation of Social and Cognitive Development (they were significantly higher on all three scales). Thus, limited power appears to account for most of the nonsignificant findings on these two factors and subscales. Comparison mothers were significantly lower on the four emotional maltreatment scales (terrorizing, spurning, denying emotional responsiveness, and corrupting/exploiting). Discriminant analysis of the video scales was used to predict maltreatment status. The structure matrix and the classification rates are reported in Table 4. The structure matrix shows the correlations of the variables with the discriminant function. The discriminant function is the best linear combination of the variables to create classifications of the variables shown at the bottom of the table. The four scales developed to assess psychological abuse (corrupting/exploiting, terrorizing, and spurning); neglect (denying emotional responsiveness); and an additional scale, touching, which loads on the psychological abuse factor constitute five of the seven scales loading most highly on the structure matrix. The PMRS correctly classified 82% of the cases with a sensitivity of .92 (proportion of maltreating mothers/children who are correctly identified) and a specificity of .71 (proportion of children not maltreated who are correctly excluded). This is a 32% improvement over chance. Discriminant analysis capitalizes on chance variation in any given prediction, therefore this 32% improvement over chance may be reduced in a cross validation study.

Maternal Measures as Predictors ofMaltreatment Status When maternal measures other than the PMRS were used to predict maltreatment status (e.g., IQ, life stress; see Table 1), maltreating mothers consistently obtained lower scores on

Psychological maltreatment rating scales

725

Table 5. Discriminant Function Analysis of Variables Measuring Mother's Resources: Groups Defined by Maltreatment Status Structure Matrix

Discrimin ant Function Analysis

Life stress No husband/partner Locke-Wallace marital satisfaction Family of origin: Relat ionship with father WAIS-R Comprehension Subtest Peabody Picture Vocabulary Test-Revised Beck Depression Inventory Family of origin: Relationship with mother

- .62 .50 .50

-.40 .30 .27 .13 .0 1

Classification Analysis Predicted Group Actual group Maltreated Comparison

n

Maltreated

23

14 (60.9%) 9 (39.1%) 5 (27.8%) 13 (72.2%) Percent correctly classified 65.85%

18

Comparison

measures of personal resources and social support, and higher scores on measures oflife stress but the differences did not reach significance. When maternal measures (see Table 1) were used to classify the two groups by official CPS maltreatment status they correctly identified 65.9% of the cases (see Table 5). The Life Stress Scale, the presence of a current relationship with a partner, and marital/partner satisfaction loading strongly on the structure matrix. These findings lend some support to Belsky's (1984) contention that these factors playa role in determining the quality of parenting.

DISCUSSION This study evaluated the validity of the PMRS, a set of scales rating positive and negative parental behavior designed to assess psychological maltreatment. These global ratings of mother-child interaction accurately identified 81.6% of mothers who were confirmed perpetrators of physical and emotional abuse or neglect from a demographically matched comparison group. Measures of maternal personal resources and social support accurately identified only 65.9% of the cases by maltreatment status with social support (marital) and stress accounting for the differences between groups. These classification rates are surprisingly high considering how closely the two groups were matched on demographic variables. The comparison group may have actually been too closely matched to the maltreatment group for a variety of reasons. First, the quality of parenting and family life in both groups was less than optimal. Second, despite our sampling precautions, incidents of psychological maltreatment were observed in our comparison group , and due to the low income/high risk status ofthis population, it is possible that some of these children had experienced other forms of maltreatment in their past that went unreported. In all but three of the cases, records checks were run on comparison mothers and children through the Department of Social Services to determine that these families had no substantiated history of child abuse, and consequently several families were dropped from the study due to prior CPS involvement. Several other comparison families were eliminated after the

726

M. R. Brassard, S. N. Hart, and D. B. Hardy

family assessments were conducted due to evidence of severe substance abuse in the family or verbal disclosure of abuse during the interviews. The PMRS correctly classified 92% of the maltreating mothers as psychologically maltreating and misclassified 29% of the comparison mothers as psychologically maltreating. While this significant misclassification rate is of some concern, we question if these misclassified cases are true false positives, or if they represent families where psychological maltreatment exists without concomitant physical abuse or neglect. Recent research suggests that a higher level of psychological maltreatment, particularly pure forms unaccompanied by physical maltreatment, may be expected in lower socioeconomic groups uninvolved with CPS (Claussen & Crittenden, 1991). This "overmatching" of our comparison group may have minimized differences between the two groups on the variables that we were measuring, but it contributed ecological validity to the discriminations our instruments were designed to make. Child protective workers who are attempting to assess psychological maltreatment rarely have to decide between maltreatment and optimal parenting, but are faced with the difficult challenge of deciding between minimally adequate and inadequate or abusive parenting. It was this type of discrimination we had to make in our analyses. Since measures of psychological maltreatment do not exist against which we can test the concurrent validity of the PMRS, we had each family's CPS records reviewed using NCCAN criteria to determine if a history of psychological maltreatment existed in the family before including them in the study. While each of our maltreating families met the NCCAN criteria for psychological maltreatment, it is possible that the PMRS was in fact not measuring constructs related to psychological maltreatment, but other variables that might be related to CPS involvement. We think this is unlikely for a number of reasons. First the PMRS is theoretically based and its factor structure is conceptually appealing. Second, the PMRS accurately identified social and cognitive competence in children regardless ofmaltreatment status (Hart & Brassard, 1990a) which suggests that they assesses critical aspects of parenting. The three aspects of parenting that emerged from the factor analyses of the PMRS were replicated in a separate analysis ofan infant/toddler sample (Hart & Brassard, 1990a) and are consistent with the research literature. The two prosocial factors of parenting-Quality of Emotional Support and Facilitation of Social and Cognitive Development-have been identified by other researchers. Claussen and Crittenden (1991) used the concepts of social/emotional neglect and of cognitive neglect in their study of psychological maltreatment in a CPS population. Polansky and colleagues (1981) identified a category of emotional/cognitive care in their study of urban and rural neglect. Hinde (1976) proposed that mothers have two distinct roles-teacher and nurturer-and our data fit his proposition. The third aspect of parenting, psychological abuse, would be expected to occur in much higher rates in some populations than in others. The denying emotional responsiveness scale ofthe PMRS was designed to measure psychological neglect. In the factor analysis this scale did not load on the Psychological Abuse Factor with the other three abuse scales (spurning, terrorizing, and corrupting/exploiting); it loaded on the Quality of Emotional Support Factor with a negative value. Thus, psychological abuse as we conceptualized it appears to be hostility directed toward the child. Psychological neglect appears to be the absence of emotional support and lack of attunement with the child physically and emotionally, as well as an absence of behaviors that foster social and cognitive growth. In our infant/toddler sample (Hart & Brassard, 1990a), denying emotional responsiveness loaded on both the Quality of Emotional Support Factor and the Facilitation of Social and Cognitive Development Factor. In both samples the quality ofEmotional Support Factor and the Facilitation of Cognitive Development Factors were significantly different in the

Psychological maltreatment rating scales

727

predicted direction for competent and incompetent children regardless of maltreatment status (Hart & Brassard, 1990).

SUMMARY AND CONCLUSIONS The PMRS is a moderately reliable and valid measure of psychologically maltreating and prosocial parental behavior that can discriminate between maltreating and nonmaltreating parents with children between the ages of 5 and 9 years of age. Three factors of parenting emerged from an exploratory factor analysis: psychological abuse; and two factors of positive parenting, quality of emotional support and facilitation of social and cognitive development. Psychological abuse was found to be defined as the presence of hostile behavior, and psychological neglect also the absence of positive parenting. A very strong beginning and some consensus have been achieved in terms of how to go about defining psychological maltreatment (Crittenden & Hart, 1989). The work of Egeland and Erickson (1987), Claussen and Crittenden (1991), Vissing and associates (1991) and of ourselves, demonstrate that psychological maltreatment is a viable research and clinical concept. Psychological maltreatment can be distinctly identified as a form of maltreatment and it can be independently assessed from other forms of maltreatment. Psychological maltreatment is a complex construct and identification and assessment present problems for researchers and practitioners alike. It is our intention that the PMRS be used only in conjunction with collateral reports ofpsychological maltreatment from as many other sources as possible. If the scales are to be used for intervention and judicial decision-making, further refinement is needed. Although our measures do seem to have acceptable levels of discriminant power, there are some limitations. They were developed on a small number of cases, the interrater reliability is not in the acceptable range for clinical use, and the test-retest reliability is based on nonmaltreating middle-class mother-child dyads. Cross validation of the measures using a new sample is a critical first step in establishing their ability to discriminate between maltreatment and comparison groups and in testing the underlying factor structure of the PMRS. Test-retest reliability data on maltreating mother-child dyads is also needed and a nonvideotape, direct observation field version must be developed and a norm developed. Strong arguments are to be made in support of psychological maltreatment receiving more attention from child protective professionals. The inability of measures of physical injury to predict degree of developmental dysfunction combined with the research findings on the developmental problems associated with psychological maltreatment suggest that we need to depend less on information on the severity of injury and more on measures of psychological maltreatment in our casework and interventions (Claussen & Crittenden, 1991; Egeland, 1985). The high levels of psychological maltreatment that co-occur with physical abuse and neglect indicate that psychological maltreatment should be systematically investigated when other forms of child maltreatment are reported. While further work is needed on the PMRS before they are ready for use in the field, at the very least CPS can begin to use these definitions of psychological maltreatment to gather data on the incidence and severity of psychological maltreatment as it co-occurs with other forms of abuse and neglect. It is time to apply our knowledge of child development and environmental interactions to gain an understanding of what constitutes a minimally adequate developmental context for children as they grow in home, schools, and daycare centers. The longitudinal research of the Minnesota group (Egeland & Erickson, 1987) has prospectively related psychologically unavailable caregiving and verbal hostile caregiving to the development of child deviance and

728

M. R. Brassard, S. N. Hart, and D. B. Hardy

delay. The work of Claussen and Crittenden, Vissing and colleagues, and ourselves (Hart & Brassard, 1990a) has demonstrated high concurrent correlations between psychological maltreatment and developmental delay in young children. In the work of Claussen and Crittenden and Vissing et aI., these correlations hold even when physical abuse is controlled for.

REFERENCES Ainsworth, M. D. S., Blehar, M., Waters, E., & Wall, S. (1978). Patterns ofattachment. Hillsdale, NJ: Erlbaum. American Humane Association (1989). Highlights ofofficial child neglect and abuse reporting, 1987. Denver: Author. American Humane Association (1988). Highlights ofofficial child neglect and abuse reporting, 1986. Denver: Author. Baily, F. T., & Baily, W. H. (1986). Operational definitions ofchild emotional maltreatment. Augusta, ME: Maine Department of Social Services. Bakeman, R., & Brown, J. V. (1980). Early interaction: Consequences for social and mental development at three years. Child Development, 51, 437-447. Barnett, D., Manly, J. T., Cicchetti, D. (1991). Continuing towards an operational definition of psychological maltreatment. Development and Psychopathology, 3, 13-30. Beck, A. T. (1970). Depression: Causes and treatment. Philadelphia, PA: University of Pennsylvania Press. Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 55, 83-86. Brassard, M. R., Germain, R., & Hart, S. N. (Eds. ). (1987). Psychological maltreatment ofchildren and youth. New York: Pergamon. Brassard, M. R., & McNeill, L. (1987). Child sexual abuse. In M. R. Brassard, R. Germain, & S. N. Hart (Eds.) Psychological maltreatment ofchildren and youth (pp. 69-88). New York: Pergamon. Claussen, A. I. E., Crittenden, P. (1991). Physical and psychological maltreatment: Relations among types of maltreatment. Child Abuse and Neglect, 15, 5-18. Cochrane, R., & Robertson, A. (1973). The Life Events Inventory: A measure of the relative severity of psychosocial stressors. Journal ofPsychosomatic Research, 17,135-19. Crittenden, P. (1988). Relationships at risk. In J. Belsky & T. Nezworski (Eds.), Clinical implications ofattachment (pp. 136-174). Hillsdale, NJ: Erlbaum. Crittenden, P., & Hart, S. N. (1989, April 25). A critical timefor collaborative research and program implementation in the area ofpsychological maltreatment. Paper presented at NCCAN Grantee's meeting, Washington, DC. DeLozier, P. P. (1982). Attachment theory and child abuse. In M. Parkes and J. Stevenson-Hinde (Eds.), The place of attachment in human behavior (pp. 95-117). New York: Basic Books. Dunn, M. L., & Dunn, M. L. (1981). Peabody Picture Vocabulary Test Revised. Circle Pines, MN: American Guidance Service. Egeland, B. (1985). The consequences ofphysical and emotional neglect on the development ofyoung children. Paper presented at the Neglect Symposium, National Center for Child Abuse and Neglect, Washington, DC. Egeland, B. (1991). From data to definition. Development and Psychopathology 3,37-43. Egeland, B., Breitenbucher, M., & Rosenberg D. (1980). Prospective study of the significance of life stress in the etiology of child abuse. Journal ofConsulting and Clinical Psychology, 48, 195-205. Egeland, B., & Erickson, M. (1987). Psychologically unavailable caregiving. In M. R. Brassard, R. Germain, & S. N. Hart (Eds.), Psychological maltreatment ofchildren and youth (110-120). New York: Pergamon. Egeland, B., & Sroufe, L. A. (undated). Observation rating measures from the Maternal Child Interaction Research Project. Obtainable from the authors, University of Minnesota, Minneapolis, MN. Egeland, B., Sroufe, L. A., & Erickson, M. (1983). The developmental consequences of different patterns of maltreatment. Child Abuse & Neglect, 7, 459-469. Epstein, S. (undated). Mother-Father-Peer Scale. Obtainable from the author, Psychology Department, Tobin Hall, University of Massachusetts, Amherst, MA 01003. Erickson, M., & Egeland, B. (1987). A developmental view of the psychological consequences of maltreatment. School Psychology Review, 16, 156-168. Farber, E. A., & Egeland, B. (1987). Invulnerability among abused and neglected children. In E. J. Anthony & B. C. Cohler (Eds.), The invulnerable child (pp. 253-288). New York: Guilford Press. Field, T., Morrow, C., Healy, B., Foster, T., Adlestein, D., & Goldstein, S. (1991). Mothers with zero Beck Depression scores act more "depressed" with their infants. Development and Psychopathology, 3, 253-262. Garbarino, J., Guttman, E., & Seeley, J. (1986). The psychologically battered child: Strategies for identification, assessment, and intervention. San Francisco, CA: Jossey-Bass. Hart, S. N., & Brassard, M. R. (1990a). Final report addendum: Developing and validating operationally defined measures ofemotional maltreatment. NCCAN Research Grant Final Report, HHS Grant ID# 90CA 1216HART. Hart, S. N., & Brassard, M. R. (l990b). Psychological maltreatment of children. In R. T. Ammerman, & M. Hersen (Eds.), Treatment offamily violence: A sourcebook (pp. 77-112). New York: Wiley & Sons. Hart, S. N., & Brassard, M. R. (1987). A major threat to children's mental health: Psychological maltreatment. American Psychologist, 42, 160-165. Hinde, R. (1976). On describing relationships. Journal ofChild Psychology and Psychiatry, 34, 1-19.

Psychological maltreatment rating scales

729

Holder, W., Newberger, E., & Loken, G . (1983) . Child Abuse and Treatment and Adoption Reform Act Amendments of 1983. Testimony in the Hearings before the Subcommittee on Labor and Human Resources of the United States Senate (pp. 219-304). Washington, DC : U.S. Government Printing Office. Hollingshead, A. F. (1975) . Four-factor index of social status. Working paper, Department ofSociology , Yale Un iversity, New Ha ven, CT. Kimmel, D., & Van der Veen , F. (1974 , February). Factors of marital adjustment in Locke's Marital Adjustment Test. Journalof Marriageand the Family, 57-63. Main, M., & Goldwyn, R. (1984). Predicting rejection of her infant from mother's representation of her own experiences : Implications for the abused-abusing intergenerational cycle. Child Abuse & Neglect, 8, 203-217. Malatesta, C. Z., Culver, c., Tesman, J. R. , & Shepard, B. (1989). The development ofemotion expression during the first twoyears of life. Monographs of the Society for Research in Child Development, Serial No . 219(54) , Nos . 1-2 . McGee, R. A., & Wolfe, D. A. (1991). Psychological maltreatment: Toward an operational definition. Development and Psychopathology, 3, 3-18. National Center on Child Abuse and Neglect. (1981) . Study findings: Study ofnational incidenceand prevalence of child abuse and neglect: 1988. Washington, DC: Author. National Center on Child Abuse and Neglect. (1988). Study findings : Study ofnational incidence and prevalence of child abuse and neglect: 1988. Washington, DC: Author. Patterson, G . (1982). A social learning approach: 3. Coercive famil y process. Eugene, OR: Castalia Publishing Co. Pianta, R. c., Smith, N., & Reeve, R. E. (1991). Observing mother and child behavior in a problem-solving situation at school entry: Relations with classroom adjustment. School Psychology Quarterly, 6, 1-15. Polansky, N., Chalmers, M. A., Williams, D. P. & Buttenwieser, E. W. (1981). Damaged parents: An anatomyof child neglect. Chicago, IL: The University of Chicago Press. Reynolds, W. M., & Gould, J. W. (1981) . A psychometric investigation of the standard and short form Beck Depression Inventory. Journal ofConsultingand ClinicalPsychology, 49(2), 306-307. Rohner, R., & Rohner, E. C. (1980). Antecedents and consequences of parental rejection: A theory of emotional abuse. Child Abuse & Neglect, 4, 189-198. Sroufe, L. A., Jacobvitz, D ., Mangelsdorf, S., DeAngelo, E., & Ward, M. J . (1985). Generational boundary dissolution between mothers and their preschool children. Child Development, 56 , 317-325. Wechsler, D. (1981). Wechsler Adult Intelligence Scale Revised. New York: Psychological Corporation. Vissing, Y. M., Straus, M. A., Gelles , R. J .,& Harrop, J. W. (1991). Verbal aggression by parents and psychosocial problems of children. Child Abuse & Neglect 15, 223-234.

Resume-s-Les mauvais traitements psychologiques sont un aspect de la maltraitance qui occupe de plus en plus d'importance en protection de I'enfance. Cependant, Ie concept pose des difficult es au niveau de la definition et du manque d'instruments pour Ie mesurer. On a done developpe Ie Psychological Maltreatment Rating Scales pour evaluer les mauvais traitements psychologiques meres-enfants, L'instrument a aussi servi aevaluer sur bande video I'interaction mere-enfant afin de tenter de pred ire la necessite d'intervention eventuelle par les services de protection de I'enfancc; 49 fanilles faisaient partie de l'echantillon . Pour verifier son efficacite, cet instrument a ete compare avec celui de l'evaluation des ressources personnelles des meres et de l'appui dont elles beneficiaient dans leur milieu . Les resultats indiquent que Ie PMRS est de fiabilite et de validite mo yennes lorsqu'ils s'agit de faire la difference entre des parents maltraitants et un groupe controle et qu 'il est un meilleur outil progn ostique que I'evaluation des ressources maternelles. L'instrument permet de deceler trois facteurs importants: la presence de mauvais traitements psychologiques, la capacite de la mere d'aider au processus d'apprentissage et de developpement de son enfant et la qual ite de appui moral qu 'elle prodigue I'enfant.

a

Resumen-EI maltrato psicologico esta obteniendo reconocimiento como uno de los conceptos centrales en el bienestar infantil; sin embargo, su utilidad ha estado limitada por problemas de definicion y la ausencia de instrumentos operacionalizados y validados. Estos "Psychological Maltreatment Rating Scales" (PMRS) fueron desarrolladas para evaluar maltrato psicologico en la interacci6n madre-hijo, y fueron usadas para reportar la interaccion grabada en video de 49 diadas madre-hijo de alto riesgo y hacer predicciones sobre la relaci6n de estas diadas con los servicios de protecci6n infanti!. Estas predicciones son comparadas con predicciones basadas en recursos personales de la madre y apo yo socia!. Los resultados demuestran que el PMRS es moderadamente confiable y una medida valida de conducta parental psicologicamente maltratante y pro-social que peude discriminar entre padres maltratentes y de control yes n predictor mas efectivo que las medidas maternales. De un analisis factorial exploratorio sugieron tre s factores en la crianza: abuso emocional y do s factores de crianza positi va. Abuso psicol6gico era la presencia de conducta hostil , y negligencia psicol6gica la ausencia de crianza positi va.