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The relationship of social support to physically abused children’s adjustment
Child Abuse & Neglect, Vol. 24, No. 5, pp. 641– 651, 2000 Copyright © 2000 Elsevier Science Ltd. Printed in the USA. All rights reserved 0145-2134/00/$–see front matter
Pergamon
PII S0145-2134(00)00123-X
THE RELATIONSHIP OF SOCIAL SUPPORT TO PHYSICALLY ABUSED CHILDREN’S ADJUSTMENT CORA E. EZZELL Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
CYNTHIA CUPIT SWENSON
AND
MICHAEL J. BRONDINO
Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
ABSTRACT Objective: This study had three main objectives: First, to assess physically abused children’s perceptions of teacher, peer, and family support; second, to determine whether the levels of perceived support differ according to the person’s social role; and third to assess which sources of social support show stronger associations with adjustment in a physically abused sample. Method: Perceived social support from teachers, families and peers was assessed in a sample of 37 physically abused children using a shortened version of the Survey of Children’s Social Support (Dubow & Ullman, 1989). Child adjustment was indexed by child and parent reports of child depression, anxiety, and anger. Results: Analyses indicated that the children rated their families, peers, and teachers highly as sources of social support, with families being rated as the most important source. Hierarchical multiple regression analyses indicated that perceived peer support was significantly negatively related to children’s and parent’s reports of children’s depression and anxiety. Furthermore, perceived family support was significantly negatively associated with child reported depression. No significant relationships were found between perceived teacher support and symptomatology. Conclusions: Overall, the results suggest that peer and family support are particularly important for physically abused children’s psychological functioning, particularly for internalizing problems. © 2000 Elsevier Science Ltd. Key Words—Physical abuse, Social support, Relationships.
INTRODUCTION A GROWING BODY of research has linked increased levels of social support with reduced adjustment difficulties in children experiencing chronic stressors. To date, this relationship has been found in samples of children who have experienced: (a) parental divorce (Cowen, PedroCarroll, & Alpert-Gillis, 1990; Wasserstein & LaGreca, 1996); (b) sexual abuse (Feiring, Taska, & Lewis, 1998; Spaccarelli & Fuchs, 1997); (c) a recent cancer diagnosis (Varni, Katz, Colegrove, & Dolgin, 1994); (d) congenital/acquired limb deficiencies (Varni, Rubenfeld, Talbot, & Setoguchi, 1989); or, (e) a natural disaster (Vernberg, LaGreca, Silverman, & Prinstein, 1996). The effects of support provided by families, peers, and teachers have been most frequently
Submitted for publication October 6, 1998; final revision received August 6, 1999; accepted August 9, 1999. Requests for reprints should be addressed to Cynthia Cupit Swenson, Ph.D., Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street—Suite CPP, Charleston, SC 29425. 641
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investigated. Besides demonstrating the benefit of support availability, studies suggest that the impact of support varies, depending on the nature of the relationship between the supportive individual and the child. Families and parents assume a nurturing role, providing children with a sense of security and protection (Hartup, 1989). Support from families and parents has been widely recognized in the literature as paramount to child adjustment (Vernberg et al., 1996). Indeed, parental and family support is negatively correlated with a variety of externalizing difficulties in children who are chronically ill and handicapped (Wallander & Varni, 1989), who reside in the inner-city (Dubow, Edwards, & Ippolito, 1997), and who have been sexually abused (Feiring et al., 1998). High familial support is also associated with fewer symptoms of depression in sexually abused children (Feiring et al., 1998; Spaccarelli & Fuchs, 1997) but is not significantly related to internalizing problems in these other samples (i.e., chronically ill and handicapped children, children from the inner-city). In general, positive peer relationships are thought to impact children’s adjustment through the companionship, intimacy, and feelings of acceptance they offer (Furman & Buhrmester, 1992; Parker & Asher, 1993). Support from peers has been linked with fewer internalizing problems in children who are chronically ill (Wallander & Varni, 1989), who have recently been diagnosed with cancer (Varni et al., 1994), and whose parents are divorced (Cowen et al., 1990). Peer support is negatively associated with externalizing problems in the former two populations. Interestingly, however, a high level of peer support is associated with more externalizing difficulties in inner-city children (Dubow et al., 1997) and lower levels of self-esteem in sexually abused children (Feiring et al., 1998). Thus, there is mixed support for the notion that peer support can mitigate internalizing and/or externalizing difficulties. Its effects on adjustment may be dependent on the stressor(s) faced by child. Lastly, support from teachers, like parental support, can increase feelings of physical safety and may help to establish familiar roles and routines, at least in children exposed to a natural disaster (Vernberg & Vogel, 1993). Although teacher support has received considerably less attention than family or peer support, in children with a recent cancer diagnosis it appears to be negatively linked with both internalizing and externalizing problems (Varni et al., 1994). The above results highlight the complicated links between social support and adjustment in high-risk children and suggest that this relationship varies depending on the stressor(s) faced by the child. Similar to other children exposed to chronic stressors, physically abused children constitute a population that is especially at risk for mental health difficulties (Kolko, 1992, 1996). Considering this high level of risk, it would seem important to investigate the possible role of social support in reducing the negative effects of abuse for these children. However, to date, no published studies have examined the relationship between social support and physically abused children’s psychological symptoms. Given the lack of empirical research in this area, it is also unclear to what extent the results from research on other populations will generalize to children experiencing physical abuse. For example, with the exception of sexual abuse, the other stressors studied are not typically due to familial behavior. Hence, it is unclear the degree to which children physically abused by a parent perceive their families as supportive, particularly compared to other individuals in their environment. Furthermore, it is unknown whether support from family members, peers, or teachers can mitigate the negative effects of physical abuse, or, alternatively, as in some other samples, whether support from these individuals may actually exacerbate children’s difficulties. Answering questions regarding the sources and degrees of support available to abused children and the relationship of these to child adjustment would benefit clinicians concerned with decreasing the difficulties that many physically abused children face. This study relied on data from a sample of physically abused children and their primary caregivers to address several fundamental questions regarding the relationship between social support and child adjustment. Specifically the study sought to answer three questions: (a) Do
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physically abused children perceive teachers, peers, and parents as sources of social support? (b) Do the levels of perceived support differ according to the person’s social role? (c) How do perceptions of social support relate to ratings of child adjustment? and, (d)Which sources of social support are associated with adjustment in a physically abused sample? To answer these questions, child ratings of perceived family, peer, and teacher support and child and parent reports of child depression, anxiety, and anger were analyzed. The indices of adjustment (i.e., child anxiety, depression, and anger) were chosen based on literature suggesting that physically abused children often experience elevated symptoms in these areas (Kolko, 1992). Furthermore, both child and parent reports of child symptomatology were assessed, due to previous research noting differences in reporters’ perceptions of children’s functioning (Loeber, Green, & Lahey, 1990). METHOD Participants Participants were 37 Medicaid-eligible physically abused children and their self-identified primary parent or caregiver. All cases of physical abuse had been substantiated by Child Protective Services. With regard to the nature of the physical abuse, most children had been hit by an object (78.4%). However, a small percentage of others had been burned impulsively (8.1%); hit, punched or kicked (8.1%); pushed or shaken (2.7%); or spanked on the bottom (2.7%). The children ranged in age from 6 to 14 years (M ⫽ 9.5). Fifty-four percent were female. Sixty-two percent were African-American, 32% Caucasian, and 6% other ethnicity. The mean age of caregivers was 34.8 years (SD ⫽ 6.9). The socioeconomic status of the sample, as assessed via Hollingshead (1975) ratings, ranged from 11 to 56, with the average individual falling in the “machine operators, semiskilled workers” category (M ⫽ 26.2, SD ⫽ 10.4). Measures Children’s perceived social support. An adapted form of the Social Support Appraisal Scale from the Survey of Children’s Social Support (SOCSS; Dubow & Ullman, 1989) was used to assess perceived family, peer, and teacher support. The original SOCSS consists of 31 questions measuring perceived support from a child’s family, peers, and teacher. Children are asked to rate how true each item is as applied to them on a 5-point Likert-type scale ranging from most of the time (1) to never true (5). Dubow and Ullman (1989) have demonstrated strong internal consistency for the original scale ranging from .78 to .82 for the subscales. Due to the length of the assessment packet administered to participating children, a shortened version of the SOCSS was used. For each form of support (i.e., family, peer, and teacher) the three items with the highest factor loadings were chosen to form each scale. Thus, a total of nine items from the original SOCSS were utilized, and the scores for each subscale ranged from 3 to 15. Internal consistency for the abbreviated scales was moderate to high (coefficient alphas ranging from .70 to .85). Items were coded such that high scores on all subscales represented higher levels of perceived support. Child-reported depression. Child-reported depression was assessed using the Children’s Depression Inventory (CDI; Kovacs, 1981). The CDI is a 27-item measure that assesses cognitive, affective, and behavioral dimensions of depression, focusing on how the child has been feeling in the last 2 weeks. For each item, children are asked to choose which sentence from a group of 3 is most like them. Each item is scored 0,1, or 2, and a total score is formed by summing the scores for each item. Raw scores of 11 and above indicate clinical levels of depression. Internal consistency (alpha coefficient ⫽ .86) and test-retest reliability (.83 from 1 week to 6 months) for the CDI are strong (Saylor, Finch, Spirito, & Bennett, 1984). In addition, construct and criterion-
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related validity have been demonstrated by the measure’s strong correlation with inpatient diagnoses of depression (Carlson & Cantwell, 1979). Child-reported anxiety. The Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978) was used to assess children’s self-report of anxiety. The RCMAS contains 37 items to which the child responds yes or no. For the present study, children’s total raw scores were used. Higher scores represent higher levels of anxiety. T scores greater than one standard deviation above the mean (i.e., T ⬎ 60) raise concern about a child’s anxiety. Psychometrically, adequate internal consistency has been demonstrated for 8- to 12-year-old children (coefficient alpha for the total RCMAS score ⫽ .66 to .87; Reynolds & Paget, 1983). Similarly, strong construct validity has been demonstrated by the measure’s strong correlations with other measures (i.e., State-Trait Anxiety Inventory) assessing similar constructs (Reynolds, 1980). Child-reported anger and aggression. Child-reported anger was assessed on the 9-item anger subscale (TSCC-ANG) of the Trauma-Symptom Checklist for Children (TSCC; Briere, 1996). The anger subscale indexes a wide range of angry (e.g., wanting to yell and break things) and aggressive behaviors (e.g., getting into fights). Items are rated using a 4-point Likert format, ranging from never (1) to almost all of the time (4). Item scores are summed to yield a total score, with lower scores indicating lower levels of anger. Raw scores are considered in the clinical range if they are 16 and above for females and 17 and above for males. The scale has strong internal consistency (coefficient alpha ⫽ .83 to .90; Briere, 1996; Crouch, Smith, Ezzell, & Saunders, in press) and construct validity (Briere, 1996). Parent-reported anxiety, depression, and aggression. Parent reports of the child’s anxiety, depression, and aggression were measured using the anxiety/depression (CBCL-A/D) and aggression (CBCL-AGG) subscales of the Child Behavior Checklist (CBCL; Achenbach, 1991). The raw scores for each of these scales are standardized by both gender and age. The clinical cutoff is a standard score of 67 or above. The CBCL is one of the most widely used measures of child functioning and has been shown to possess strong psychometric properties. Reliabilities across studies, raters, and various test-retest reliability periods have consistently ranged from the low 60s to the high 80s and 90s (Achenbach, 1991).
PROCEDURES Consent and Assessment Participants were recruited for this study through child protective services (CPS) in a medium size city in the Southeastern United States. Parents or caregivers who agreed to participate signed a consent form allowing CPS to give their name and address to the project coordinator. Parents were contacted, and those who agreed to participate were given an appointment time to be interviewed at an outpatient clinic of a medical school by a master’s or doctoral level therapist. At the beginning of the appointment, consent forms approved by the Institution Review Board were reviewed and signed by the participating parent. The consent forms informed the parents that we were conducting a study assessing services for physically abused children. Participating children also were informed about the study and were asked to sign an assent form. All parents were interviewed separately from their children.
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Table 1. Means, Standard Deviations, and Ranges for Social Support and Adjustment Measures Measure
M
SD
Range
Perceived Family Support Perceived Teacher Support Perceived Peer Support CDI RCMAS TSCC-ANG CBCL-A/D CBCL-AGG
13.41a 11.19a 12.76a 8.41a 9.32b** 13.27a 57.77b 60.35b
2.13 3.65 2.62 7.20 5.46** 4.05 10.08 11.37
6–15 3–15 6–15 0–32 0–24** 4–21 50–86 50–93
Note. N ⫽ 37, CDI ⫽ Children’s Depression Inventory, RCMAS ⫽ Revised Children’s Manifest Anxiety Scale total score, TSCC-ANG ⫽ Trauma-Symptom Checklist for Children-Anger subscale, CBCL-A/D ⫽ Child Behavior Checklist-Anxiety/Depression subscale, CBCL-ACG ⫽ Child Behavior Checklist-Aggression subscale. a Reported in raw scores. b Reported in standard scores.
RESULTS Data Analysis Procedures The study’s questions were addressed using several statistical techniques. Means and standard deviations were calculated to describe the sample in terms of their demographic characteristics and the variables used in the analyses. A repeated measures analysis of variance (ANOVA) was run to test for differences between the respondents’ mean levels of perceived teacher, parent, and peer support. Since the ANOVA’s overall F-test only indicated that at least one level of perceived support differed from one or more of the other levels, the ANOVA was followed by related samples t-tests to determine the exact nature of the observed differences. Pearson correlation coefficients were calculated to describe the bivariate relationships between the ratings of perceived support and the indices of child adjustment. Finally, hierarchical multiple regression analyses were used to examine simultaneously the relationship between the ratings of each type of social support and child adjustment while controlling for the other types of support. The multiple regression procedure made it possible to determine the incremental contribution of each type of social support to the observed variation in the ratings of child adjustment. Tests of the various statistical models’ assumptions were run prior to performing any analyses to ensure that misleading conclusions would not be reached due to violations of those assumptions. For all analyses, the assumptions were found to be met, eliminating the need to transform any data or use alternative analytic techniques. All subscales on the social support measure were coded so that higher scores reflected higher levels of perceived support. Perceived Social Support Table 1 lists the means and standard deviations for all variables used in the analyses. From Table 1 it can be seen that the childrens’ reported levels of perceived social support were high for all categories of support providers in that the ratings for each category were close to the total possible scores. Differences in the mean levels of perceived social support were assessed using repeated measures ANOVA, with child SOCSS ratings as the dependent variable. The significant overall F test, F(2, 72) ⫽ 5.68, p ⬍ .005, indicated that the children’s perceptions of support differed among the support categories. To better understand these differences, related samples t-tests were computed for all pairs of types of support. To provide appropriate statistical control of the family-wise Type I error rate, we evaluated the t-tests at a Bonferroni-adjusted alpha level of .017 (i.e., .05
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C. E. Ezzell, C. Cupit Swenson, and M. J. Brondino Table 2. Zero-Order Correlations Among Perceived Support and Adjustment Variables Fam
Fam Peers Teachers CDI RCMAS TSCC-ANG CBCL-A/D CBCL-ACG
1.00 ⫺.23 .36* ⫺.31 .00 ⫺.03 ⫺.03 ⫺.01
Peers
Teach
CDI
RCMAS
TSCC ANG
CBCL A/Da
1.00 .10 ⫺.51** ⫺.46** ⫺.33 ⫺.42** ⫺.24
1.00 ⫺.23 .21 .13 ⫺.06 ⫺.31
1.00 .06 .55** .66** .48**
1.00 .53** .49** .12
1.00 .47** .28
1.00 .64**
Note. N ⫽ 37, CDI ⫽ Children’s Depression Inventory, RCMAS ⫽ Revised Children’s Manifest Anxiety Scale, TSCC-ANG ⫽ Trauma-Symptom Checklist for Children-Anger subscale, CBCL-A/D ⫽ Child Behavior Checklist-Anxiety/ Depression subscale, CBCL-AGG ⫽ Child Behavior Checklist-Aggression subscale. a Reported in raw scores. * p ⬍ .05; ** p ⬍ .01.
divided by three pairwise t-tests). The t-tests indicated that children perceived their families as providing significantly different levels of support than their teachers, t (36) ⫽ 3.65, p ⬍ .017. Examination of the mean ratings for perceived family and teacher support indicated that families were perceived as providing greater support than teachers. The children’s ratings of perceived support for peers, however, did not differ significantly from ratings for family members or teachers. Relationships Between Perceived Support and Child Adjustment Zero-order Pearson correlation coefficients were computed to describe the relationships between the perceived support variables and scores on the CDI, RCMAS, TSCC-ANG, CBCL-A/D, and the CBCL-AGG. From Table 2, it can be seen that among the perceived support variables, family and teacher support were moderately positively correlated indicating that as ratings of family support increased in magnitude, so too did the ratings of teacher support. The correlations between family and peer, and between teacher and peer ratings were not significant. With regard to the relations between perceived support and symptomatology, perceived peer support was significantly negatively related to child reported depression and anxiety, and to parent reported anxiety/depression. This negative correlation indicates that as perceived peer support increased, child and parent reported anxiety and depression decreased. Both of these correlations were in the expected direction. Neither perceived teacher nor family support were significantly related to any indices of adjustment. Prediction of Adjustment Hierarchical multiple-regression analyses were conducted to further understand the relationships between perceived social support and symptomatology. Each of the five indices of symptomatology was regressed, in turn, on the set of three variables representing perceived levels of family, teacher, and peer support. The order of entry of the perceived support variables (i.e., perceived teacher, peer, and family support) was determined based on prior research findings that perceived teacher and peer support were more strongly linked to key indices of adjustment than was perceived family support (Rhee, 1993; Varni et al., 1994). After each variable was entered, an F test was calculated for the increment in the overall model’s R2 value to determine if the new predictor variable increased the proportion of variation explained in each index of child adjustment over the other predictor variable or variables already in the model. Each model’s R2 value, the change in R2 due to the addition of each support predictor variables, the standardized and unstandardized regression
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Table 3. Regression Analysis for Prediction of Children’s Symptomatology
Predicting CDI Teacher support Peer support Family support Predicting RCMAS Teacher support Peer support Family support Predicting TSCC-ANG Teacher support Peer support Family support Predicting CBCL-A/D Teacher support Peer support Family support Predicting CBCL-AGG Teacher support Peer support Family support
R2
⌬R 2
.05 .29 .45
F
B
b
.00 .24 .16
1.79 10.90** 9.20**
⫺.23 ⫺.49 ⫺.45
⫺1.38 ⫺4.13 ⫺4.64
.04 .27 .34
.00 .23 .07
0.00 11.50** 3.30
.20 ⫺.48 ⫺.30
.95 ⫺3.07 ⫺2.33
.02 .13 .18
.00 .11 .05
0.00 3.70 1.70
.13 ⫺.34 ⫺.24
.42 ⫺1.54 ⫺1.36
.00 .17 .19
.00 .17 .02
0.00 6.80* 0.80
⫺.06 ⫺.41 ⫺.14
⫺.49 ⫺4.88 ⫺2.10
.10 .15 .15
.00 ⫹.05 ⫹.00
3.85 2.00 0.00
⫺.31 ⫺.22 .05
⫺3.00 ⫺2.97 .89
Note. N ⫽ 37, CDI ⫽ Children’s Depression Inventory, RCMAS ⫽ Revised Children’s Manifest Anxiety Scale, TSCC-ANG ⫽ Trauma-Symptom Checklist for Children-Anger subscale, CBCL-A/D ⫽ Child Behavior Checklist-Anxiety/Depression subscale, CBCL-AGG ⫽ Child Behavior ChecklistAggression subscale. * p ⬍ .05; ** p ⬍ .01.
coefficients, and the results of the F tests are presented in Table 3. Consistent with the correlations presented earlier, a nonsignificant increment in the R-square over the null model indicated that perceived teacher support was not significantly related to any indices of symptomatology. However, perceived peer support was significantly negatively related to children’s reports of depression on the CDI and to childrens’ (RCMAS) and parents’ (CBCL) reports of childrens’ anxiety/ depression after controlling for perceived teacher support. Perceived family support was also significantly negatively related to children’s report of depression on the CDI, after controlling for teacher and peer support. Perceived family support was not significantly related to any other form of symptomatology.
DISCUSSION This study investigated the relationship between perceived family, teacher, and peer social support and mental health symptomatology in a sample of physically abused children. Although the children in the study reported receiving a high level of support from all three sources, comparisons of the levels of support across the sources showed differences. Families were rated as providing significantly greater levels of support than teachers, while family and peer, and teacher and peer support levels did not differ significantly. In the regression analyses, perceived teacher support was not significantly related to any assessed index of symptomatology. However, after controlling for the effect of teacher support, peer support was found to contribute significantly to reductions in child- and parent-reported depression and anxiety. Furthermore, perceived family support was found to be significantly related to lower levels of child-reported depression after adjusting for the effects of teacher and peer support. In these cases of substantiated parental physical abuse, that children perceived high support from
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their family is an important finding. Even in the face of physical abuse, children may still feel that they are an important part of their family and that their families care about them and do things for them. Those children who perceive or receive support from families may benefit, given the relationship between family support and reduced depression. Families are often regarded as the primary source of support for children (Vernberg et al., 1996), and certainly in other samples that support is important to mental health. For example, support, at least from the mother, is associated with emotional adjustment in sexually abused children (Feiring et al., 1998; Spaccarelli & Fuchs, 1997). The findings linking family support to reduced internalizing behaviors did not hold for externalizing behaviors, such as aggression. Thus, although family support is important to children undergoing stressors, more than support may be needed to prevent or reduce aggressive behavior. This result carries important treatment implications, especially for physically abused children because of the high risk of subsequent aggression. Although family cohesion and warmth certainly relate to youth antisocial behavior (Achenbach & Edelbrock, 1978), to more fully address externalizing behaviors, factors in addition to family support should be addressed. These may include ineffective discipline strategies, poor individual problem solving, association with deviant peers, and poor academic performance (Elliott, Huizinga, & Ageton, 1985; Simcha-Fagan & Schwartz, 1986). Consistent with studies involving other populations (Cowen et al., 1990; Varni et al., 1994; Wallander & Varni, 1989), peer support was related to reduced internalizing symptoms. The benefits from positive peer relationships, including perceived support, are numerous and include decreased feelings of loneliness, increased sense of belonging, and greater validation and sense of self-worth (Parker & Asher, 1993). With the exception of Feiring and colleagues’ (1998) findings, this study adds to a growing body of literature on the benefits of peer support in reducing internalizing difficulties of at-risk children. That peer support did not relate to reduced externalizing problems was a surprising finding. Perhaps, as with families, feeling a part of a peer group may be insufficient for reducing aggression. If the supportive peer group engages in aggressive behavior, then the youth, although feeling supported, may also be more likely to engage in the aggression. Although children spend a large part of their day with teachers, for children in this study, teacher support was not related to reduced internalizing or externalizing problems. Although teachers certainly can influence the life of students and their parents, the opportunity to develop supportive relationships with students may be limited. Many of the children in this study may have had multiple teachers, reducing the amount of time spent with an individual. The limited contact may have been insufficient time for developing a relationship in which the children felt that they could obtain advice about their problems. In fact, for children exhibiting aggressive behavior in particular, interactions with teachers may be mainly around discipline or attempts to reduce disruptive behavior in the classroom. Therefore, children may not seek out or experience a warm supportive relationship that involves obtaining help with solving personal problems. Extension of the current study will enhance our understanding of the role teachers have in children’s development and functioning. Important to interpreting the results of this study is the consideration of three important limitations. First, the small sample size precluded our ability to examine the role of other factors (e.g., severity of maltreatment, SES) in predicting the outcomes of interest. Second, perceived social support was assessed after the physical abuse had been substantiated. Thus, it is uncertain how the events that occurred after the abuse had been substantiated may have impacted children’s perceptions and/or reports of perceived support, particularly perceived family support. Last, sampling bias limits the generalization of the findings. The population examined included children who were Medicaid-eligible and who were being supervised by CPS. Thus, findings may not
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generalize to physically abused children who are not Medicaid-eligible or to those who are not supervised by CPS. Despite these limitations, this study provides important information regarding the relationship between perceived social support and symptomatology in physically abused children and highlights several important issues worthy of future research. For example, it is unclear whether high social support causes more positive adjustment or whether children with more positive adjustment are better able to elicit social support from others. In addition, it would be of interest to compare, utilizing the same measures, the effects of support across different at-risk populations. Although studies have been conducted on the effects of social support in a variety of high-risk samples, due to the variability in the support and adjustment measures utilized across studies, comparison of findings is difficult. Furthermore, the links between externalizing problems and familial support deserve additional attention in order to increase our understanding of mechanisms for decreasing aggression in physically abused children. This appears to be a particularly worthwhile endeavor, given the intergenerational transmission that occurs with child physical abuse (Egeland, Jacobitz, & Papatola, 1987). Additionally, in previous research, Dubow and Ullman (1989) found that children listed a variety of people other than immediate family members, peers, and teachers, as providing support to them (e.g., coach, therapist, parents’ friends); how support from these individuals relates to physically abused children’s adjustment is an area warranting investigation. Similarly, it is unclear from which family members support was coming, as well as the nature of the support (e.g., instrumental, emotional). Lastly, given previous research demonstrating differences in children’s and parent’s reports on children’s functioning (Loeber et al., 1990), it would be of interest to assess parent’s perceptions of their children’s social support and the relationship of these perceptions to children’s perceived support and adjustment. Individuals working with physically abused children should be aware of the potential benefits of social support. If a child has few supportive relationships, interventions that target enhancing children’s social support network may be beneficial. Furthermore, given the relationship between family support and depression, therapeutic work to improve the parent-child relationship and encourage parents toward a supportive stance may be important to physically abused children’s adjustment. Future research that continues to enhance our understanding of the links between social support and symptomatology should provide guidance to clinicians on how to decrease the frequency and intensity of the difficulties that many physically abused children experience. Acknowledgements—The authors wish to thank C. Hope Cunningham, Ralph Terry, Ione Sack, and Gene Caldwell for their assistance with this project.
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Egeland, B., Jacobitz, D., & Papatola, K. (1987). Intergenerational continuity of abuse. In R. Gelles & J. Lancaster (Eds.), Child abuse and neglect: Biosocial dimensions (pp. 255–276). Chicago, IL: Aldine. Elliott, D. S., Huizinga, D., & Ageton, S. S. (1985). Explaining delinquency and drug use. Beverly Hills, CA: Sage. Feiring, C., Taska, L. S., & Lewis, M. (1998). Social support and children’s and adolescent’s adaptation to sexual abuse. Journal of Interpersonal Violence, 13, 240 –260. Furman, W., & Buhrmester, D. (1992). Age and sex differences in perceptions of networks of personal relationships. Child Development, 63, 103–115. Hartup, W. W. (1989). Social relationships in developmental perspective. American Psychologist, 44, 120 –126. Hollingshead, A. B. (1975). Four factor index of social status. Unpublished manuscript. New Haven, CT: Yale University, Department of Sociology. Kolko, D. J. (1992). Characteristics of child victims of physical violence: Research findings and clinical implications. Journal of Interpersonal Violence, 7, 244 –276. Kolko, D. J. (1996). Child physical abuse. In J. Briere, L. Berliner, J. A. Bulkley, C. Jenny, & T. Reid (Eds.), The APSAC handbook on child maltreatment (pp. 21–50). Thousand Oaks, CA: Sage Publications. Kovacs, M. (1981). Rating scales to assess depression in school aged children. Acta Paedopsychiatrica, 46, 305–315. Loeber, R., Green, S. M., & Lahey, B. B. (1990). Mental health professionals’ perceptions of the utility of children, mothers, and teachers as informants of child psychopathology. Journal of Clinical Child Psychology, 19, 136 –143. Parker, J. G., & Asher, S. R. (1993). Friendship and friendship quality in middle childhood: Links with peer group acceptance and feelings of loneliness and social dissatisfaction. Developmental Psychology, 29, 611– 621. Reynolds, C. R. (1980). Concurrent validity of What I Think and Feel: The Revised Children’s Manifest Anxiety Scale. Journal of Consulting and Clinical Psychology, 48, 774 –775. Reynolds, C. R., & Paget, K. D. (1983). National normative and reliability data for the Revised Children’s Manifest Anxiety Scale. School Psychology Review, 12, 324 –336. Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children’s manifest anxiety. Journal of Abnormal Child Psychology, 6, 271–280. Rhee, U. (1993). Self-perceptions of competence and social support in Korean children. Early Child Development and Care, 85, 56 – 66. Saylor, C. F., Finch, A. J., Jr., Spirito, A., & Bennett, B. (1984). The Children’s Depression Inventory: A systematic evaluation of psychometric properties. Journal of Consulting and Clinical Psychology, 52, 955–967. Simcha-Fagan, O., & Schwartz, J. E. (1986). Neighborhood and delinquency: An assessment of contextual effects. Criminology, 24, 667–703. Spaccarelli, S., & Fuchs, C. (1997). Variability in symptom expression among sexually abused girls: Developing multivariate models. Journal of Clinical Child Psychology, 26, 24 –25. Varni, J. W., Katz, E. R., Colegrove, R., & Dolgin, M. (1994). Perceived social support and adjustment of children with newly diagnosed cancer. Journal of Developmental and Behavioral Pediatrics, 15, 20 –26. Varni, J. W., Rubenfeld, L. A., Talbot, D., & Setoguchi, Y. (1989). Stress, social support, and depressive symptomatology in children with congenital/acquired limb deficiencies. Journal of Pediatric Psychology, 14, 515–530. Vernberg, E. M., LaGreca, A. M., Silverman, W. K., & Prinstein, M. J. (1996). Prediction of posttraumatic stress symptoms in children after Hurricane Andrew. Journal of Abnormal Psychology, 105, 237–248. Vernberg, E. M., & Vogel, J. (1993). Interventions with children after disasters. Journal of Clinical Child Psychology, 22, 484 – 498. Wallander, J. L., & Varni, J. L. (1989). Social support and adjustment in chronically ill and handicapped children. American Journal of Community Psychology, 17, 185–201. Wasserstein, S. B., & LaGreca, A. M. (1996). Can peer support buffer against behavioral consequences of parental discord? Journal of Clinical Child Psychology, 25, 177–182.
RE´SUME´ Objectif: Cette e´tude s’est donne´ trois objectifs: (1) e´valuer la perception qu’ont des enfants maltraite´s physiquement vis-a`-vis de leur enseignant, de leurs pairs et de leurs appuis familiaux; (2) de´terminer si ce niveau de soutien tel que perc¸u varie selon le roˆle social de la personne en queston; et (3) de´terminer quelles sources d’appui social sont fortement relie´es a` l’adaptation de l’enfant. Me´thode: Chez un e´chantillon de 37 enfants maltraite´s physiquement on e´value´ leur perception des apuis venant de leur enseignants, de leur famille et de leurs paires. Pour ce, on a eu recours au Survey of Children’s Social Support (Dubow & Ullman, 1989). L’adaptation de l’enfant a e´te´ e´value´e a` partir de te´moignages de l’enfant et de ses parents portant sur la de´pression, l’angoisse et la rage qu’il aurait connues. Re´sultats: L’analyse de´montre que les enfants ont identifie´ leur famille, leurs paires et leurs enseignants comme des sources d’appui importantes. Les familles figurent en premie`re place. Une analyse hie´archique a` re´gression multiple indique des liens ne´gatifs entre les appuis venant des paires et la de´pression et l’angoisse des enfants— ces dernie`res telles que rapporte´es par les enfants et leurs parents. De plus, il existe un lien ne´gatif entre les apuis familiaux tels que perc¸us par les enfants, et la de´pression. On a remarque´ aucun lien important entre l’appui des enseignants et les symptoˆmes. Conclusions: en ge´ne´ral, les re´sultats portent a` croire que les appuis des paires et de la famille s’ave`rent tre`s importants vis-a`-vis du fonctionnement psychologique des enfants qui ont subi des mauvais traitements physiques, surtout en ce qui concerne l’inte´riorisation de leurs troubles.
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RESUMEN Objetivo: Este estudio tenı´a tres objetivos principales: Primero, evaluar las percepciones de nin˜os fı´sicamente abusados de su maestro, compan˜eros y apoyo familiar; segundo, determinar si los niveles de apoyo percibidos se diferencian de acuerdo con el rol social de la persona; y tercero evaluar cuales fuentes de apoyo social muestran asociaciones ma´s fuertes con el ajuste en una muestra fı´sicamente abusada. Me´todo: El apoyo social percibido de maestros, familias y compan˜eros fue evaluado en una muestra de 37 nin˜os fı´sicamente abusados utilizando una versio´n corta del “Survey of Children’s Social Support” (Dubow & Ullman, 1989). El ajuste infantil fue identificado por los reportes del nin˜o y de los padres de depresio´n infantil, ansiedad y rabia. Resultados: Los ana´lisis indican que los nin˜os evaluaban como fuentes muy altas de apoyo social a sus familias, compan˜eros y maestros, con las familias como la fuente ma´s importante. Los ana´lisis de regresio´n mu´ltiple jera´rquica indicaron que el apoyo de los compan˜eros era significativa y negativamente relacionado con los reportes de los nin˜os y los padres de depresio´n y ansiedad. Ma´s aun, el apoyo familiar percibido estuvo significativa y negativamente asociado con la depresio´ infantil reportada. No se encontraron relaciones significativas entre el apoyo percibido de los maestros y una sintomatologı´a. Conclusiones: En general, los resultados sugieren que el apoyo de compan˜eros y familiares son particularmente importante para el funcionamiento psicolo´gico de nin˜os abusados fı´sicamente, particularamente para internalizar los problemas.
Pergamon
PII S0145-2134(00)00123-X
THE RELATIONSHIP OF SOCIAL SUPPORT TO PHYSICALLY ABUSED CHILDREN’S ADJUSTMENT CORA E. EZZELL Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
CYNTHIA CUPIT SWENSON
AND
MICHAEL J. BRONDINO
Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
ABSTRACT Objective: This study had three main objectives: First, to assess physically abused children’s perceptions of teacher, peer, and family support; second, to determine whether the levels of perceived support differ according to the person’s social role; and third to assess which sources of social support show stronger associations with adjustment in a physically abused sample. Method: Perceived social support from teachers, families and peers was assessed in a sample of 37 physically abused children using a shortened version of the Survey of Children’s Social Support (Dubow & Ullman, 1989). Child adjustment was indexed by child and parent reports of child depression, anxiety, and anger. Results: Analyses indicated that the children rated their families, peers, and teachers highly as sources of social support, with families being rated as the most important source. Hierarchical multiple regression analyses indicated that perceived peer support was significantly negatively related to children’s and parent’s reports of children’s depression and anxiety. Furthermore, perceived family support was significantly negatively associated with child reported depression. No significant relationships were found between perceived teacher support and symptomatology. Conclusions: Overall, the results suggest that peer and family support are particularly important for physically abused children’s psychological functioning, particularly for internalizing problems. © 2000 Elsevier Science Ltd. Key Words—Physical abuse, Social support, Relationships.
INTRODUCTION A GROWING BODY of research has linked increased levels of social support with reduced adjustment difficulties in children experiencing chronic stressors. To date, this relationship has been found in samples of children who have experienced: (a) parental divorce (Cowen, PedroCarroll, & Alpert-Gillis, 1990; Wasserstein & LaGreca, 1996); (b) sexual abuse (Feiring, Taska, & Lewis, 1998; Spaccarelli & Fuchs, 1997); (c) a recent cancer diagnosis (Varni, Katz, Colegrove, & Dolgin, 1994); (d) congenital/acquired limb deficiencies (Varni, Rubenfeld, Talbot, & Setoguchi, 1989); or, (e) a natural disaster (Vernberg, LaGreca, Silverman, & Prinstein, 1996). The effects of support provided by families, peers, and teachers have been most frequently
Submitted for publication October 6, 1998; final revision received August 6, 1999; accepted August 9, 1999. Requests for reprints should be addressed to Cynthia Cupit Swenson, Ph.D., Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street—Suite CPP, Charleston, SC 29425. 641
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investigated. Besides demonstrating the benefit of support availability, studies suggest that the impact of support varies, depending on the nature of the relationship between the supportive individual and the child. Families and parents assume a nurturing role, providing children with a sense of security and protection (Hartup, 1989). Support from families and parents has been widely recognized in the literature as paramount to child adjustment (Vernberg et al., 1996). Indeed, parental and family support is negatively correlated with a variety of externalizing difficulties in children who are chronically ill and handicapped (Wallander & Varni, 1989), who reside in the inner-city (Dubow, Edwards, & Ippolito, 1997), and who have been sexually abused (Feiring et al., 1998). High familial support is also associated with fewer symptoms of depression in sexually abused children (Feiring et al., 1998; Spaccarelli & Fuchs, 1997) but is not significantly related to internalizing problems in these other samples (i.e., chronically ill and handicapped children, children from the inner-city). In general, positive peer relationships are thought to impact children’s adjustment through the companionship, intimacy, and feelings of acceptance they offer (Furman & Buhrmester, 1992; Parker & Asher, 1993). Support from peers has been linked with fewer internalizing problems in children who are chronically ill (Wallander & Varni, 1989), who have recently been diagnosed with cancer (Varni et al., 1994), and whose parents are divorced (Cowen et al., 1990). Peer support is negatively associated with externalizing problems in the former two populations. Interestingly, however, a high level of peer support is associated with more externalizing difficulties in inner-city children (Dubow et al., 1997) and lower levels of self-esteem in sexually abused children (Feiring et al., 1998). Thus, there is mixed support for the notion that peer support can mitigate internalizing and/or externalizing difficulties. Its effects on adjustment may be dependent on the stressor(s) faced by child. Lastly, support from teachers, like parental support, can increase feelings of physical safety and may help to establish familiar roles and routines, at least in children exposed to a natural disaster (Vernberg & Vogel, 1993). Although teacher support has received considerably less attention than family or peer support, in children with a recent cancer diagnosis it appears to be negatively linked with both internalizing and externalizing problems (Varni et al., 1994). The above results highlight the complicated links between social support and adjustment in high-risk children and suggest that this relationship varies depending on the stressor(s) faced by the child. Similar to other children exposed to chronic stressors, physically abused children constitute a population that is especially at risk for mental health difficulties (Kolko, 1992, 1996). Considering this high level of risk, it would seem important to investigate the possible role of social support in reducing the negative effects of abuse for these children. However, to date, no published studies have examined the relationship between social support and physically abused children’s psychological symptoms. Given the lack of empirical research in this area, it is also unclear to what extent the results from research on other populations will generalize to children experiencing physical abuse. For example, with the exception of sexual abuse, the other stressors studied are not typically due to familial behavior. Hence, it is unclear the degree to which children physically abused by a parent perceive their families as supportive, particularly compared to other individuals in their environment. Furthermore, it is unknown whether support from family members, peers, or teachers can mitigate the negative effects of physical abuse, or, alternatively, as in some other samples, whether support from these individuals may actually exacerbate children’s difficulties. Answering questions regarding the sources and degrees of support available to abused children and the relationship of these to child adjustment would benefit clinicians concerned with decreasing the difficulties that many physically abused children face. This study relied on data from a sample of physically abused children and their primary caregivers to address several fundamental questions regarding the relationship between social support and child adjustment. Specifically the study sought to answer three questions: (a) Do
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physically abused children perceive teachers, peers, and parents as sources of social support? (b) Do the levels of perceived support differ according to the person’s social role? (c) How do perceptions of social support relate to ratings of child adjustment? and, (d)Which sources of social support are associated with adjustment in a physically abused sample? To answer these questions, child ratings of perceived family, peer, and teacher support and child and parent reports of child depression, anxiety, and anger were analyzed. The indices of adjustment (i.e., child anxiety, depression, and anger) were chosen based on literature suggesting that physically abused children often experience elevated symptoms in these areas (Kolko, 1992). Furthermore, both child and parent reports of child symptomatology were assessed, due to previous research noting differences in reporters’ perceptions of children’s functioning (Loeber, Green, & Lahey, 1990). METHOD Participants Participants were 37 Medicaid-eligible physically abused children and their self-identified primary parent or caregiver. All cases of physical abuse had been substantiated by Child Protective Services. With regard to the nature of the physical abuse, most children had been hit by an object (78.4%). However, a small percentage of others had been burned impulsively (8.1%); hit, punched or kicked (8.1%); pushed or shaken (2.7%); or spanked on the bottom (2.7%). The children ranged in age from 6 to 14 years (M ⫽ 9.5). Fifty-four percent were female. Sixty-two percent were African-American, 32% Caucasian, and 6% other ethnicity. The mean age of caregivers was 34.8 years (SD ⫽ 6.9). The socioeconomic status of the sample, as assessed via Hollingshead (1975) ratings, ranged from 11 to 56, with the average individual falling in the “machine operators, semiskilled workers” category (M ⫽ 26.2, SD ⫽ 10.4). Measures Children’s perceived social support. An adapted form of the Social Support Appraisal Scale from the Survey of Children’s Social Support (SOCSS; Dubow & Ullman, 1989) was used to assess perceived family, peer, and teacher support. The original SOCSS consists of 31 questions measuring perceived support from a child’s family, peers, and teacher. Children are asked to rate how true each item is as applied to them on a 5-point Likert-type scale ranging from most of the time (1) to never true (5). Dubow and Ullman (1989) have demonstrated strong internal consistency for the original scale ranging from .78 to .82 for the subscales. Due to the length of the assessment packet administered to participating children, a shortened version of the SOCSS was used. For each form of support (i.e., family, peer, and teacher) the three items with the highest factor loadings were chosen to form each scale. Thus, a total of nine items from the original SOCSS were utilized, and the scores for each subscale ranged from 3 to 15. Internal consistency for the abbreviated scales was moderate to high (coefficient alphas ranging from .70 to .85). Items were coded such that high scores on all subscales represented higher levels of perceived support. Child-reported depression. Child-reported depression was assessed using the Children’s Depression Inventory (CDI; Kovacs, 1981). The CDI is a 27-item measure that assesses cognitive, affective, and behavioral dimensions of depression, focusing on how the child has been feeling in the last 2 weeks. For each item, children are asked to choose which sentence from a group of 3 is most like them. Each item is scored 0,1, or 2, and a total score is formed by summing the scores for each item. Raw scores of 11 and above indicate clinical levels of depression. Internal consistency (alpha coefficient ⫽ .86) and test-retest reliability (.83 from 1 week to 6 months) for the CDI are strong (Saylor, Finch, Spirito, & Bennett, 1984). In addition, construct and criterion-
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related validity have been demonstrated by the measure’s strong correlation with inpatient diagnoses of depression (Carlson & Cantwell, 1979). Child-reported anxiety. The Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978) was used to assess children’s self-report of anxiety. The RCMAS contains 37 items to which the child responds yes or no. For the present study, children’s total raw scores were used. Higher scores represent higher levels of anxiety. T scores greater than one standard deviation above the mean (i.e., T ⬎ 60) raise concern about a child’s anxiety. Psychometrically, adequate internal consistency has been demonstrated for 8- to 12-year-old children (coefficient alpha for the total RCMAS score ⫽ .66 to .87; Reynolds & Paget, 1983). Similarly, strong construct validity has been demonstrated by the measure’s strong correlations with other measures (i.e., State-Trait Anxiety Inventory) assessing similar constructs (Reynolds, 1980). Child-reported anger and aggression. Child-reported anger was assessed on the 9-item anger subscale (TSCC-ANG) of the Trauma-Symptom Checklist for Children (TSCC; Briere, 1996). The anger subscale indexes a wide range of angry (e.g., wanting to yell and break things) and aggressive behaviors (e.g., getting into fights). Items are rated using a 4-point Likert format, ranging from never (1) to almost all of the time (4). Item scores are summed to yield a total score, with lower scores indicating lower levels of anger. Raw scores are considered in the clinical range if they are 16 and above for females and 17 and above for males. The scale has strong internal consistency (coefficient alpha ⫽ .83 to .90; Briere, 1996; Crouch, Smith, Ezzell, & Saunders, in press) and construct validity (Briere, 1996). Parent-reported anxiety, depression, and aggression. Parent reports of the child’s anxiety, depression, and aggression were measured using the anxiety/depression (CBCL-A/D) and aggression (CBCL-AGG) subscales of the Child Behavior Checklist (CBCL; Achenbach, 1991). The raw scores for each of these scales are standardized by both gender and age. The clinical cutoff is a standard score of 67 or above. The CBCL is one of the most widely used measures of child functioning and has been shown to possess strong psychometric properties. Reliabilities across studies, raters, and various test-retest reliability periods have consistently ranged from the low 60s to the high 80s and 90s (Achenbach, 1991).
PROCEDURES Consent and Assessment Participants were recruited for this study through child protective services (CPS) in a medium size city in the Southeastern United States. Parents or caregivers who agreed to participate signed a consent form allowing CPS to give their name and address to the project coordinator. Parents were contacted, and those who agreed to participate were given an appointment time to be interviewed at an outpatient clinic of a medical school by a master’s or doctoral level therapist. At the beginning of the appointment, consent forms approved by the Institution Review Board were reviewed and signed by the participating parent. The consent forms informed the parents that we were conducting a study assessing services for physically abused children. Participating children also were informed about the study and were asked to sign an assent form. All parents were interviewed separately from their children.
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Table 1. Means, Standard Deviations, and Ranges for Social Support and Adjustment Measures Measure
M
SD
Range
Perceived Family Support Perceived Teacher Support Perceived Peer Support CDI RCMAS TSCC-ANG CBCL-A/D CBCL-AGG
13.41a 11.19a 12.76a 8.41a 9.32b** 13.27a 57.77b 60.35b
2.13 3.65 2.62 7.20 5.46** 4.05 10.08 11.37
6–15 3–15 6–15 0–32 0–24** 4–21 50–86 50–93
Note. N ⫽ 37, CDI ⫽ Children’s Depression Inventory, RCMAS ⫽ Revised Children’s Manifest Anxiety Scale total score, TSCC-ANG ⫽ Trauma-Symptom Checklist for Children-Anger subscale, CBCL-A/D ⫽ Child Behavior Checklist-Anxiety/Depression subscale, CBCL-ACG ⫽ Child Behavior Checklist-Aggression subscale. a Reported in raw scores. b Reported in standard scores.
RESULTS Data Analysis Procedures The study’s questions were addressed using several statistical techniques. Means and standard deviations were calculated to describe the sample in terms of their demographic characteristics and the variables used in the analyses. A repeated measures analysis of variance (ANOVA) was run to test for differences between the respondents’ mean levels of perceived teacher, parent, and peer support. Since the ANOVA’s overall F-test only indicated that at least one level of perceived support differed from one or more of the other levels, the ANOVA was followed by related samples t-tests to determine the exact nature of the observed differences. Pearson correlation coefficients were calculated to describe the bivariate relationships between the ratings of perceived support and the indices of child adjustment. Finally, hierarchical multiple regression analyses were used to examine simultaneously the relationship between the ratings of each type of social support and child adjustment while controlling for the other types of support. The multiple regression procedure made it possible to determine the incremental contribution of each type of social support to the observed variation in the ratings of child adjustment. Tests of the various statistical models’ assumptions were run prior to performing any analyses to ensure that misleading conclusions would not be reached due to violations of those assumptions. For all analyses, the assumptions were found to be met, eliminating the need to transform any data or use alternative analytic techniques. All subscales on the social support measure were coded so that higher scores reflected higher levels of perceived support. Perceived Social Support Table 1 lists the means and standard deviations for all variables used in the analyses. From Table 1 it can be seen that the childrens’ reported levels of perceived social support were high for all categories of support providers in that the ratings for each category were close to the total possible scores. Differences in the mean levels of perceived social support were assessed using repeated measures ANOVA, with child SOCSS ratings as the dependent variable. The significant overall F test, F(2, 72) ⫽ 5.68, p ⬍ .005, indicated that the children’s perceptions of support differed among the support categories. To better understand these differences, related samples t-tests were computed for all pairs of types of support. To provide appropriate statistical control of the family-wise Type I error rate, we evaluated the t-tests at a Bonferroni-adjusted alpha level of .017 (i.e., .05
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C. E. Ezzell, C. Cupit Swenson, and M. J. Brondino Table 2. Zero-Order Correlations Among Perceived Support and Adjustment Variables Fam
Fam Peers Teachers CDI RCMAS TSCC-ANG CBCL-A/D CBCL-ACG
1.00 ⫺.23 .36* ⫺.31 .00 ⫺.03 ⫺.03 ⫺.01
Peers
Teach
CDI
RCMAS
TSCC ANG
CBCL A/Da
1.00 .10 ⫺.51** ⫺.46** ⫺.33 ⫺.42** ⫺.24
1.00 ⫺.23 .21 .13 ⫺.06 ⫺.31
1.00 .06 .55** .66** .48**
1.00 .53** .49** .12
1.00 .47** .28
1.00 .64**
Note. N ⫽ 37, CDI ⫽ Children’s Depression Inventory, RCMAS ⫽ Revised Children’s Manifest Anxiety Scale, TSCC-ANG ⫽ Trauma-Symptom Checklist for Children-Anger subscale, CBCL-A/D ⫽ Child Behavior Checklist-Anxiety/ Depression subscale, CBCL-AGG ⫽ Child Behavior Checklist-Aggression subscale. a Reported in raw scores. * p ⬍ .05; ** p ⬍ .01.
divided by three pairwise t-tests). The t-tests indicated that children perceived their families as providing significantly different levels of support than their teachers, t (36) ⫽ 3.65, p ⬍ .017. Examination of the mean ratings for perceived family and teacher support indicated that families were perceived as providing greater support than teachers. The children’s ratings of perceived support for peers, however, did not differ significantly from ratings for family members or teachers. Relationships Between Perceived Support and Child Adjustment Zero-order Pearson correlation coefficients were computed to describe the relationships between the perceived support variables and scores on the CDI, RCMAS, TSCC-ANG, CBCL-A/D, and the CBCL-AGG. From Table 2, it can be seen that among the perceived support variables, family and teacher support were moderately positively correlated indicating that as ratings of family support increased in magnitude, so too did the ratings of teacher support. The correlations between family and peer, and between teacher and peer ratings were not significant. With regard to the relations between perceived support and symptomatology, perceived peer support was significantly negatively related to child reported depression and anxiety, and to parent reported anxiety/depression. This negative correlation indicates that as perceived peer support increased, child and parent reported anxiety and depression decreased. Both of these correlations were in the expected direction. Neither perceived teacher nor family support were significantly related to any indices of adjustment. Prediction of Adjustment Hierarchical multiple-regression analyses were conducted to further understand the relationships between perceived social support and symptomatology. Each of the five indices of symptomatology was regressed, in turn, on the set of three variables representing perceived levels of family, teacher, and peer support. The order of entry of the perceived support variables (i.e., perceived teacher, peer, and family support) was determined based on prior research findings that perceived teacher and peer support were more strongly linked to key indices of adjustment than was perceived family support (Rhee, 1993; Varni et al., 1994). After each variable was entered, an F test was calculated for the increment in the overall model’s R2 value to determine if the new predictor variable increased the proportion of variation explained in each index of child adjustment over the other predictor variable or variables already in the model. Each model’s R2 value, the change in R2 due to the addition of each support predictor variables, the standardized and unstandardized regression
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Table 3. Regression Analysis for Prediction of Children’s Symptomatology
Predicting CDI Teacher support Peer support Family support Predicting RCMAS Teacher support Peer support Family support Predicting TSCC-ANG Teacher support Peer support Family support Predicting CBCL-A/D Teacher support Peer support Family support Predicting CBCL-AGG Teacher support Peer support Family support
R2
⌬R 2
.05 .29 .45
F
B
b
.00 .24 .16
1.79 10.90** 9.20**
⫺.23 ⫺.49 ⫺.45
⫺1.38 ⫺4.13 ⫺4.64
.04 .27 .34
.00 .23 .07
0.00 11.50** 3.30
.20 ⫺.48 ⫺.30
.95 ⫺3.07 ⫺2.33
.02 .13 .18
.00 .11 .05
0.00 3.70 1.70
.13 ⫺.34 ⫺.24
.42 ⫺1.54 ⫺1.36
.00 .17 .19
.00 .17 .02
0.00 6.80* 0.80
⫺.06 ⫺.41 ⫺.14
⫺.49 ⫺4.88 ⫺2.10
.10 .15 .15
.00 ⫹.05 ⫹.00
3.85 2.00 0.00
⫺.31 ⫺.22 .05
⫺3.00 ⫺2.97 .89
Note. N ⫽ 37, CDI ⫽ Children’s Depression Inventory, RCMAS ⫽ Revised Children’s Manifest Anxiety Scale, TSCC-ANG ⫽ Trauma-Symptom Checklist for Children-Anger subscale, CBCL-A/D ⫽ Child Behavior Checklist-Anxiety/Depression subscale, CBCL-AGG ⫽ Child Behavior ChecklistAggression subscale. * p ⬍ .05; ** p ⬍ .01.
coefficients, and the results of the F tests are presented in Table 3. Consistent with the correlations presented earlier, a nonsignificant increment in the R-square over the null model indicated that perceived teacher support was not significantly related to any indices of symptomatology. However, perceived peer support was significantly negatively related to children’s reports of depression on the CDI and to childrens’ (RCMAS) and parents’ (CBCL) reports of childrens’ anxiety/ depression after controlling for perceived teacher support. Perceived family support was also significantly negatively related to children’s report of depression on the CDI, after controlling for teacher and peer support. Perceived family support was not significantly related to any other form of symptomatology.
DISCUSSION This study investigated the relationship between perceived family, teacher, and peer social support and mental health symptomatology in a sample of physically abused children. Although the children in the study reported receiving a high level of support from all three sources, comparisons of the levels of support across the sources showed differences. Families were rated as providing significantly greater levels of support than teachers, while family and peer, and teacher and peer support levels did not differ significantly. In the regression analyses, perceived teacher support was not significantly related to any assessed index of symptomatology. However, after controlling for the effect of teacher support, peer support was found to contribute significantly to reductions in child- and parent-reported depression and anxiety. Furthermore, perceived family support was found to be significantly related to lower levels of child-reported depression after adjusting for the effects of teacher and peer support. In these cases of substantiated parental physical abuse, that children perceived high support from
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their family is an important finding. Even in the face of physical abuse, children may still feel that they are an important part of their family and that their families care about them and do things for them. Those children who perceive or receive support from families may benefit, given the relationship between family support and reduced depression. Families are often regarded as the primary source of support for children (Vernberg et al., 1996), and certainly in other samples that support is important to mental health. For example, support, at least from the mother, is associated with emotional adjustment in sexually abused children (Feiring et al., 1998; Spaccarelli & Fuchs, 1997). The findings linking family support to reduced internalizing behaviors did not hold for externalizing behaviors, such as aggression. Thus, although family support is important to children undergoing stressors, more than support may be needed to prevent or reduce aggressive behavior. This result carries important treatment implications, especially for physically abused children because of the high risk of subsequent aggression. Although family cohesion and warmth certainly relate to youth antisocial behavior (Achenbach & Edelbrock, 1978), to more fully address externalizing behaviors, factors in addition to family support should be addressed. These may include ineffective discipline strategies, poor individual problem solving, association with deviant peers, and poor academic performance (Elliott, Huizinga, & Ageton, 1985; Simcha-Fagan & Schwartz, 1986). Consistent with studies involving other populations (Cowen et al., 1990; Varni et al., 1994; Wallander & Varni, 1989), peer support was related to reduced internalizing symptoms. The benefits from positive peer relationships, including perceived support, are numerous and include decreased feelings of loneliness, increased sense of belonging, and greater validation and sense of self-worth (Parker & Asher, 1993). With the exception of Feiring and colleagues’ (1998) findings, this study adds to a growing body of literature on the benefits of peer support in reducing internalizing difficulties of at-risk children. That peer support did not relate to reduced externalizing problems was a surprising finding. Perhaps, as with families, feeling a part of a peer group may be insufficient for reducing aggression. If the supportive peer group engages in aggressive behavior, then the youth, although feeling supported, may also be more likely to engage in the aggression. Although children spend a large part of their day with teachers, for children in this study, teacher support was not related to reduced internalizing or externalizing problems. Although teachers certainly can influence the life of students and their parents, the opportunity to develop supportive relationships with students may be limited. Many of the children in this study may have had multiple teachers, reducing the amount of time spent with an individual. The limited contact may have been insufficient time for developing a relationship in which the children felt that they could obtain advice about their problems. In fact, for children exhibiting aggressive behavior in particular, interactions with teachers may be mainly around discipline or attempts to reduce disruptive behavior in the classroom. Therefore, children may not seek out or experience a warm supportive relationship that involves obtaining help with solving personal problems. Extension of the current study will enhance our understanding of the role teachers have in children’s development and functioning. Important to interpreting the results of this study is the consideration of three important limitations. First, the small sample size precluded our ability to examine the role of other factors (e.g., severity of maltreatment, SES) in predicting the outcomes of interest. Second, perceived social support was assessed after the physical abuse had been substantiated. Thus, it is uncertain how the events that occurred after the abuse had been substantiated may have impacted children’s perceptions and/or reports of perceived support, particularly perceived family support. Last, sampling bias limits the generalization of the findings. The population examined included children who were Medicaid-eligible and who were being supervised by CPS. Thus, findings may not
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generalize to physically abused children who are not Medicaid-eligible or to those who are not supervised by CPS. Despite these limitations, this study provides important information regarding the relationship between perceived social support and symptomatology in physically abused children and highlights several important issues worthy of future research. For example, it is unclear whether high social support causes more positive adjustment or whether children with more positive adjustment are better able to elicit social support from others. In addition, it would be of interest to compare, utilizing the same measures, the effects of support across different at-risk populations. Although studies have been conducted on the effects of social support in a variety of high-risk samples, due to the variability in the support and adjustment measures utilized across studies, comparison of findings is difficult. Furthermore, the links between externalizing problems and familial support deserve additional attention in order to increase our understanding of mechanisms for decreasing aggression in physically abused children. This appears to be a particularly worthwhile endeavor, given the intergenerational transmission that occurs with child physical abuse (Egeland, Jacobitz, & Papatola, 1987). Additionally, in previous research, Dubow and Ullman (1989) found that children listed a variety of people other than immediate family members, peers, and teachers, as providing support to them (e.g., coach, therapist, parents’ friends); how support from these individuals relates to physically abused children’s adjustment is an area warranting investigation. Similarly, it is unclear from which family members support was coming, as well as the nature of the support (e.g., instrumental, emotional). Lastly, given previous research demonstrating differences in children’s and parent’s reports on children’s functioning (Loeber et al., 1990), it would be of interest to assess parent’s perceptions of their children’s social support and the relationship of these perceptions to children’s perceived support and adjustment. Individuals working with physically abused children should be aware of the potential benefits of social support. If a child has few supportive relationships, interventions that target enhancing children’s social support network may be beneficial. Furthermore, given the relationship between family support and depression, therapeutic work to improve the parent-child relationship and encourage parents toward a supportive stance may be important to physically abused children’s adjustment. Future research that continues to enhance our understanding of the links between social support and symptomatology should provide guidance to clinicians on how to decrease the frequency and intensity of the difficulties that many physically abused children experience. Acknowledgements—The authors wish to thank C. Hope Cunningham, Ralph Terry, Ione Sack, and Gene Caldwell for their assistance with this project.
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Egeland, B., Jacobitz, D., & Papatola, K. (1987). Intergenerational continuity of abuse. In R. Gelles & J. Lancaster (Eds.), Child abuse and neglect: Biosocial dimensions (pp. 255–276). Chicago, IL: Aldine. Elliott, D. S., Huizinga, D., & Ageton, S. S. (1985). Explaining delinquency and drug use. Beverly Hills, CA: Sage. Feiring, C., Taska, L. S., & Lewis, M. (1998). Social support and children’s and adolescent’s adaptation to sexual abuse. Journal of Interpersonal Violence, 13, 240 –260. Furman, W., & Buhrmester, D. (1992). Age and sex differences in perceptions of networks of personal relationships. Child Development, 63, 103–115. Hartup, W. W. (1989). Social relationships in developmental perspective. American Psychologist, 44, 120 –126. Hollingshead, A. B. (1975). Four factor index of social status. Unpublished manuscript. New Haven, CT: Yale University, Department of Sociology. Kolko, D. J. (1992). Characteristics of child victims of physical violence: Research findings and clinical implications. Journal of Interpersonal Violence, 7, 244 –276. Kolko, D. J. (1996). Child physical abuse. In J. Briere, L. Berliner, J. A. Bulkley, C. Jenny, & T. Reid (Eds.), The APSAC handbook on child maltreatment (pp. 21–50). Thousand Oaks, CA: Sage Publications. Kovacs, M. (1981). Rating scales to assess depression in school aged children. Acta Paedopsychiatrica, 46, 305–315. Loeber, R., Green, S. M., & Lahey, B. B. (1990). Mental health professionals’ perceptions of the utility of children, mothers, and teachers as informants of child psychopathology. Journal of Clinical Child Psychology, 19, 136 –143. Parker, J. G., & Asher, S. R. (1993). Friendship and friendship quality in middle childhood: Links with peer group acceptance and feelings of loneliness and social dissatisfaction. Developmental Psychology, 29, 611– 621. Reynolds, C. R. (1980). Concurrent validity of What I Think and Feel: The Revised Children’s Manifest Anxiety Scale. Journal of Consulting and Clinical Psychology, 48, 774 –775. Reynolds, C. R., & Paget, K. D. (1983). National normative and reliability data for the Revised Children’s Manifest Anxiety Scale. School Psychology Review, 12, 324 –336. Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children’s manifest anxiety. Journal of Abnormal Child Psychology, 6, 271–280. Rhee, U. (1993). Self-perceptions of competence and social support in Korean children. Early Child Development and Care, 85, 56 – 66. Saylor, C. F., Finch, A. J., Jr., Spirito, A., & Bennett, B. (1984). The Children’s Depression Inventory: A systematic evaluation of psychometric properties. Journal of Consulting and Clinical Psychology, 52, 955–967. Simcha-Fagan, O., & Schwartz, J. E. (1986). Neighborhood and delinquency: An assessment of contextual effects. Criminology, 24, 667–703. Spaccarelli, S., & Fuchs, C. (1997). Variability in symptom expression among sexually abused girls: Developing multivariate models. Journal of Clinical Child Psychology, 26, 24 –25. Varni, J. W., Katz, E. R., Colegrove, R., & Dolgin, M. (1994). Perceived social support and adjustment of children with newly diagnosed cancer. Journal of Developmental and Behavioral Pediatrics, 15, 20 –26. Varni, J. W., Rubenfeld, L. A., Talbot, D., & Setoguchi, Y. (1989). Stress, social support, and depressive symptomatology in children with congenital/acquired limb deficiencies. Journal of Pediatric Psychology, 14, 515–530. Vernberg, E. M., LaGreca, A. M., Silverman, W. K., & Prinstein, M. J. (1996). Prediction of posttraumatic stress symptoms in children after Hurricane Andrew. Journal of Abnormal Psychology, 105, 237–248. Vernberg, E. M., & Vogel, J. (1993). Interventions with children after disasters. Journal of Clinical Child Psychology, 22, 484 – 498. Wallander, J. L., & Varni, J. L. (1989). Social support and adjustment in chronically ill and handicapped children. American Journal of Community Psychology, 17, 185–201. Wasserstein, S. B., & LaGreca, A. M. (1996). Can peer support buffer against behavioral consequences of parental discord? Journal of Clinical Child Psychology, 25, 177–182.
RE´SUME´ Objectif: Cette e´tude s’est donne´ trois objectifs: (1) e´valuer la perception qu’ont des enfants maltraite´s physiquement vis-a`-vis de leur enseignant, de leurs pairs et de leurs appuis familiaux; (2) de´terminer si ce niveau de soutien tel que perc¸u varie selon le roˆle social de la personne en queston; et (3) de´terminer quelles sources d’appui social sont fortement relie´es a` l’adaptation de l’enfant. Me´thode: Chez un e´chantillon de 37 enfants maltraite´s physiquement on e´value´ leur perception des apuis venant de leur enseignants, de leur famille et de leurs paires. Pour ce, on a eu recours au Survey of Children’s Social Support (Dubow & Ullman, 1989). L’adaptation de l’enfant a e´te´ e´value´e a` partir de te´moignages de l’enfant et de ses parents portant sur la de´pression, l’angoisse et la rage qu’il aurait connues. Re´sultats: L’analyse de´montre que les enfants ont identifie´ leur famille, leurs paires et leurs enseignants comme des sources d’appui importantes. Les familles figurent en premie`re place. Une analyse hie´archique a` re´gression multiple indique des liens ne´gatifs entre les appuis venant des paires et la de´pression et l’angoisse des enfants— ces dernie`res telles que rapporte´es par les enfants et leurs parents. De plus, il existe un lien ne´gatif entre les apuis familiaux tels que perc¸us par les enfants, et la de´pression. On a remarque´ aucun lien important entre l’appui des enseignants et les symptoˆmes. Conclusions: en ge´ne´ral, les re´sultats portent a` croire que les appuis des paires et de la famille s’ave`rent tre`s importants vis-a`-vis du fonctionnement psychologique des enfants qui ont subi des mauvais traitements physiques, surtout en ce qui concerne l’inte´riorisation de leurs troubles.
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RESUMEN Objetivo: Este estudio tenı´a tres objetivos principales: Primero, evaluar las percepciones de nin˜os fı´sicamente abusados de su maestro, compan˜eros y apoyo familiar; segundo, determinar si los niveles de apoyo percibidos se diferencian de acuerdo con el rol social de la persona; y tercero evaluar cuales fuentes de apoyo social muestran asociaciones ma´s fuertes con el ajuste en una muestra fı´sicamente abusada. Me´todo: El apoyo social percibido de maestros, familias y compan˜eros fue evaluado en una muestra de 37 nin˜os fı´sicamente abusados utilizando una versio´n corta del “Survey of Children’s Social Support” (Dubow & Ullman, 1989). El ajuste infantil fue identificado por los reportes del nin˜o y de los padres de depresio´n infantil, ansiedad y rabia. Resultados: Los ana´lisis indican que los nin˜os evaluaban como fuentes muy altas de apoyo social a sus familias, compan˜eros y maestros, con las familias como la fuente ma´s importante. Los ana´lisis de regresio´n mu´ltiple jera´rquica indicaron que el apoyo de los compan˜eros era significativa y negativamente relacionado con los reportes de los nin˜os y los padres de depresio´n y ansiedad. Ma´s aun, el apoyo familiar percibido estuvo significativa y negativamente asociado con la depresio´ infantil reportada. No se encontraron relaciones significativas entre el apoyo percibido de los maestros y una sintomatologı´a. Conclusiones: En general, los resultados sugieren que el apoyo de compan˜eros y familiares son particularmente importante para el funcionamiento psicolo´gico de nin˜os abusados fı´sicamente, particularamente para internalizar los problemas.