The role of coping strategies in the pathway between child maltreatment and internalizing and externalizing behaviors

Child Abuse & Neglect 101 (2020) 104323

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Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg

Research article

The role of coping strategies in the pathway between child maltreatment and internalizing and externalizing behaviors

T

Faith VanMetera,*, Elizabeth D. Handleyb, Dante Cicchettia,b a b

Institute of Child Development, University of Minnesota, United States Mt. Hope Family Center, University of Rochester, United States

A R T IC LE I N F O

ABS TRA CT

Keywords: Child maltreatment Coping strategies Psychopathology Internalizing symptoms Externalizing symptoms

Background: Child maltreatment has been repeatedly linked to internalizing and externalizing disorders, though few studies have examined the mechanisms of this pathway. Furthermore, children cope with difficult demands from their environments in a variety of ways, using emotion-focused (e.g., crying and verbal aggression), avoidant (e.g., disengaging), or problem-focused (e.g., seeking help from an adult) strategies. Objective: The current investigation examined if the coping strategies children employ when faced with everyday environmental stresses are a potential mechanism in the pathway between child maltreatment and internalizing and externalizing symptoms. Participants and setting: Participants included 198 maltreated and 222 non-maltreated children ages 4–12 who attended a day summer camp for 2 consecutive years. Methods: The study utilized a longitudinal design by following the children at two time points to determine if coping at Time 1 mediated the pathway between maltreatment and internalizing and externalizing symptoms at Time 2 (measured one year later). Results: Results from path analyses showed that maltreatment was associated with increased emotion-focused (b = .20, SE = .05, p < .001) and decreased problem-focused coping (b = -.25, SE = .05, p < .001). Results also indicated that emotion-focused coping represents a mechanism by which maltreated children are at increased risk for externalizing behaviors (with an indirect effect estimate of 0.023, SE = 0.053; CI: 0.004, 0.23). Conclusions: The results highlight the impact maltreatment can have on coping strategies and that these strategies can play an important role in the development of psychopathology. This has important implications for clinicians, who could integrate reducing emotion-focused coping into intervention efforts for maltreated children

1. Introduction Child maltreatment has been repeatedly linked to increased risk for negative mental and physical health outcomes, such as anxiety, depression, antisocial behavior, and substance use disorders (Cicchetti & Handley, 2019; Malinosky-Rummell & Hansen, 1993; Smith & Thornberry, 1995; Vachon, Krueger, Rogosch, & Cicchetti, 2015). Child maltreatment is defined by an experience of abuse and/or neglect that endangers children or is harmful to their development (Sedlak et al., 2010). Despite interest in the consequences of maltreatment, there has been little work on the mechanisms that drive these effects, partly due to a paucity of longitudinal studies. Therefore, there is still much that is unknown about the developmental trajectories of children following ⁎

Corresponding author at: University of Minnesota Institute of Child Development, 51 E River Parkway, Minneapolis, MN 55455, United States. E-mail address: [email protected] (F. VanMeter).

https://doi.org/10.1016/j.chiabu.2019.104323 Received 16 July 2019; Received in revised form 2 December 2019; Accepted 9 December 2019 0145-2134/ © 2019 Elsevier Ltd. All rights reserved.

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maltreatment. While many studies have shown that maltreatment is associated with increased risk for internalizing and externalizing symptoms (Cicchetti & Toth, 1995, 2005; Kim & Cicchetti, 2010), few have elucidated potential reasons for this association. The aim of the current study was to examine coping strategies as a potential mechanism in the pathway between maltreatment and internalizing and externalizing symptoms in children. Children constantly face life stressors in multiple domains of their lives: when interacting with peers, completing tasks at school, or at home with their families. Children vary in their abilities and strategies to cope with these stressors. The type of coping strategies maltreated and nonmaltreated children employ could help to explain differences in adjustment among maltreated children (Jackson, Huffhines, Stone, Fleming, & Gabrielli, 2017; Sesar, Šimić, & Barišić, 2010). Therefore, determining how maltreated children cope with stress is essential for understanding how maltreatment might impact future psychopathology. 1.1. Conceptualization of coping Lazarus and Folkman’s (1984) model of coping, though initially proposed for an adult sample, has widely dominated the child and adolescent coping literature. Within this framework, coping is defined as cognitive and behavioral efforts made to manage external or internal demands that are stressful or threatening to the individual (Burt & Katz, 1988; Lazarus & Folkman, 1984; Tremblay, Hébert, & Piché, 1999). This model frames coping as a goal-oriented process in which individuals direct their thoughts and behaviors toward resolving the source of stress and managing reactions to the stressor (Jackson et al., 2017; Lazarus, 1993). Further, Compas et al. (1997, 1999), who have applied Lazarus and Folkman’s adult coping model to youth populations, conceptualize coping as a conscious volitional effort to regulate emotion, behavior, cognition, physiology, and the environment in response to stressful situations. Although coping is a subset of self-regulatory processes, it refers specifically to regulatory efforts consciously used in response to stress (Compas, Connor, Saltzman, Thomsen, & Wadsworth, 1999). This is different from broad self-regulation, which includes conscious and nonconscious responses to both stressful and nonstressful situations (Eisenberg, Fabes, & Guthrie, 1997). When proposing the model, Lazarus and Folkman (1984) posited two general dimensions of coping that aim to represent the overarching characteristics of responses to stress. These two dimensions include problem-focused coping and emotion-focused coping and have been used readily throughout the youth coping literature (Browne, 2002; Carlo et al., 2012; Jackson et al., 2017). Problemfocused coping is defined as directing responses toward resolving the stressor while emotion-focused coping is defined as working to alleviate emotions that arise because of the stressor (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001; Lazarus & Folkman, 1984). Responses considered problem-focused coping can include seeking solutions to the stressor and taking actions to alter the stressful situation. Emotion-focused coping can include responses such as expressing emotions or using emotions to seek support from others. Though these two coping dimensions have been widely used in studies involving youth, critics have argued that these dimensions are too broad and do not encompass all categories of coping, such as avoidant coping strategies (Compas et al., 2001; Coyne & Gottlieb, 1996). Avoidant coping, also termed disengagement coping, refers to responses that orient the individual away from the stressor or emotions and thoughts brought about by the stressor (Seiffge-Krenke & Klessinger, 2000). This can include strategies such as withdrawal from or denial of the stressor. The current study utilizes these three dimensions (problem-focused, emotion-focused, and avoidant) when measuring types of coping to gain a broad picture of children’s responses to stress. Specifically, the current study examined how a history of a maltreating environment might influence which coping strategies children utilize when facing stressful situations. 1.2. Coping and behavioral problems The literature suggests that the way in which children cope with stress is related to their mental wellbeing (Seiffge-Krenke & Klessinger, 2000; Steel, Sanna, Hammond, Whipple, & Cross, 2004; Whiffen & MacIntosh, 2005). While there is no clear consensus among the field, problem-focused coping has been framed as adaptive and emotion-focused and avoidant coping has been framed as maladaptive (Thoits, 1995; Zeidner & Saklofske, 1996). Generally, children who use emotion-focused coping are more likely to be psychologically maladjusted (Carlo et al., 2012; Chaffin, Wherry, & Dykman, 1997). For example, children who employed aggression among peers in response to stress, as evaluated by their teachers, presented more adjustment problems than children who employed problem-focused coping strategies (Chaffin et al., 1997). More specifically, Asarnow, Carlson, and Guthrie (1987) found a positive association between physically aggressive responses to stress and depressive symptoms among children, indicating that there might be a relationship between coping and internalizing symptoms. Interestingly, some forms of emotion-focused coping have been identified as adaptive strategies. For example, expressing emotion through crying or emotive language has been associated with decreased acute anxiety (Kennedy-Moore & Watson, 2001). Avoidant coping has been linked to poor long-term psychological adjustment (Herman-Stabl, Stemmler, & Petersen, 1995; Holahan & Moos, 1987). Specifically, avoidant coping strategies have been associated with increased anxiety and depression symptomology in victims of sexual abuse (Gold, Milan, Mayall, & Johnson, 1994). Paradoxically, avoidant coping strategies have also been shown to diminish acute stress (Roth & Cohen, 1986). Therefore, though avoidant coping might successfully relieve stress in the short-term, persistent use of these strategies may lead to long-term negative mental health outcomes. Herman-Stabl et al. (1995) posit that perhaps avoidant coping strategies prevent an individual from confronting and solving their problems; therefore, creating increased stress which may contribute to negative long-term mental health outcomes. Alternatively, problem-focused coping has been linked to adaptive psychological adjustment (Grant et al., 2003; Smith et al., 2006). Actively seeking to solve or alter a stressful situation has been associated with positive mental health outcomes (Runtz & 2

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Schallow, 1997). Furthermore, asking advice or requesting support from others following a problem has been linked to decreased levels of anxiety (Smith et al., 2006). Problem-focused coping strategies also have been shown to buffer the effects of stressful experiences (Compas et al., 2001). Problem-focused coping may allow an individual to perceive a situation as less stressful, resulting in the individual internalizing less stress. 1.3. Maltreatment and coping Because coping strategies impact mental health outcomes, it is particularly important to understand which children might be most at risk of developing maladaptive coping strategies. Atypical patterns of coping are theorized to originate from the same early experiences of chronic, uncontrollable stress that contribute to dysregulated biological stress reactivity (Wadsworth, 2015). The Response to Stress model (Connor-Smith, Compas, Wadsworth, Thomsen, & Saltzman, 2000) posits that children begin regulating themselves in infancy in coregulation with a caregiver. This regulation develops over time until a child is able to independently manage difficult situations and soothe themselves. To develop a healthy set of coping strategies, children need to be exposed to mild and moderate stress, positive coping models, and appropriate scaffolding from a caregiver (Abaied & Rudolph, 2010; Compas, 2009; Wadsworth, 2015). Children exposed to maltreatment might lack the experiences necessary to develop problem-focused coping strategies. Further, maltreated children might develop maladaptive coping strategies to protect themselves from overwhelmingly stressful situations (Ullman & Peter-Hagene, 2014). Children, particularly young children, might not have the tolerance to handle stressful situations and thus avoid these situations as a form of protecting stress systems (Schuder & Lyons-Ruth, 2004). Cognitive theories of depression also suggest that maltreated children might develop negative coping patterns from early invalidating interactions with their caregivers (Segrin, Woszidlo, Givertz, & Montgomery, 2013). These interactions could include conflicting emotional signals, absence of affective expression, and physical distance from the maltreating parent (Lyons-Ruth, Connel, & Zoll, 1991). Therefore, repeated exposure to extreme stress and lack of exposure to healthy, alternative models of coping might solidify maladaptive coping strategies. There has been limited work examining the effects of maltreatment on coping strategies, and much of that work includes examinations of how adults cope specifically with their maltreatment (retrospectively reported; Crittenden, 1992; Hager & Runtz, 2012). Further, much work examining the relationship between coping strategies and maltreatment use an entirely maltreated sample; therefore, it is difficult to understand how maltreatment predicts specific coping strategies. Tremblay et al. (1999) found that adults who were sexually abused were more likely to employ avoidant strategies to cope with their abuse, perhaps to prevent rumination and discussion of abuse. Research suggests that emotion-focused coping is associated with negative long-term psychological outcomes for individuals who experienced child sexual abuse (Kuyken & Brewin, 1999; Sigmon, Greene, Rohan, & Nichols, 1997). On the other hand, problem-focused coping has been found to be associated with more positive psychological outcomes for individuals who experienced child sexual abuse (Cerezo & Frias, 1994; Coffey, Leitenberg, Henning, Turner, & Bennett, 1996; Lange et al., 1999; Wolfe, Gentile, & Wolfe, 1989). Specifically, seeking social support and active problem-solving strategies are associated with more positive psychological outcomes for adults with a history of child sexual abuse. Further, experiencing multiple subtypes of maltreatment is associated with difficulties in generally regulating emotions following stress (Kim & Cicchetti, 2010). Thus, individuals who have experienced more than one subtype of maltreatment might be more likely to employ increased emotion-focused coping strategies and decreased problem-focused coping strategies when faced with stressors. There has been limited work examining if maltreatment beyond sexual abuse influences coping strategies. The current study will address this gap in the literature by examining if children who have experienced general maltreatment (children who have experienced incidents of abuse and/or neglect), and specifically number of subtypes of maltreatment, are more likely to employ a particular coping strategy compared to their nonmaltreated peers. Subtypes of maltreatment commonly co-occur and may persist across development. Therefore, treating maltreatment subtypes as independently occurring is not representative of the nature of maltreatment as it occurs in children’s lives (Warmingham, Handley, Rogosch, Manly, & Cicchetti, 2019). The number of subtypes experienced aims to allow for a better understanding of cumulative risk associated with the different types of maltreatment and provides greater statistical variability (Handley, Rogosch, Guild, & Cicchetti, 2015). 1.4. Coping as a mediator in the pathway between maltreatment and behavioral problems Because experiences of different forms of maltreatment (sexual abuse and general abuse/neglect) is associated with specific coping strategies and these coping strategies are associated with behavioral outcomes, it is possible that there is a potential mediational pathway between experiences of maltreatment and the development of behavioral problems. This can be understood by uniting two models of stress adaptation: allostatic load (AL) and adaptive calibration model (ACM;). AL theory explains how toxic early environments damage the physiologic stress-response system resulting from the body’s attempts to maintain homeostasis in the face of extreme adversity (McEwen, 2013). Repeated activations of the sympathetic-adrenomedullary (SAM) system and hypothalamic-pituitary-adrenal axis (HPA) can cause wear and tear on the body, resulting in physical and mental illness (Evans & Kim, 2013). The ACM emphasizes the beneficial functions of behavioral adaptations to stressful environments (Ellis, Del Guidice, & Shirtcliff, 2013). For example, avoidant and emotion-focused coping are critical responses for adapting to a harsh, stressful environment. Integrating these models emphasizes that while a child is more likely to try to adapt to their environment (by engaging in maladaptive coping strategies), this does not necessarily result in healthy developmental outcomes (Wadsworth, 2015). An overworked stress response system might allow the child to better function in the chaotic environment (avoidant coping strategies might be particularly helpful in protecting children in these environments) but could also put the child at additional risk for physical and 3

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mental health outcomes, such as internalizing and externalizing behaviors. Therefore, coping strategies might play an important factor in mediating the pathway between a history of maltreatment and the development of internalizing and externalizing symptoms in children. This has been previously examined in a handful of studies. For example, avoidant coping strategies have been found to mediate the relationship between child sexual abuse and psychological distress among adolescent females (Shapiro & Levendosky, 1999). Further, problem-focused coping strategies (such as confronting the stressor and accepting responsibility of the stress) have been found to lessen the chances of psychological distress following sexual abuse (Steel et al., 2004). Emotion-focused coping also has been found to partially mediate the relationship between physical and psychological abuse and negative physical health outcomes (Hager & Runtz, 2012). Tremblay et al. (1999) tested coping strategies as mediators between child sexual abuse and internalizing and externalizing symptoms and only found direct (not mediational) effects. Although no study has found that coping strategies mediate the relationship between types of maltreatment and internalizing and externalizing symptoms, previous work would suggest that coping strategies might be greatly influenced by a history of maltreatment and in turn those coping strategies might then influence the development of psychopathology. The current study will examine this relationship with the goal of identifying a potential point of intervention for maltreated children to reduce the development of psychopathology symptoms. 2. The current study Although research has shown that maltreatment is associated with internalizing and externalizing symptoms, there has been little work on the potential mechanisms that carry maltreatment forward into maladaptation. Limited work has shown that children’s experiences of maltreatment can influence coping strategies, which in turn might contribute to mental health outcomes. However, previous research examining coping strategies among maltreated individuals has been retrospective and has often focused on how these individuals cope with the stress of previous abuse, rather than stress more generally. The current study addressed this gap by using longitudinal data to examine whether coping strategies for life stress mediated the relationship between child maltreatment, prospectively assessed, and internalizing and externalizing behaviors. Specifically, children were followed over the course of 2 consecutive years of a summer day camp. Utilizing this design is important because it allows for the examination of change over time and because childhood is a time in which symptomology and behavior can rapidly change (Bongers, Koot, van der Ende, & Verhulst, 2003). It was hypothesized that: 1) Maltreatment would be associated with an increase in the use of emotion-focused and avoidant coping strategies and a decrease in problem-focused coping strategies compared to non-maltreated children at Time 1. 2) Emotion-focused and avoidant coping strategies would increase the likelihood of internalizing and externalizing symptoms and problem-focused coping strategies would decrease the likelihood of internalizing and externalizing symptoms at Time 2. 3) Finally, emotion-focused, avoidant, and problem-focused coping strategies at Time 1 would mediate the relationship between child maltreatment and internalizing and externalizing symptoms at Time 2. 3. Method 3.1. Participants Participants included 416 children, aged 5–12 years old (M = 7.42, SD = 1.77) and 59 % male. All children attended 2 consecutive years of a summer day camp program in upstate New York that was designed for low-income school-aged children. The sample included both maltreated (n = 197) and nonmaltreated (n = 219) children. The racial composition of the children, as indicated by the children’s mothers, was diverse: 57.1 % identified as being African American, 20.5 % Caucasian, 5 % Latino, and 17.5 % identified with other racial backgrounds. The maltreated and nonmaltreated children were comparable in terms of age, gender, ethnicity, and SES (measured as receipt of public assistance). The majority of maltreated children in the current sample experienced neglect (34.52 %), followed by emotional abuse (33.33 %), physical abuse (15.24 %), and sexual abuse (6.19 %). The majority of the maltreated children experienced more than one type of maltreatment (83 %). All maltreatment was perpetrated by family members, with the majority of maltreatment being perpetrated by mothers. 3.2. Recruitment Maltreated children were recruited through a Department of Human Services (DHS) liaison who examined Child Protective Services reports to identify children with a history of maltreatment. The maltreated group was made up of families from low SES backgrounds (consistent with national demographics; Sedlak et al., 2010). Therefore, a comparable group of nonmaltreated children were recruited from families receiving Temporary Assistance for Needy Families. DHS liaisons searched records within New York State to confirm the absence of documented maltreatment for the nonmaltreated sample. Further, research assistants unaware to maltreatment status completed Maternal Maltreatment Classification Interviews (Cicchetti, Toth, & Manly, 2003) with mothers from both groups to verify maltreatment experiences or lack of experiences. Parents of maltreated and nonmaltreated children provided informed consent for their child’s participation in the summer camp and research assessments conducted during the summer camp as well as examination of their DHS records. 4

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3.3. Procedure All data were collected over the course of a week-long day camp for two consecutive years. The camp provided a natural and comfortable environment in which the children’s behaviors and interactions could be observed. The camp was 5 consecutive days and 7 h per day and was completely free of charge. Children were bussed to and from the camp. Children were placed in small groups (8–10 per group) of the same sex and age. Throughout the week, children participated in recreational activities as well as research assessments. The study was approved by the university institutional review board and informed consent was obtained for all research participants at each time point. All measures were administered by camp counselors, who were trained research assistants unaware of maltreatment status and research hypotheses (see Cicchetti & Manly, 1990, for detailed descriptions of camp procedures). Camp counselors observed the same group of children during the entirety of the week, but children did not have the same counselor between years. Therefore, raters at Time 2 were different from Time 1. By having independent raters at each time point, it was ensured that any biases from one reporter did not carry over to the next year. 3.4. Measures Maltreatment Classification System. Reports of maltreatment contained within DHS records were coded using the Maltreatment Classification System (MCS; Barnett, Manly, & Cicchetti, 1991; Cicchetti & Barnett, 1991). The MCS is based on specific, operational definitions of each maltreatment subtype and its severity. The MCS utilizes a structured approach to obtaining information from the narrative and investigative documents contained in DHS records. This allows for researchers to consistently determine maltreatment characteristics across cases and allows for the most accurate diagnosis of maltreatment possible given the available information. In the current study, the number of subtypes of maltreatment present was included as a predictor, as it allows for a more nuanced understanding of cumulative risk associated with multiple different types of maltreatment (Handley et al., 2015). The subtypes, measured by the MCS, included physical abuse, sexual abuse, emotional abuse, and neglect. Scores could range from 0 to 4 subtypes. Children who were in the nonmaltreated group received a 0 for this variable. Coping Strategies Rating (CSR). Three dimensions of coping (emotion-focused, avoidant, and problem-focused) were assessed by camp counselors using an adaptive version of the Coping Strategies Rating questionnaire (Smith et al., 2006) during the first year the children attended camp (Time 1). Camp counselors were asked to report how each child generally dealt with problems they encountered while at the camp. They were presented with a list of various responses to stress and were asked to score each item on a Likert scale (1 not at all likely) to 7 (extremely likely). The items were then collapsed into 3 dimensions (emotion-focused, avoidant, and problem-focused) based on face validity. Each question was collapsed into the dimension it most appropriately measured. The questionnaire items for each dimension can be found in Table 1. The internal consistency of each subscale was good. The emotionfocused coping subscale consisted of 4 items (α = .65), the avoidant coping subscale consisted of 5 items (α = .72), and the problemfocused coping subscale consisted of 5 items (α = .85). Two counselors rated each child on these measures. Inter-rater reliability for each subscale was calculated. The intra-class correlation values for these scales range from .78 to .94, indicating good reliability among the camp counselors. Teacher Report Form (TRF). The TRF (Achenbach, 1994) provided an index of children’s overall internalizing and externalizing symptomology, as assessed by the children’s camp counselors. The measure included 118 items assessing behavior problems for children aged 4-16. Each item was rated on a scale from 0 to 2, with 0 indicating the item is not true, 1 indicating that it is sometimes true, and 2 indicating that it is always true. Each item corresponds to psychometrically validated internalizing and externalizing broadband subscales (Nakamura, Ebesutani, Bernstein, & Chorpita, 2009). An overall internalizing symptomology T- score was Table 1 Coping Strategies Rating Questionnaire Items. Dimension

Item

Problem-focused Coping Takes some constructive action to improve a problem situation (e.g., tell others to stop teasing) Tells problems to friends or family in the hope of getting support Tries to think about the situations in a positive way (e.g. tells himself/herself that everything will be OK, tries to put the problem in perspective) Asks an adult or another child to help solve the problem Talks with a friend or family member about the problem to help find a solution Avoidant Coping Avoids thinking about a problem or attempts to ignore it (e.g., fantasizes that things were different or wishes things were different) Leaves or avoids a problem situation (e.g., stays away from people who make him/her feel bad) Avoids thinking about the problem by distracting himself or herself with other activities (e.g., plays by himself or with others) Denies that there really is a problem Does nothing Emotion-focused Coping Cries to elicit assistance from others to help solve the problem (e.g., cries so that an adult intervenes on the child’s behalf when he or she is being bullied) Cries to release pent-up feelings or to elicit comforting from others Resolves problems through physical or verbal aggression (e.g., pushes or kicks a child who has been teasing him/her) Uses physical or verbal aggression to release pent-up feelings (e.g., kicking a wall after being embarrassed)

5

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Table 2 Sample Information for Study Variables. Frequency (%) Number of subtypes of maltreatment among maltreated group Number of subtypes of maltreatment 0 1 2 3 4 Internalizing symptoms Time 1 Below clinical range Borderline clinical range Meeting clinical range Time 2 Below clinical range Borderline clinical range Meeting clinical range Externalizing symptoms Time 1 Below clinical range Borderline clinical range Meeting clinical range Time 2 Below clinical range Borderline clinical range Meeting clinical range Coping strategies Problem-focused Avoidant Emotion-focused

Mean (SD) 2.07 (.87)

219 (52.6 %) 50 (12 %) 75 (18 %) 43 (10.3 %) 10 (2.4 %) 54.05 (3.83) 367 (88.2 %) 34 (8.17 %) 15 (3.61 %) 53.71 (3.39) 382 (92.0 %) 28 (6.7 %) 5 (1.2 %) 55.50 (5.83) 331 (79.6 %) 44 (10.6 %) 41 (9.9 %) 55.92 (6.12) 317 (78.5 %) 33 (8.17 %) 54 (13.4 %) 3.97 (.99) 3.40 (.87) 3.03 (1.14)

created by averaging the T-scores from 3 scales: somatic symptoms, depression, and anxiety (α = .53). An overall externalizing symptomology T-score was created by averaging the T-scores from 2 scales: aggression and delinquency (α = .80). The TRF was administered during the first year of camp (Time 1) as well as the second year of camp (Time 2). Two counselors rated each child on these measures. Inter-rater reliability for each internalizing and externalizing symptomology was calculated. The intra-class correlation values for these scales range from .81 to .86 for externalizing symptoms and .62–.70 for internalizing symptoms. Analytic plan. We tested whether 3 coping strategies (active, avoidant, and emotion-focused) mediated the effects of maltreatment on internalizing and externalizing symptomology. Structural equation models were tested using AMOS Version 25 (Arbuckle, 2014). All paths were modeled except those connecting avoidant coping to externalizing symptoms at Time 2, internalizing symptoms at Time 1 to externalizing symptoms at Time 2, and externalizing symptoms at Time 1 to internalizing symptoms at Time 2. These paths were not modeled because they had insignificant or weak correlations and removing the paths significantly improved model fit. Missing data were handled using full information maximum likelihood. Rmediation (Tofighi & MacKinnon, 2011) was used to calculate 95 % asymmetric confidence intervals to determine if significant mediation is present. Model fit was evaluated with the chi-square test statistic, comparative fit index (CFI) and root mean square error of approximation (RMSEA). CFI values greater than .95, RMSEA values less than .06, and a nonsignificant chi-square statistic were considered to indicate good model fit (Hu & Bentler, 1999; Yu & Muthén, 2001). 4. Results Descriptives. Descriptive information for the sample can be found in Table 2. The maltreated group experienced a range of number of subtypes (M = 2.07, SD = .87), though few children experienced all 4 subtypes (2.4 % of the whole sample, or 5.6 % of the maltreated group). However, the majority of the maltreated children experienced more than one subtype (71.9 % of the maltreated group). For the TRF ratings, scores below 60 are considered in the normal range, scores between 60–63 are considered in the borderline clinical range, and scores above 63 are in the clinical range (Achenbach, 1994). Most children in the sample were in the normal range for internalizing and externalizing symptoms at both time points. Few children were in the clinical range for internalizing symptoms (3.61 % at Time 1 and 1.2 % at Time 2). However, many more children were in the clinical range for externalizing symptoms (9.9 % at Time 1 and 13.4 % at Time 2). Furthermore, there were no gender differences between coping strategies and thus this variable was excluded from analyses. Correlations among the study variables are presented in Table 3. The number of subtypes variable was overwhelmingly associated with other study variables. Specifically, the maltreatment parameter predominantly predicted increased internalizing and externalizing symptoms at both Time 1 and Time 2. Further, higher number of maltreatment subtypes was significantly correlated with lower levels of problem-focused and higher levels of emotion-focused coping strategies. Avoidant coping strategies were associated 6

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Table 3 Correlations Among Study Variables.

1. 2. 3. 4. 5. 6. 7. 8.

Number of subtypes Internalizing T1 Externalizing T1 Internalizing T2 Externalizing T2 Problem-focused Coping T1 Avoidant Coping T1 Emotion-focused Coping T1

1.

2.

3.

4.

5.

6.

7.

8.

– .280** .255** .216** .186** −.231** −.085 .225**

.280** – .236** .385** .089 −.391** .195** .207**

.255** .236** – .102* .542** −.404** −.343** .448**

.216** .385** .102* – .186** −.243** .107* .051

.186** .089 .542** .186** – −.264** −.235 .324**

−.231** −.291** −.404** −.243** −.264** – .045 −.332**

−.085 .195** −.343** .107* −.235** .045 – −.263**

.225** .207** .448** .051 .324** −.332** −.263** –

Notes: *p < .05; **p < .01; ***p < .001.

with increased internalizing symptoms at Time 2 and decreased externalizing symptoms at Time 2. On the other hand, active coping strategies were associated with decreased internalizing and externalizing symptoms at Time 2. Lastly, emotion-focused coping strategies were not associated with internalizing symptoms at Time 2 but were associated with increased externalizing symptoms at Time 2. Model results. The model including number of maltreatment subtypes (χ2(3) = 4.228, p = .238, CFI = .998, RMSEA = .031) evidenced good model fit. Results from this model are presented in Fig. 1. As expected, number of maltreatment subtypes predicted increased internalizing (b = .28, SE = .18, p < .001) and externalizing symptoms at Time 1 (b = .23, SE = .28, p < .001). However, number of maltreatment subtypes did not predict internalizing (b = .112, SE = .16, p = .053) or externalizing symptoms (b = .031, SE = .26, p = .551) after accounting for symptoms at Time 1. In line with our hypotheses, a greater number of maltreatment subtypes predicted less active coping (b = -.25, SE = .05, p < .001) and more emotion-focused coping (b = .20, SE = .05, p < .001). However, number of maltreatment subtypes did not predict avoidant coping strategies (b = -.07, SE = .04, p = .220). There were no significant associations between active coping and internalizing (b = -.10, SE = .18, p = .067) or externalizing symptoms (b = -.05, SE = .29, p = .315) at Time 2. Furthermore, there were no significant associations between avoidant coping and internalizing (b = .05, SE = .19, p = .337) symptoms at Time 2. There were no significant associations between emotion-focused coping and internalizing at Time 2 (b = -.06, SE = .15, p = .254.); however, emotion-focused coping did predict higher levels of externalizing symptoms at Time 2 (b = .10, SE = .25, p = .039). Therefore, Rmediation (Tofighi & MacKinnon, 2011) was used to calculate 95 % asymmetric confidence intervals and determine if emotion-focused coping strategies mediated the effect of maltreatment on externalizing symptoms at Time 2. Results supported significant mediation (with an indirect effect estimate of 0.023, SE = 0.053; CI: 0.004, 0.23).

5. Discussion The purpose of the current study was to examine the impact of maltreatment on coping strategies and to determine if coping strategies are a mechanism in the pathway between maltreatment and internalizing and externalizing symptoms in school-aged children. The results show that the number of subtypes of maltreatment was associated with increased internalizing and externalizing symptoms. The number of subtypes of maltreatment was also associated with less problem-focused coping and more emotion-focused coping. Emotion-focused coping was found to mediate the effect of maltreatment on externalizing symptoms at Time 2. In line with previous work, maltreatment was associated with increases in internalizing and externalizing symptoms (Cicchetti & Toth, 1995, 2005; Moylan et al., 2010). Specifically, results indicated that as number of subtypes of maltreatment increased, the

Fig. 1. Theoretical model and results for path analysis including number of maltreatment subtypes as the predictor. Numbers reported are standardized beta coefficients for each path. Residual correlations were estimated but not depicted for ease of interpretation. *p < .05; **p < .01; ***p < .001. 7

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likelihood of developing internalizing and externalizing symptoms increased as well. Children who experience multiple types of maltreatment may express more negative developmental outcomes, including mental and physical health outcomes, than children experiencing a single type of maltreatment (Manly, Cicchetti, & Barnett, 1994; Manly, Kim, Rogosch, & Cicchetti, 2001). The current study provided novel results for the impact of maltreatment on the three dimensions of coping strategies. As hypothesized, number of subtypes of maltreatment was associated with increased emotion-focused coping strategies. Further, emotionfocused coping strategies mediated the relationship between number of subtypes of maltreatment and externalizing symptoms, indicating that it is a mechanism for which maltreated children are at increased risk for externalizing symptoms. Maltreated children might be more at risk for developing emotion-focused coping strategies than nonmaltreated children because maltreated children’s caregivers are more likely to respond to stress with emotional responses (including aggression), which in turn might teach children to respond emotionally to their own stressful situations (Crittenden, 1992). It is also possible that children might respond more emotionally to situations because they perceive them to be more hostile than nonmaltreated children. Children experiencing all types of abuse and/or neglect are more likely to make hostile attributions when interacting with others, meaning they misconstrue the actions of others to have negative or aggressive intent (Crick, Grotpeter, & Bigbee, 2002; Price & Glad, 2003; Teisl & Cicchetti, 2008). Therefore, the more hostile a child perceives a situation to be, the more likely they might be to respond with emotion-focused actions (such as aggression or crying). Further, these results support the theory of integrating the AL and ACM models to explain why coping strategies might mediate the pathway between maltreatment and externalizing symptoms (Evans & Kim, 2013; McEwen, 2013; Wadsworth, 2015). Children might respond to a chronically highly stressful situation with increased emotion-focused responses to increase adaptation to that environment. For example, children might respond to incidents of abuse with increased physical aggression toward the perpetrator and this coping strategy will then be utilized in other scenarios. The repeated use of this coping strategy could excessively activate stress response systems, increasing the wear and tear on the body, resulting in increased risk for developing externalizing symptoms. For the same reasons that maltreatment might predict increased emotion-focused coping, it might predict decreased problemfocused coping. Nonmaltreated children have caregivers who have modeled healthier coping strategies than maltreated children’s caregivers (Crittenden, 1992). Previous work has shown that problem-focused coping strategies can act as a buffer against stress (Compas et al., 2001). However, results from the current study showed that problem-focused coping was not associated with decreased internalizing or externalizing symptoms. Though problem-focused coping was correlated with decreased internalizing (r = -.179, p < .01) and externalizing (r = -.210, p < .01) symptoms at Time 2, results are not significant among these variables in the path analysis. Though these strategies might be associated with healthier functioning, perhaps it is more crucial to understand the level of stress children are perceiving when examining mental health outcomes than how they cope with that stress. Even if children are able to cope with stress in constructive ways, the effects of increased stress might nonetheless negatively impact their development. Contrary to our hypothesis, number of subtypes of maltreatment was not associated with avoidant coping. This result is initially surprising, given that previous work has shown that maltreated adults are more likely to employ avoidant strategies than problemfocused coping (Tremblay et al., 1999). However, emotion-focused and avoidant coping were strongly negatively correlated (r = -.51, p < .01), indicating that these coping strategies may not occur within the same individuals. Therefore, because maltreated children were more likely to use emotion-focused coping strategies, these same children may have been less likely to use avoidant coping strategies. Also contrary to our hypotheses, avoidant and problem-focused coping did not significantly influence internalizing or externalizing symptoms or mediate the relationship between number of subtypes of maltreatment and the psychopathology symptoms. Therefore, emotion-focused coping is influential in increasing the likelihood of the development of psychopathology, but problem-focused coping does not act as a protective factor, as previous work has suggested (Compas et al., 2001). Although emotionfocused coping can exacerbate the negative consequences of maltreatment, employing problem-focused coping is not enough to deviate these children from developmental pathways toward psychopathology. However, more work needs to me done to better understand that nature of this pathway. Findings of the present study should be interpreted in light of study limitations. One important limitation is that there was only a one-year time lapse between the mediating variable and the outcome variables. Because the study examined change over time between the outcome variables at Time 1 and Time 2, it would have been meaningful to have a longer period between the two time points, or to have more than two time points to elucidate if coping strategies influence more long-term outcomes. Additionally, children were identified as maltreated or nonmaltreated based on known and identified maltreatment. It is possible, particularly since the nonmaltreated group was at increased risk for maltreatment based on demographic characteristics, that children in this sample could have experienced non-reported maltreatment. Though the current study used the MCS (Barnett et al., 1991), the Maternal Child Maltreatment Interviews (Cicchetti et al., 2003), and checked the child abuse registry to best identify and quantify abuse characteristics, it is difficult to have certainty that the nonmaltreated children in fact had no history of maltreatment. Lastly, all measures were scored by camp counselors, who only interacted with the children at the camp. Although it would be helpful for the scorers to have had more time with the children, and in a more naturalistic setting, by the end of the camp, counselors had spent approximately 35 h with the children. Further, the emotion-focused coping scale had a lower internal consistency (α = .65) than the avoidant coping (α = .72) or problem-focused coping (α = .85) scales. This is likely because the emotion-focused coping scale was made up of two types of coping related to internal responses to stress and two related to external responses. However, because past work had identified the domain of emotion-coping (Compas et al., 2001; Lazarus & Folkman, 1984), these measures were aggregated. Furthermore, while the internal consistency was lower than the others, it was still adequate for us. Also, previous work has shown that assessing internal states are more difficult for observers than assessing external states (Achenbach, McConaughy, & Howell, 1987). In the current study, internal 8

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states are assessed in the form of avoidant coping and internalizing behaviors. While results should be interpreted in light of this limitation, the reliability between raters for these measures was fair (with an ICC of .78 for avoidant coping, and .62–.70 for internalizing behaviors) indicating that the observers’ scores are likely valid. Lastly, it is worth noting that moderately significant associations may occur by chance and this study is limited by the multiple comparisons tested. Despite these limitations, the current study addressed important gaps in research by highlighting the impact maltreatment has on coping strategies and that emotion-focused coping represents a mechanism by which maltreated children are at risk for externalizing behaviors. This has important implications for clinicians, who could integrate reducing emotion-focused coping into intervention efforts for maltreated children. This could be done by rehearsing coping strategies used during stressful scenarios that typically evoke emotion-focused responses. Future work can extend the current study by examining additional developmental outcomes that could be influenced by coping, such as academic performance and physical health. Future work could also explore the pathway between maltreatment and coping to begin to understand why maltreatment may influence what coping strategies children choose to employ when faced with stress. Acknowledgments This research was supported by the Office of Child Abuse and Neglect and the Spunk Fund, Inc., whose generous assistance is gratefully acknowledged. We would also like to thank the children who participated in this study. Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.chiabu.2019. 104323. References Abaied, J. L., & Rudolph, K. D. (2010). 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