Desmond K. Runyan, MD, DrPHDesmond K. Runyan, MD, DrPHJonathan Kotch, Terri Lewis, Jamie Jonathan Kotch, Terri Lewis, Jamie

SmithSmithUniversity of North Carolina at Chapel University of North Carolina at Chapel

HillHillRichard Thompson Richard Thompson

Juvenile Protective AssociationJuvenile Protective Association

Listening to Children: Listening to Children: What do 12 year olds tell What do 12 year olds tell

us about their us about their psychological psychological maltreatmentmaltreatment??

Listening to Children: Listening to Children: What do 12 year olds tell What do 12 year olds tell

us about their us about their psychological psychological maltreatmentmaltreatment??

AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

• U.S. Department of Health and Human U.S. Department of Health and Human Services Services Administration for Children, Youth, and Administration for Children, Youth, and Families Families Children's Bureau Children's Bureau Office on Child Abuse and Neglect Office on Child Abuse and Neglect

• U.S. Department of Health and Human U.S. Department of Health and Human Services Services National Institutes of Health National Institutes of Health National Institute of Child Health and Human National Institute of Child Health and Human Development   Development  

BackgroundBackgroundBackgroundBackground

• LONGSCAN (LONGSCAN (LongLongitudinal itudinal SStudies on tudies on CChild hild AAbuse and buse and NNeglect) a consortium eglect) a consortium of 5 longitudinal studies of of 5 longitudinal studies of maltreatment maltreatment

• Data on maltreatment from multiple Data on maltreatment from multiple sources sources Parent report on discipline at age 8Parent report on discipline at age 8 CPS record reviews at two year CPS record reviews at two year

intervalsintervals At Age 12, children asked about their At Age 12, children asked about their

abuse histories. abuse histories.

Research QuestionsResearch QuestionsResearch QuestionsResearch Questions

• What is the impact of What is the impact of psychological maltreatment on psychological maltreatment on child mental health status?child mental health status? Outcomes as reported by children Outcomes as reported by children Outcomes as reported by Outcomes as reported by

caregivers?caregivers?

SampleSampleSampleSample

• LONGSCAN subjects from all 5 sitesLONGSCAN subjects from all 5 sites

• Child completing an Age 12 Child completing an Age 12 InterviewInterview

• CComplete data on the Self-Report of omplete data on the Self-Report of Abuse MeasureAbuse Measure

• Sample Sample NN = 851 = 851

Sample DemographicsSample DemographicsSample DemographicsSample DemographicsMean Age:Mean Age:

• 12.4 years (SD = 0.44)12.4 years (SD = 0.44)

GenderGender::• 49.7% Boys; 50.3% Girls49.7% Boys; 50.3% Girls

RaceRace: : • 27.1% White; 54.3% Black; 18.6% 27.1% White; 54.3% Black; 18.6% Other Other

Site:Site: • 12% Midwestern12% Midwestern• 22% Eastern 22% Eastern • 19% Southern 19% Southern • 26% Southwestern 26% Southwestern • 21% Northwestern21% Northwestern

Independent VariablesIndependent VariablesIndependent VariablesIndependent Variables

• Exposure to emotional maltreatment Exposure to emotional maltreatment was was determined by:determined by:

Reviews of child protective service Reviews of child protective service (CPS) reports.(CPS) reports.

Using a project developed Using a project developed instrument that addressed instrument that addressed terrorizing, threaten abandonment, terrorizing, threaten abandonment, humiliation, shame, and other humiliation, shame, and other hurtful events.hurtful events.

Child Protective Services Child Protective Services ReportsReports

Child Protective Services Child Protective Services ReportsReports

• Abstraction of CPS narratives using a Abstraction of CPS narratives using a Modified Maltreatment Coding System: Modified Maltreatment Coding System: Adaptation of system developed by Adaptation of system developed by

Barnett, Manly & Cicchetti. Barnett, Manly & Cicchetti. • # of Psychological Maltreatment # of Psychological Maltreatment

Allegations through Age 12 (Allegations through Age 12 (MM = 0.79, = 0.79, SD = 1.53). SD = 1.53).

• 34% (n = 293) children had at least one 34% (n = 293) children had at least one psychological maltreatment allegation.psychological maltreatment allegation.

Child Self-Report of AbuseChild Self-Report of AbuseChild Self-Report of AbuseChild Self-Report of Abuse• Adolescent participants are asked about their Adolescent participants are asked about their

maltreatment experiences at the age 12 maltreatment experiences at the age 12 interview.interview.

• The LONGSCAN self-report of abuse measure The LONGSCAN self-report of abuse measure 3 modules assessing lifetime experience of 3 modules assessing lifetime experience of

abuse abuse A-CASI (audio-computer assisted self A-CASI (audio-computer assisted self

interview).interview).• 18 Psychological Maltreatment items (n = 18) - 18 Psychological Maltreatment items (n = 18) -

items listed on next slide. items listed on next slide. • Items were summed to create a Psychological Items were summed to create a Psychological

Maltreatment Score (Maltreatment Score (MM = 1.2, SD = 2.2). = 1.2, SD = 2.2).• 40% (n = 343) of participants endorsed one or 40% (n = 343) of participants endorsed one or

more psychological maltreatment items.more psychological maltreatment items.

Self-Report of Psychological Self-Report of Psychological Maltreatment Items Maltreatment Items

(example items)(example items)

Self-Report of Psychological Self-Report of Psychological Maltreatment Items Maltreatment Items

(example items)(example items)Has any parent…Has any parent…

•ever made you feel that you ever made you feel that you couldn’t do anything right, no couldn’t do anything right, no matter how hard you tried?matter how hard you tried?

•ever punished you in an unusual ever punished you in an unusual way-like tying you up, or locking way-like tying you up, or locking you in a closet?you in a closet?

•ever threatened to hurt you badly?ever threatened to hurt you badly?•ever threatened to kill you?ever threatened to kill you?•ever threatened to kick you out of ever threatened to kick you out of your home, or to have you taken your home, or to have you taken away?away?

Dependent VariablesDependent VariablesDependent VariablesDependent Variables• Child Behavior Checklist Child Behavior Checklist

internalizing, externalizing, and internalizing, externalizing, and total problems T scores.total problems T scores.

• Youth Self-ReportYouth Self-Report internalizing, externalizing, & internalizing, externalizing, &

total T scores.total T scores.• Trauma Symptom Checklist for Trauma Symptom Checklist for

ChildrenChildren anxiety, anger, & depression T anxiety, anger, & depression T

scores.scores.

Child Behavior Checklist Child Behavior Checklist (CBCL)(CBCL)

Child Behavior Checklist Child Behavior Checklist (CBCL)(CBCL)

• Parent report of child Parent report of child competencies & behaviorcompetencies & behavior

• 113 item checklist, problem 113 item checklist, problem behavior itemsbehavior items

• Answer set from 0 (not true) to 2 Answer set from 0 (not true) to 2 (very true or often true) indicates (very true or often true) indicates behaviorbehavior

• Higher scores = increased Higher scores = increased behavior problemsbehavior problems

• LONGSCAN Age 12 InterviewLONGSCAN Age 12 Interview

Distribution of CBCL T Distribution of CBCL T ScoresScores

Distribution of CBCL T Distribution of CBCL T ScoresScores

020406080100120140160

Obs

30 35 40 45 50 55 60 65 70 75 80 85

Internalizing

020406080100120140160180

Obs

30 35 40 45 50 55 60 65 70 75 80 85 90

Externalizing

020406080100120140

Obs

25 30 35 40 45 50 55 60 65 70 75 80 85 90

Total Problems

M = 51.3SD = 11.0

23% (n = 191) Borderline/ Clinical Range (>=60)

M = 55.2SD = 11.1

35% (n = 290) Borderline/ Clinical Range (>=60)

M = 53.9SD = 11.7

32% (n = 269) Borderline/ Clinical Range (>=60)

Youth Self Report (YSR)Youth Self Report (YSR)Youth Self Report (YSR)Youth Self Report (YSR)

• Child report of child Child report of child competencies & behaviorcompetencies & behavior

• 113 item checklist, problem 113 item checklist, problem behavior itemsbehavior items

• Answer set from 0 (not true) to 2 Answer set from 0 (not true) to 2 (very true or often true) indicates (very true or often true) indicates behaviorbehavior

• Higher scores = increased Higher scores = increased behavior problemsbehavior problems

• LONGSCAN Age 12 InterviewLONGSCAN Age 12 Interview

Distribution of YSR T Distribution of YSR T ScoresScores

Distribution of YSR T Distribution of YSR T ScoresScores

020406080100120140160180

Obs

25 30 35 40 45 50 55 60 65 70 75 80 85 90 95

Internalizing

020406080100120140160

Obs

25 30 35 40 45 50 55 60 65 70 75 80 85 90

Externalizing

020406080100120140160

Obs

25 30 35 40 45 50 55 60 65 70 75 80 85 90

Total Problems

M = 48.6SD = 9.9

13% (n = 110) Borderline/ Clinical Range (>=60)

M = 48.0SD = 10.7

13% (n = 111) Borderline/ Clinical Range (>=60)

M = 49.5SD = 10.6

18% (n = 153) Borderline/ Clinical Range (>=60)

Trauma Symptom Checklist Trauma Symptom Checklist (TSC)(TSC)

Trauma Symptom Checklist Trauma Symptom Checklist (TSC)(TSC)

• 44 item symptom checklist, five 44 item symptom checklist, five subscales: anxiety, depression, post-subscales: anxiety, depression, post-traumatic stress, dissociation, & anger.traumatic stress, dissociation, & anger.

• Answer set of 0 (never) to 3 (almost all the Answer set of 0 (never) to 3 (almost all the time) indicates frequency of each time) indicates frequency of each symptom symptom

• Higher scores indicate increased Higher scores indicate increased symptoms.symptoms.

• Child report, LONGSCAN Age 12 InterviewChild report, LONGSCAN Age 12 InterviewT scores used in the analysis:T scores used in the analysis:

AnxietyAnxiety AngerAnger DepressionDepression

Distribution of TSC T Distribution of TSC T ScoresScores

Distribution of TSC T Distribution of TSC T ScoresScores

0

50

100

150

200

250300

Obs

30 35 40 45 50 55 60 65 70 75 80 85 90 95100

Anxiety

050100150200250300350

Obs

35 40 45 50 55 60 65 70 75 80 85

Anger

0

50

100

150

200

Obs

30 35 40 45 50 55 60 65 70 75 80 85 90 95

Depression

M = 41.2SD = 9.5

2% (n = 19) Borderline/ Clinical Range (>=65)

M = 40.5SD = 8.0

2% (n = 18) Borderline/ Clinical Range (>=65)

M = 39.8SD = 8.7

2% (n = 17) Borderline/ Clinical Range (>=65)

Analysis PlanAnalysis PlanAnalysis PlanAnalysis Plan

• Correlations between Correlations between Independent and Dependent Independent and Dependent Variables.Variables.

• Regression analyses predicting Regression analyses predicting Child Functioning (CBCL, YSR, Child Functioning (CBCL, YSR, TSC T scores).TSC T scores).

CorrelationsCorrelationsCorrelationsCorrelations# of CPS

Psychological Abuse

Allegations

Sum Score for Child Self-Report of

Psychological Maltreatment

Child Behavior Checklist (n=830) Internalizing .12*** .14*** Externalizing .17*** .16*** Total Problems .16*** .16***Youth Self Report (n=837)

Internalizing .06* .33*** Externalizing .10** .33*** Total Problems .09** .37***Trauma Symptom Checklist (n=823) Anxiety .03 .30*** Anger .00 .40*** Depression .04 .39**** p < .05 ** p < .01 *** * p < .05 ** p < .01 *** p < .001p < .001

Internalizing

Externalizing

Tot Problems

Std B Std B Std B

Gender (Fem=0, Male=1)

.05 -.02 .00

Race (Other=0, White=1)

.10** .01 .06

Midwestern Site -.07 -.15*** -.13**Eastern Site -.10* -.09 -.09*Southern Site -.04 -.06 -.04Southwestern Site -.05 .01 .00CPS Psychological Abuse Allegations

.07 .10** .09*

Child Self-Report of Psychological Maltreatment

.13*** .13*** .14***

R2 .06*** .08*** .08***

Regression Analysis Predicting Regression Analysis Predicting CBCL T ScoresCBCL T Scores

Regression Analysis Predicting Regression Analysis Predicting CBCL T ScoresCBCL T Scores

* p < .05 ** p < .01 *** * p < .05 ** p < .01 *** p < .001p < .001

Internalizing

Externalizing

Tot Problems

Std B Std B Std B

Gender (Fem=0, Male=1)

.02 -.05 -.03

Race (Other=0, White=1)

.01 .00 .02

Midwestern Site -.02 -.02 -.02Eastern Site -.03 -.12** -.08Southern Site -.00 -.03 -.04Southwestern Site -.04 -.00 -.05CPS Psychological Abuse Allegations

.04 .04 -.04

Child Self-Report of Psychological Maltreatment

.33*** .32*** .36***

R2 .10*** .13*** .15***

Regression Analysis Predicting Regression Analysis Predicting YSR T Scores YSR T Scores Regression Analysis Predicting Regression Analysis Predicting YSR T Scores YSR T Scores

* p < .05 ** p < .01 *** * p < .05 ** p < .01 *** p < .001p < .001

Anxiety Anger Depression

Std B Std B Std B

Gender (Fem=0, Male=1)

-.01 .07* -.08**

Race (Other=0, White=1)

.04 -.01 .05

Midwestern Site .01 .00 -.01Eastern Site .03 .08 .06Southern Site .05 .10* .06Southwestern Site .07 .02 .07CPS Psychological Abuse Allegations

.00 .00 .01

Child Self-Report of Psychological Maltreatment

.29*** .40*** .37***

R2 .10*** .18*** .17***

Regression Analysis Predicting Regression Analysis Predicting TSC T Scores TSC T Scores Regression Analysis Predicting Regression Analysis Predicting TSC T Scores TSC T Scores

* p < .05 ** p < .01 *** * p < .05 ** p < .01 *** p < .001p < .001

DiscussionDiscussionDiscussionDiscussion

• The correlations between parent The correlations between parent reported outcomes and either reported outcomes and either CPS or self-reported CPS or self-reported psychological maltreatment were psychological maltreatment were low but significant.low but significant.

• The correlations between the The correlations between the child report of outcomes & child child report of outcomes & child report of psychological report of psychological maltreatment were large & maltreatment were large & significant.significant.

Discussion (cont.)Discussion (cont.)Discussion (cont.)Discussion (cont.)• In analyses controlled for site and In analyses controlled for site and

gender, self-reported psychological gender, self-reported psychological maltreatment predicted most of the maltreatment predicted most of the variation in child outcome.variation in child outcome.

• In analyses controlled for study site In analyses controlled for study site and gender, CPS allegations and gender, CPS allegations containing reports of psychological containing reports of psychological maltreatment explain almost none maltreatment explain almost none of the variance in child outcome.of the variance in child outcome.

ConclusionsConclusionsConclusionsConclusions• Our MMCS coding system captures Our MMCS coding system captures

allegations of psychological abuse.allegations of psychological abuse.• Official reports of psychological abuse Official reports of psychological abuse

pale in comparison to the psychological pale in comparison to the psychological maltreatment reported by children.maltreatment reported by children.

• Psychological maltreatment has Psychological maltreatment has profound effects on children that would profound effects on children that would be missed if we relied upon official be missed if we relied upon official reports.reports.

• We need to ask the childrenWe need to ask the children• For more information, visit our website For more information, visit our website

at at http://www.iprc.unc.edu/longscan/http://www.iprc.unc.edu/longscan/