Multiple Aspects of Maltreatment: Moving Toward a Holistic Framework

Abstract

The ways that researchers define and categorize maltreatment experiences determine both the priorities and scope of scholarly work in the field. In this chapter we review extant literature on maltreatment experiences and consider the benefits and limitations of the current focus on discrete types of maltreatment (i.e., physical abuse, sexual abuse, emotional abuse and neglect). We then offer suggestions for moving prevention efforts beyond the focus on individual maltreatment experiences to more broadly address the complex nature of early adversity. We consider the need for research identifying the meaningful ways in which maltreatment experiences overlap and suggest promising research methodology. We further suggest that the field would benefit from a more holistic preventative framework anchored by a public health model of primary, secondary, and tertiary prevention.

We would like to acknowledge Bart Klika’s contribution to the writing of this chapter.

Reflection: Research on Subtypes of Child Maltreatment and Their Co-occurrence

• Todd I. Herrenkohl 

1. University of Washington,, Seattle, , WA, , USA

   Todd I. Herrenkohl

Following researchers of an earlier generation, I have spent much of the past 20 years studying the life-course patterns of individuals who experienced child maltreatment, with a particular interest in how these individuals cope with and rebound from early adversity. Having been trained in prevention science, I have always held the belief that our primary objective as researchers should be to produce findings that translate very directly to actionable steps for program planning. It is through this lens that I review and critique others’ research, and reflect on my own.

What follows is a brief essay on what we know about subtypes of child maltreatment, based largely on a review of literature in which colleagues and I point to inconsistencies in published studies. In our review, we looked at how other researchers approached the task of measuring and analyzing the different subtypes of child abuse (e.g., physical, emotional, and sexual) and neglect. We also looked at findings on the co-occurrence of these subtypes, or the degree to which they overlap. What we found is what most in the field now assume—and have come to understand from documented life histories of individuals who have grown up in abusive home environments—that subtypes do indeed overlap and the more severe and frequent the abuse of one or any form, the more damage inflicted on the individual. However, questions of how and to what extent subtypes overlap in the studies we reviewed are not simply answered. To some extent, what the findings communicated to us is that the answers depend on the choices made in the research process.

The numbers tell the story: In our review, we found that estimates of the co-occurrence of abuse subtypes ranged from around 33 % to 94 % across samples, even when data used in studies were culled from a single data source, such as child welfare records. When more than one data source was used, estimates of the co-occurrence among subtypes varied even more. How the subtypes were measured and whether the variables factored in qualities of an abusive experience—such as whether the abuse was more or less severe—added even more variability.

Another approach to examining questions about co-occurrence is to look at what percentage of individuals exposed to one form of abuse or neglect report exposure to another form. Dong and colleagues (2004) found that rate of co-occurrence varied considerably depending on which subtype was considered first. Among those who reported first that they had been emotionally abused, for example, over 80 % reported they had also been physically abused and about 59 % also reported being emotionally or physically neglected. Interestingly, when sexual abuse was considered first, the overlap with other forms of abuse was much lower—in the range of 20–40 %.

Pointing to the variability and apparent inconsistencies in the data sources and strategies used by researchers is not to imply the findings have no meaning or lack scientific rigor. It is more to suggest that what we know about issues like child abuse subtypes and their covariation is influenced sometimes notably by how researchers choose to study the issue. The take-home message in all of this, it then seems, is that rather than layering new findings on old, we need to first take a step back and ask fundamental questions about how best to study the issue—to question the choices behind a method and to assess whether the method aligns (or not) with those used in other studies. Ultimately, if the goal is to improve practice (as I believe it should be), new research findings are only helpful if they advance what we already know.

The more that is learned about how and to what extent subtypes of maltreatment add to the burden of risk for outcomes like adult depression and cardiovascular disease, which are costly yet increasingly preventable, the better positioned we in the field will be to tailor intervention programs to the very particular needs of individuals, families, and their ethnic and cultural groups. Researchers can help further that goal by continuing to drill down to the underlying patterns and mechanisms of risk that characterize the lived experiences of maltreated children, while all the time remaining mindful of the need to constantly refine, iterate, and standardize our research strategies so that results from studies, like those on child abuse subtypes, are more directly comparable, replicable, and usable in the real world.