The moderating effect of relationships on intergenerational risk for infant neglect by young mothers

Abstract

Infant neglect is the form of child maltreatment that occurs most often, yet has been least amenable to prevention. A maternal history of childhood maltreatment is a potent risk factor for child neglect, yet most maltreated mothers break intergenerational cycles of child abuse and neglect. Little is known about what protective factors support discontinuity in intergenerational transmission. This study examined whether certain factors (positive childhood care, older maternal age, social support) buffer intergenerational risk for neglect among the infants of young mothers, a population at high risk of being victimized. For young mothers in the sample (<21 years at birth; n = 447), the effect of a maternal history was assessed separately for different maltreatment types according to data on substantiated reports from Child Protective Services. Early risk for neglect was assessed using maternal self-report of parenting empathy. The results revealed that both infants and their mothers experienced neglect more often than any other maltreatment type. However, approximately 77% of maltreated mothers broke the cycle with their infants (<30 months). Maternal age moderated the relation between a maternal history of neglect and infant neglect, and social support moderated the relation between childhood neglect and maternal empathy. Neglected mothers had considerably higher levels of parenting empathy when they had frequent access to social support than when they had less frequent support, whereas the protective effect of social support was not nearly as strong for nonmaltreated mothers. Study findings highlight resilience in parenting despite risk for infant neglect, but underscore the context specificity of protective processes.

Introduction

Infant neglect is the most common form of child maltreatment and arguably poses the greatest threat to children's well-being, yet it has received limited public attention (Dubowitz, 2007). In 2012, Child Protective Services (CPS) identified approximately 679,000 children who were victims of abuse and neglect. Over three-quarters (78%) of these children suffered neglect, a figure that far exceeds physical abuse (18%) and sexual abuse (9%) combined (U.S. Department of Health & Human Services, Administration for Children & Families, Children's Bureau, 2013). Children birth to one year have the highest rate of victimization (21 per 1,000 children of the same age in the U.S.) and incur the most serious harm from neglect (Sedlak et al., 2010, U.S. DHAC and FCB, 2013).

Infant exposure to neglect, especially when severe and prolonged, has been found to have adverse and long lasting consequences for children's physical, cognitive, and socioemotional development in ways that are that are distinct from other forms of maltreatment (De Bellis, 2005, Erickson and Egeland, 2002; Hildyard and Wolfe, 2002, Kim and Cicchetti, 2006, Pollak et al., 2010). Exposure to neglect during this sensitive period may undermine neuronal development and limit overall brain growth (De Bellis, 2005), lead to serious health concerns (DePanfilis, 2006, Shonkoff et al., 2009), result in cognitive, academic, and language problems (Erickson & Egeland, 2002), and lead to insecure attachments, poor self-regulation, difficulty with peers, internalizing and externalizing problems, and mental illness (Cyr, Euser, Bakermans-Kranenburg, & Van IJzendoorn, 2010; Kim and Cicchetti, 2006, Erickson and Egeland, 2002). Neglect also causes the majority (70%) of maltreatment-related deaths, half (48%) of which occur before a child's first birthday (U.S. Department of Health & Human Services, Administration for Children & Families, Children's Bureau, 2013).

The perpetrators of child maltreatment are most often parents (80%; U.S. Deparment of Health, Administration for Children & Families, Children's Bureau, 2013), and this is especially true in cases of neglect. An estimated 92% of neglected children are victimized by a biological parent, compared to 64% of abused children (Sedlak et al., 2010). Young mothers, in particular, are at heightened risk for neglecting their offspring (Sidebotham and Golding, 2001, Slack et al., 2004).

We assessed infant neglect using cumulative records from the state CPS agency prenatally until their most recent report at Time 2 data collection (up to May 2011). We utilized a dummy variable for infant neglect by any perpetrator (1 = substantiated report of neglect but no substantiated reports of abuse; 0 = no substantiated reports of maltreatment of any kind). Six cases of physical abuse (with or without neglect) were removed to maintain “clean” maltreatment categories. No other forms of maltreatment (e.g., sexual abuse, emotional abuse, congenital drug addiction) were reported for infants in the study. We coded alternative response cases with a disposition of “concern” as maltreatment when a family received services (n = 2), but “concern” with no services and “no concern” as non-maltreated (n = 1).

Research on the relation between infant maltreatment and maternal age suggests that young mothers are more likely to neglect their infants than are adult mothers (Coley and Chase-Lansdale, 1998, Whitman et al., 2001). Furthermore, the youngest mothers may be at highest risk for neglectful parenting (Stier et al., 1993, Zuravin and DiBlasio, 1992). For example, a study by Stier et al. (1993) found that the rate of neglect was 2.4 times as high for parents under age 18 than for mothers age 19 to 34. Another study by Zuravin and DiBlasio (1992) found higher risk for neglect even when restricting maternal age to the teenage years (18 years or younger at first birth); neglectful adolescent mothers were more likely than their nonmaltreating peers to have had their first child at a younger age. The etiology of infant neglect by young mothers may be explained in part by their lack of developmental preparedness for parenthood, but also by their disproportionate exposure to risk conditions compared to women who delay parenting until adulthood. More than their older counterparts, young mothers tend to endure difficult life circumstances linked to neglect, such as a maternal history of childhood maltreatment, poverty, social isolation, and single parent status, that, when compounded with their immaturity, may compromise their ability to demonstrate empathy and provide adequate care (Borkowski et al., 2007, Goldman and Salus, 2003, Slack et al., 2004).

Prominent theories on child maltreatment, including ecological systems approaches, explain infant neglect as a consequence of dynamic transactions among children, young parents, and their environments (Belsky, 1993, Cicchetti and Lynch, 1993). This view also is reflected in Relational Developmental Systems theories (Lerner et al., 2013, Overton, 2013) that consider multiple aspects of a developmental system (e.g., individual history, social relationships, and environmental context). The ontogeny of social relationships appears to play a prominent role in such approaches. A mother's experiences of childhood positive care and maltreatment influence her affective and cognitive interpretations of her parenting role, as well as her interactions with her current social context. Maltreated mothers have smaller and less satisfying social support networks (Vranceanu, Hobfoll, & Johnson, 2007) and are more likely to experience higher levels of parenting stress and to maltreat their offspring (Deater-Deckard, 2004, Gaudin, 2001).

Understanding how such risk factors are implicated in the etiology of neglect is only half of the picture, however. A resilience framework, defining resilience as “positive adaptation within the context of significant adversity” (Luthar, Cicchetti, & Becker, 2000, p. 543), offers a complimentary perspective, in which interventionists and policymakers seek to understand how to offset risk for neglect (Masten and Powell, 2003, Werner, 2000). At present, the empirical literature on infant maltreatment is replete with findings on maladaptive parenting in high-risk contexts rather than successful parenting under similar conditions. This approach unnecessarily limits prevention research to identifying risks to be ameliorated rather than avenues for promoting healthy parenting. For example, the majority of maltreatment researchers emphasize continuity versus discontinuity in intergenerational transmission of maltreatment, despite the fact that most parents break these cycles (Kaufman and Zigler, 1987, Ertem et al., 2000).

The study of intergenerational cycles of maltreatment has garnered considerable interest from researchers (Ertem et al., 2000, Kaufman and Zigler, 1987, Thornberry et al., 2012), including recent attention from investigators interested in adolescent parenting (Borkowski et al., 2007, Dixon et al., 2009). The theoretical underpinning is that exposure to maltreatment in childhood increases the odds that an individual will become a perpetrator as an adult, through insecure attachments and dysfunctional internal working models of relationships (Bowlby, 1977), learned behaviors (Bandura, 1973), or a “cascade” effect, in which maltreatment disturbs key developmental processes that negatively affect relational competence over time (Masten & Cicchetti, 2010). However, the field currently lacks universal agreement on the extent of intergenerational transmission (Kaufman and Zigler, 1987, Pears and Capaldi, 2001, Thornberry et al., 2012). Some critics have noted that few studies are methodologically rigorous, and actual continuity may be lower than Kaufman and Zigler's (1987) widely cited estimate of 30% (Ertem et al., 2000, Thornberry et al., 2012). The controversy surrounding intergenerational cycles suggests the need for more refined research. For example, studies rarely distinguish neglect from abuse in each generation, or delineate findings by age of the child or parent (Bartlett & Easterbrooks, 2012).

The extent of intergenerational continuity may be unclear, but most researchers agree that discontinuity is the most common outcome (Kaufman and Zigler, 1987, Ertem et al., 2000, Thornberry et al., 2012). Prospective longitudinal investigations have shown only modest correlations across generations (Conger, McCarty, Yang, Lahey, & Burgess, 2009). Identifying moderators of transmission is a promising place to begin to understand the processes that underlie discontinuity and can inform prevention (Berlin et al., 2011, Dixon et al., 2005a, Dixon et al., 2005b).

In recent years, resilience-based research has begun to elucidate protective factors that reduce child maltreatment, including nurturing attachments, knowledge about parenting and child development, concrete supports, parental resilience, and social connections (Children's Bureau, Child Welfare Information Gateway, FRIENDS National Resource Center for Community-Based Child Abuse Prevention, & the Center for the Study of Social Policy, 2011). Nevertheless, little is known about which of these factors moderate intergenerational cycles of maltreatment and reduce risk for infant neglect more specifically. Several decades of research on protective factors suggests that positive relationships with caregivers, family members, and other members of social support networks increase the odds that individuals will interact with their offspring in sensitive and empathetic ways (Werner, 2000). A reasonable inference from this literature, then, is that these factors may play a key role in explaining why a parental history of childhood maltreatment increases the chances for, yet does not guarantee, maltreatment in the next generation (Ertem et al., 2000, Kaufman and Zigler, 1987).

The small number of studies that examine a parent's childhood history of maltreatment as a risk factor for infant neglect implicate social and financial protective factors in particular (Belsky et al., 2009, Dixon et al., 2009). Dixon et al. (2009) determined that the presence of social support and financial solvency distinguished “cycle breakers” from families referred to CPS. Egeland and colleagues (e.g., Egeland, Jacobvitz, & Sroufe, 1988) showed that nonrepeating parents were more likely to have: had a supportive parent, experienced fewer stressful events, participated in psychotherapy, had a supportive intimate relationship, and exhibited a conscious resolve not to repeat negative patterns. More recently, Bartlett and Easterbrooks (2012) found that when mothers reported physical abuse and also positive care in childhood, they were not at increased risk for neglect, suggesting a compensatory effect of nurturing parenting in the context of an abusive childhood. Taken together, the literature indicates that supportive relationships may be a key factor in ending cycles of child maltreatment related to neglect (Dixon et al., 2005a, Dixon et al., 2005b; Dixon et al., 2009, Egeland et al., 1988, Kaufman and Zigler, 1987).

Beginning at birth, and perhaps even before, individuals are embedded in social and caregiving systems (Winnicott, 1965). Consequently, relationships with others in these systems exert influence on individual development (Chase-Lansdale & Brooks-Gunn, 1994) and impact parenting in the next generation (Vondra & Belsky, 1993). However, the nature of relationships in childhood (e.g., nurturing, abusive, neglectful) and social support (e.g., quantity, quality, type) are as consequential to parenting as are their presence or absence (Coley and Chase-Lansdale, 1998, Voight et al., 1996). Lieberman, Padrón, van Horn, and Harris (2005) suggested that children who experience maltreatment “may be able to register simultaneously the ‘bad’ and the ‘good’ parts of their parents” (p. 512) and subsequently repeat positive care receiving experiences within parent–child interactions in the present. From this vantage point, discontinuity in intergenerational cycles of maltreatment may be partially explained by the presence of nurturing relational experiences that a mother can draw upon to formulate more adaptive caregiving strategies with her own child. Since mothers’ perceptions of the care they received early in life may differentiate neglectful parents from nonmaltreating parents (Gaudin, 2001), incorporating maternal perceptions of positive care into explanatory models of transmission may be useful.

Support received in the context of healthy relationships, whether from family members, informal social networks, or service providers and formal programs, enhances young mothers’ overall well-being and maternal functioning (Leadbeater & Linares, 1992). Adequate social support is associated with less parental stress and depression, and greater parental sensitivity; thus, it may be a key factor in counteracting risk for infant neglect (Gaudin, 2001, Li et al., 2010, Whitman et al., 2001, Zolotor and Runyan, 2006) and in distinguishing young mothers who break cycles of maltreatment from those who do not (Dixon et al., 2009). The buffering model of social support (Armstrong, Birnie-Lefcovitch, & Ungar, 2005), the notion that “social support protects individuals from the potentially harmful effects of stressful events” (p. 272), is widely embraced by maltreatment policymakers, researchers, and interventionists, yet it is based on a surprisingly unrefined empirical literature (Thompson, 1995). The role of social support in preventing child neglect is complex (Gaudin, 2001, Li et al., 2010), and this study seeks to identify particular relational mechanisms of protection that moderate cycles of maltreatment leading to infant neglect, and to begin to explain how they operate in young families’ lives.

Researchers do not yet have conceptual clarity with regard to definition and operationalization of infant neglect, and inconsistencies in the literature have made research and cross-study comparison difficult (Dubowitz, 2007). Just what constitutes neglect is perhaps more vague than for other forms of maltreatment because it is frequently evidenced by an act of omission rather than a prominent parental behavior or visible injury. As a result, neglect is greatly underreported and not well-examined (DePanfilis, 2006). One of the most hotly debated issues related to identifying neglect is what source of information to use. Data from CPS have a number of advantages—they are routinely collected, widely available, and identify cases in which neglect is highly likely to have occurred. However, CPS data miss up to half of actual instances that occur (Cross and Casanueva, 2009, Dubowitz et al., 2005) and represent a conservative estimate. Assessment of early risk for maltreatment may help to identify children who are not reported to CPS. Research suggests that parental lack of empathy may be related to early neglect risk (de Paúl and Guibert, 2008, Shahar, 2001).

Several researchers have found that a parental lack of empathy is associated with child neglect (Lounds et al., 2006, Schatz and Lounds, 2007, Shahar, 2001), and that sensitive, empathetic mothering is “woefully lacking in the caregiving environments of maltreated infants” (Cicchetti, Rogosch, Toth, & Sturge-Apple, 2011, p. 789). Neglectful mothers are less able to “read” and respond to their babies’ emotional cues or to engage in emotional perspective taking (Dubowitz et al., 2005), and they are less expressive, offer little exchange of emotional information, and acknowledge their children less than do non-maltreating mothers (Gaudin, Polansky, Kilpatrick, & Shilton, 1996). This may reflect an inability to empathize with their children (de Paúl & Guibert, 2008). Adolescent parents, in particular, lack empathy in interactions with their babies (Schatz and Lounds, 2007, Shahar, 2001) and may be especially unlikely to pick up on and respond to an infant's needs when they have been maltreatment victims (Leerkes, Crockenberg, & Burrous, 2004).

The aim of the present study was to investigate the effect of relationships and maternal age on intergenerational risk for neglect in a high-risk sample—adolescent mothers with infants. Specifically, we examined whether positive care in childhood, social support while parenting, and older maternal age at birth moderated the association between young mothers’ childhood history of abuse and neglect and neglect of their own infants. Because a prevention-based approach to research suggests that early indicators of risk also require attention, we also examined maternal lack of empathy as a correlate of infant neglect risk. In light of prior findings (Ertem et al., 2000, Thornberry et al., 2012), we expected that a maternal history of childhood maltreatment would be associated with more likelihood of infant neglect and less likelihood of parental empathy, but that the majority of mothers who were victims of childhood maltreatment would not neglect their children. We also hypothesized that older age, positive childhood care, and access to frequent, reliable social support would moderate cycles leading to infant neglect.