ReviewIntergenerational effects of childhood maltreatment: A systematic review of the parenting practices of adult survivors of childhood abuse, neglect, and violence
Introduction
The impact of childhood abuse, neglect, and violence exposure on adult physical and emotional health and behaviors is significant and well documented (Anda et al., 2006; Hughes et al., 2017; Norman et al., 2012; Widom, Czaja, Bentley, & Johnson, 2012) including increases in the rate of PTSD, depression, and other mental health disorders; substance use; obesity; risky health behaviors; perceived stress and difficulty controlling one’s anger; and physical health problems (Anda et al., 2006; Widom, Horan, & Brzustowicz, 2015). Given the strong impact on adults’ affective and behavioral responses, it is not surprising that growing evidence suggests that childhood maltreatment experiences also affect parenting practices (Savage, Tarabulsy, Pearson, Collin-Vézina, & Gagné, 2019). While much of the literature focuses on the intergenerational transmission of abusive parenting practices, a growing body of research investigates associations with other parenting outcomes – both positive and negative. The goal of the current review is to examine associations among childhood maltreatment experiences (defined here as physical, sexual, or emotional abuse and neglect, and witnessing violence) and this full range of parenting behaviors. Doing so will shed light on the varied ways that the effects of parents’ childhood maltreatment experiences have an impact on their children in the next generation and inform the ways in which clinicians intervene to support children and families.
Given the significant toll that child maltreatment inflicts on its victims, there has been much interest in the intergenerational transmission of maltreatment, also referred to as the “cycle of violence,” or whether or not a parent’s experience of childhood maltreatment increases the risk that his or her child will also be maltreated, and thus perpetuate the harm. Child maltreatment has been operationalized over the years in numerous ways in the clinical and research literatures (Gardner, Thomas, & Erskine, 2019; Humphreys et al., 2020; Valentine, Acuff, Freeman, & Andreas, 1984). However, there is growing definitional consensus among recent studies and reviews consistent with the World Health Organization’s characterization, which describes child maltreatment as “all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power. Exposure to intimate partner violence is also sometimes included as a form of child maltreatment” (World Health Organization, 2016). Thus, within the context of this review, childhood maltreatment is characterized as the experience of physical, sexual or emotional abuse and/or neglect, as well as witnessing family violence.
Several narrative reviews over the past 30 years have evaluated the literature that addresses this question, frequently noting the limited methodological rigor of the contributing studies (e.g., Kaufman & Zigler, 1987; Ertem, Leventhal, and Dobbs, 2000; Thornberry, Knight, & Lovegrove, 2012). Thornberry et al. (2012), for example, evaluated 47 studies against a standard of 11 methodological criteria and noted significant shortcomings in the methodology of most of the studies, including an overwhelming reliance on retrospective recall of parental maltreatment, clinical rather than representative samples, and short follow-up periods to assess the child generation’s maltreatment experiences. The authors assessed that there was insufficient evidence to draw a firm conclusion regarding the cycle of maltreatment. Recently, Madigan et al. (2019) found modest associations (k = 80, d = 0.45, 95% CI [0.37, 0.54]) in a large, meta-analytic review of this body of literature and identified a moderating effect of methodological quality among the studies examining physical abuse (b = -.051, p < .05), for which the effect size decreased as methodological rigor increased.
In addition to the methodological shortcomings noted above, inconsistency in the definition of intergenerational trauma also contributes to the challenge of navigating this body of literature. Specifically, the literature tends to incorporate conceptualizations of intergenerational maltreatment that reflect the second generations’ maltreatment either including (1) experiences that occur at the hands of any adult (what Madigan et al. (2019) refers to as victim-to-victim transmission) or (2) only that which occurs at the hands of the maltreated parent (victim-to-perpetrator transmission). Although studies utilizing each of these definitions are often pooled together, conceptually they are distinct, though there may be overlap in risk factors. We are interested in examining the range of parenting behaviors in which adults who were maltreated as children engage, and therefore within the abusive parenting category of this review we include only studies examining victim-to-perpetrator transmission.
Given the modest associations in support of the cycle of maltreatment, a synthesis is also needed of the literature that examines the impact of childhood maltreatment on a wider range of parenting behaviors, spanning from behaviors that are problematic but not abusive, to lower levels of behaviors more typically considered positive. Compromised parenting behaviors (such as role reversal and rejecting, controlling, permissive, or intrusive behaviors) and reduced positive parenting behaviors (such as decreased use of consistent discipline or limit-setting) are likely much more common outcomes, given evidence that the majority of adults maltreated as children do not perpetrate maltreatment with their own children (Augustyn, Thornberry, & Henry, 2019; Egeland, Jacobvitz, & Sroufe, 1988; Kaufman & Zigler, 1987). Though less extreme than maltreatment, these other forms of compromised parenting are also associated with increased risk for negative social, emotional, and behavioral outcomes among children (Gershoff, Lansford, Sexton, Davis-Kean, & Sameroff, 2012; Kawabata, Alink, Tseng, van IJzendoorn, & Crick, 2011; Pinquart, 2017; Prevatt, 2003). In a small subset of studies, problematic but non-abusive parenting practices or characteristics (e.g., hostility or low parenting confidence) have been found to mediate the association between maternal childhood maltreatment and child psychopathology (Plant et al., 2017).
While negative parenting outcomes are most frequently examined, reduced positive parenting outcomes can also have detrimental effects on children (Kawabata et al., 2011; Serbin, Kingdon, Ruttle, & Stack, 2015; Stormshak, Bierman, McMahon, & Lengua, 2000). Although parenting behaviors occur on a continuum of more or less competent skills, the limited use of positive strategies and sensitive interactions should not be equated with the use of negative parenting behaviors, and vice versa. Parents’ childhood maltreatment experiences may affect one category of parenting behaviors but not the other, reflecting differing developmental processes. Therefore, they should be examined separately. Finally, given the well-documented benefits and protective effects of positive parenting on child outcomes (Eshel, Daelmans, Cabral De Mello, & Martines, 2006; Pettit, Bates, & Dodge, 1997; Sandler, Ingram, Wolchik, Tein, & Winslow, 2015), a close examination of its association with parents’ childhood experiences is warranted.
A recent meta-analysis (Savage et al., 2019) examined the association between childhood maltreatment and subsequent parenting among 32 studies of mothers of children ages 0 to 6 years old. Parenting outcome measures were categorized into positive, negative or potentially abusive, and relationship-based (e.g., bonding). A small association between childhood maltreatment and parenting was found to be moderated by the type of parenting examined, with the weakest effects for positive parenting (r = -.07) and stronger, but still small, effects for negative and relationship-based parenting behaviors (r = -.15 and -.20 respectively). While this review examined an impressive breadth of parenting behaviors among women who have experienced childhood maltreatment, several important gaps remain to be addressed. First, in Savage et al.’s review, a wide range of behavioral and affective outcomes fell into the positive and negative parenting categories, but a finer-grained analysis is needed that distinguishes amongst abusive parenting, problematic parenting behaviors, positive parenting behaviors, and positive parental affect. Additionally, a number of negative parenting behaviors, such as inconsistent discipline or permissiveness, were not included in Savage et al.’s review. Second, Savage et al. focused solely on maternal parenting of children ages 0-6 years old. It is important to consider the impact of parents’ childhood maltreatment on children in the school years and adolescence, as well as studies including fathers. Finally, while the meta-analytic approach facilitated a quantitative analysis of the results of the included studies, as well as examination of a number of moderators, it precluded the examination of indirect effects that might help to further explain the transmission of maltreatment across generations.
The current systematic narrative review therefore examines the extensive literature base that investigates associations among parental childhood maltreatment experiences and a full range of parenting behaviors and children’s ages. The framework of the systematic review also allows us to address a wider range of studies (e.g., those with different study designs or insufficient statistical data included in the manuscript), populations (e.g., mothers as well as fathers, parents who participated in interventions), and outcomes (e.g., varied parenting behaviors). Results are discussed within four primary parenting categories: abusive parenting, problematic parenting behaviors, positive parenting behaviors, and positive parental affect. In addition to reviewing the direct effects of parental childhood interpersonal traumatic experiences on multiple domains of parenting, when included studies examined moderators or mediators, these findings are also noted.
Section snippets
Selection of publications
Methodology for the current systematic review followed the PRISMA guidelines (Moher et al., 2015). Relevant studies were identified by searching the on-line databases PsycInfo and PubMed, by examining the reference lists of articles found in the initial search, and from suggestions from colleagues with expertise in the field. For each database, the following search terms were used: child* (trauma OR maltreatment OR abuse) and parent* (style OR behavior OR practice OR skills OR discipline). The
Results
Of the 97 included articles that evaluated associations between childhood traumatic experiences and at least one of the focal aspects of parenting, 46 articles examined abusive parenting, 28 articles examined problematic parenting behaviors, 12 articles examined positive parenting behaviors, and 23 examined positive parenting affect. A narrative synthesis of the findings of these studies follows below, organized by relevant subthemes within each parenting category. Although not a primary focus
Discussion
This systematic review synthesizes the research examining associations among childhood maltreatment (physical and emotional abuse and neglect, sexual abuse, and witnessing violence) and a full range of positive and negative parenting behaviors. Thus, it goes beyond evaluating the validity of putative intergenerational cycles of violence and abuse to focus on the commission and omission of aspects of parenting that have the potential to greatly affect children’s adjustment. As summarized in the
Limitations of the included articles
As noted throughout the above discussion, and as evidenced by the quality assessment ratings, several methodological limitations exist within this body of literature, especially outside of the cycle of violence literature which tended to utilize comparatively more rigorous methodology, with at least some studies examining multiple forms of maltreatment, utilizing heterogenous samples, and conducting assessments prospectively. In particular, the vast majority of research included in this review
Conclusion
Understanding the breadth of ways that childhood adversity can have an impact on these varied aspects of parenting can inform our efforts to support adults who were maltreated as children in their efforts to parent the next generation of children. Although studies of potential mediators and moderators revealed few clear explanatory pathways, the extant studies suggest a complex picture of combined environmental, familial, and individual influences that serve to increase or reduce the risks of
Role of Funding Sources
Dr. Carolyn Greene received funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD) of the National Institutes of Health (Grant K23HD094824) which supported the writing of this manuscript. NICHD had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. No data from the NICHD supported study are included in this manuscript.
Contributors
C. Greene, L. Haisley, and C. Wallace designed the study, conducted the literature search, and provided summaries of the included studies. C. Greene wrote the first draft of the manuscript and J. Ford and L. Haisley contributed substantial revisions. C. Greene and C. Wallace prepared the table of study characteristics. All authors reviewed and approved the final draft.
Declaration of Competing Interest
Dr. Julian Ford is co-owner of Advanced Trauma Solutions, Inc., the sole licensed distributor of the TARGET model which is copyrighted by the University of Connecticut. All other authors declare that they have no conflicts of interest.
Carolyn A. Greene, Ph.D. is a licensed clinical child psychologist and assistant professor of psychiatry at the UConn School of Medicine. Her research interests include intrafamilial mechanisms that contribute to and protect against the development of childhood psychopathology, parental socialization of children’s emotions, and the impact of trauma on parent and child emotion regulation.
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Carolyn A. Greene, Ph.D. is a licensed clinical child psychologist and assistant professor of psychiatry at the UConn School of Medicine. Her research interests include intrafamilial mechanisms that contribute to and protect against the development of childhood psychopathology, parental socialization of children’s emotions, and the impact of trauma on parent and child emotion regulation.
Lauren Haisley, Ph.D. is a licensed clinical psychologist who completed her graduate training at the University of Connecticut, and recently completed a post-doctoral fellowship at the Medical College of Wisconsin in pediatric neuropsychology. Her research is guided by a top-down focus on theoretical concepts such as self-regulation and executive functioning, and a bottom-up drive to help specific populations known to have executive dysfunction including children with neurological injury and children with trauma histories.
Cara Wallace, Psy.D. is a clinical child psychologist at Connecticut Pediatrics @ CHC. Her research interests include the intergenerational transmission of trauma symptoms, the impact of trauma symptoms on pediatric health, and the relationship between parenting, attachment behaviors, and child trauma.
Julian D. Ford, Ph.D., A.B.P.P. is a professor of Psychiatry and Law at the University of Connecticut, and principal investigator and director of the Center for Trauma Recovery and Juvenile Justice and the Center for the Treatment of Developmental Trauma Disorders in the National Child Traumatic Stress Studies. He is president of the International Society for Traumatic Stress Studies. His research focuses on the epidemiology, structure, assessment and psychosocial treatment of post-traumatic stress disorder and complex traumatic stress disorders.