Desmond K. Runyan, MD, DrPH Jonathan Kotch, Terri Lewis, Jamie Smith University of North Carolina at Chapel Hill Richard Thompson Juvenile Protective Association.

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Desmond K. Runyan, MD, DrPH Jonathan Kotch, Terri Lewis, Jamie Smith University of North Carolina at Chapel Hill Richard Thompson Juvenile Protective Association Listening to Children: What do 12 year olds tell us about their psychological maltreatment?

AcknowledgementsAcknowledgements U.S. Department of Health and Human Services Administration for Children, Youth, and Families Children's Bureau Office on Child Abuse and NeglectU.S. Department of Health and Human Services Administration for Children, Youth, and Families Children's Bureau Office on Child Abuse and Neglect U.S. Department of Health and Human Services National Institutes of Health National Institute of Child Health and Human DevelopmentU.S. Department of Health and Human Services National Institutes of Health National Institute of Child Health and Human Development

BackgroundBackground LONGSCAN (Longitudinal Studies on Child Abuse and Neglect) a consortium of 5 longitudinal studies of maltreatmentLONGSCAN (Longitudinal Studies on Child Abuse and Neglect) a consortium of 5 longitudinal studies of maltreatment Data on maltreatment from multiple sourcesData on maltreatment from multiple sources  Parent report on discipline at age 8  CPS record reviews at two year intervals  At Age 12, children asked about their abuse histories.

Research Questions What is the impact of psychological maltreatment on child mental health status?What is the impact of psychological maltreatment on child mental health status?  Outcomes as reported by children  Outcomes as reported by caregivers?

SampleSample LONGSCAN subjects from all 5 sitesLONGSCAN subjects from all 5 sites Child completing an Age 12 InterviewChild completing an Age 12 Interview Complete data on the Self-Report of Abuse MeasureComplete data on the Self-Report of Abuse Measure Sample N = 851Sample N = 851

Sample Demographics Mean Age: 12.4 years (SD = 0.44) 12.4 years (SD = 0.44) Gender: 49.7% Boys; 50.3% Girls 49.7% Boys; 50.3% Girls Race: 27.1% White; 54.3% Black; 18.6% Other 27.1% White; 54.3% Black; 18.6% OtherSite: 12% Midwestern 12% Midwestern 22% Eastern 22% Eastern 19% Southern 19% Southern 26% Southwestern 26% Southwestern 21% Northwestern 21% Northwestern

Independent Variables Exposure to emotional maltreatment was Exposure to emotional maltreatment was determined by: determined by:  Reviews of child protective service (CPS) reports.  Using a project developed instrument that addressed terrorizing, threaten abandonment, humiliation, shame, and other hurtful events.

Child Protective Services Reports Abstraction of CPS narratives using a Modified Maltreatment Coding System:Abstraction of CPS narratives using a Modified Maltreatment Coding System:  Adaptation of system developed by Barnett, Manly & Cicchetti. # of Psychological Maltreatment Allegations through Age 12 (M = 0.79, SD = 1.53).# of Psychological Maltreatment Allegations through Age 12 (M = 0.79, SD = 1.53). 34% (n = 293) children had at least one psychological maltreatment allegation.34% (n = 293) children had at least one psychological maltreatment allegation.

Child Self-Report of Abuse Adolescent participants are asked about their maltreatment experiences at the age 12 interview.Adolescent participants are asked about their maltreatment experiences at the age 12 interview. The LONGSCAN self-report of abuse measureThe LONGSCAN self-report of abuse measure  3 modules assessing lifetime experience of abuse  A-CASI (audio-computer assisted self interview). 18 Psychological Maltreatment items (n = 18) - items listed on next slide.18 Psychological Maltreatment items (n = 18) - items listed on next slide. Items were summed to create a Psychological Maltreatment Score (M = 1.2, SD = 2.2).Items were summed to create a Psychological Maltreatment Score (M = 1.2, SD = 2.2). 40% (n = 343) of participants endorsed one or more psychological maltreatment items.40% (n = 343) of participants endorsed one or more psychological maltreatment items.

Self-Report of Psychological Maltreatment Items (example items) Has any parent… ever made you feel that you couldn’t do anything right, no matter how hard you tried?ever made you feel that you couldn’t do anything right, no matter how hard you tried? ever punished you in an unusual way-like tying you up, or locking you in a closet?ever punished you in an unusual way-like tying you up, or locking 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 your home, or to have you taken away?ever threatened to kick you out of your home, or to have you taken away?

Dependent Variables Child Behavior ChecklistChild Behavior Checklist  internalizing, externalizing, and total problems T scores. Youth Self-ReportYouth Self-Report  internalizing, externalizing, & total T scores. Trauma Symptom Checklist for ChildrenTrauma Symptom Checklist for Children  anxiety, anger, & depression T scores.

Child Behavior Checklist (CBCL) Parent report of child competencies & behaviorParent report of child competencies & behavior 113 item checklist, problem behavior items113 item checklist, problem behavior items Answer set from 0 (not true) to 2 (very true or often true) indicates behaviorAnswer set from 0 (not true) to 2 (very true or often true) indicates behavior Higher scores = increased behavior problemsHigher scores = increased behavior problems LONGSCAN Age 12 InterviewLONGSCAN Age 12 Interview

Distribution of CBCL T Scores M = 51.3 SD = % (n = 191) Borderline/ Clinical Range (>=60) M = 55.2 SD = % (n = 290) Borderline/ Clinical Range (>=60) M = 53.9 SD = % (n = 269) Borderline/ Clinical Range (>=60)

Youth Self Report (YSR) Child report of child competencies & behaviorChild report of child competencies & behavior 113 item checklist, problem behavior items113 item checklist, problem behavior items Answer set from 0 (not true) to 2 (very true or often true) indicates behaviorAnswer set from 0 (not true) to 2 (very true or often true) indicates behavior Higher scores = increased behavior problemsHigher scores = increased behavior problems LONGSCAN Age 12 InterviewLONGSCAN Age 12 Interview

Distribution of YSR T Scores M = 48.6 SD = % (n = 110) Borderline/ Clinical Range (>=60) M = 48.0 SD = % (n = 111) Borderline/ Clinical Range (>=60) M = 49.5 SD = % (n = 153) Borderline/ Clinical Range (>=60)

Trauma Symptom Checklist (TSC) 44 item symptom checklist, five subscales: anxiety, depression, post-traumatic stress, dissociation, & anger.44 item symptom checklist, five subscales: anxiety, depression, post-traumatic stress, dissociation, & anger. Answer set of 0 (never) to 3 (almost all the time) indicates frequency of each symptomAnswer set of 0 (never) to 3 (almost all the time) indicates frequency of each symptom Higher scores indicate increased symptoms.Higher scores indicate increased symptoms. Child report, LONGSCAN Age 12 InterviewChild report, LONGSCAN Age 12 Interview T scores used in the analysis:  Anxiety  Anger  Depression

Distribution of TSC T Scores M = 41.2 SD = 9.5 2% (n = 19) Borderline/ Clinical Range (>=65) M = 40.5 SD = 8.0 2% (n = 18) Borderline/ Clinical Range (>=65) M = 39.8 SD = 8.7 2% (n = 17) Borderline/ Clinical Range (>=65)

Analysis Plan Correlations between Independent and Dependent Variables.Correlations between Independent and Dependent Variables. Regression analyses predicting Child Functioning (CBCL, YSR, TSC T scores).Regression analyses predicting Child Functioning (CBCL, YSR, TSC T scores).

CorrelationsCorrelations # 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*** 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 <.001

InternalizingExternalizingTot Problems Std B Gender (Fem=0, Male=1) Race (Other=0, White=1).10** Midwestern Site *** -.13** Eastern Site-.10* * Southern Site Southwestern Site CPS Psychological Abuse Allegations.07.10**.09* Child Self-Report of Psychological Maltreatment.13***.14*** R2R2.06***.08*** Regression Analysis Predicting CBCL T Scores * p <.05 ** p <.01 *** p <.001

InternalizingExternalizingTot Problems Std B Gender (Fem=0, Male=1) Race (Other=0, White=1) Midwestern Site-.02 Eastern Site **-.08 Southern Site Southwestern Site CPS Psychological Abuse Allegations Child Self-Report of Psychological Maltreatment.33***.32***.36*** R2R2.10***.13***.15*** Regression Analysis Predicting YSR T Scores Regression Analysis Predicting YSR T Scores * p <.05 ** p <.01 *** p <.001

AnxietyAngerDepression Std B Gender (Fem=0, Male=1) * -.08** Race (Other=0, White=1) Midwestern Site Eastern Site Southern Site.05.10*.06 Southwestern Site CPS Psychological Abuse Allegations Child Self-Report of Psychological Maltreatment.29***.40***.37*** R2R2.10***.18***.17*** Regression Analysis Predicting TSC T Scores Regression Analysis Predicting TSC T Scores * p <.05 ** p <.01 *** p <.001

DiscussionDiscussion The correlations between parent reported outcomes and either CPS or self-reported psychological maltreatment were low but significant.The correlations between parent reported outcomes and either CPS or self-reported psychological maltreatment were low but significant. The correlations between the child report of outcomes & child report of psychological maltreatment were large & significant.The correlations between the child report of outcomes & child report of psychological maltreatment were large & significant.

Discussion (cont.) In analyses controlled for site and gender, self-reported psychological maltreatment predicted most of the variation in child outcome.In analyses controlled for site and gender, self-reported psychological maltreatment predicted most of the variation in child outcome. In analyses controlled for study site and gender, CPS allegations containing reports of psychological maltreatment explain almost none of the variance in child outcome.In analyses controlled for study site and gender, CPS allegations containing reports of psychological maltreatment explain almost none of the variance in child outcome.

ConclusionsConclusions Our MMCS coding system captures allegations of psychological abuse.Our MMCS coding system captures allegations of psychological abuse. Official reports of psychological abuse pale in comparison to the psychological maltreatment reported by children.Official reports of psychological abuse pale in comparison to the psychological maltreatment reported by children. Psychological maltreatment has profound effects on children that would be missed if we relied upon official reports.Psychological maltreatment has profound effects on children that would be missed if we relied upon official reports. We need to ask the childrenWe need to ask the children For more information, visit our website at more information, visit our website at