1. LONGSCAN: The Consortium of Longitudinal Studies in Child Abuse and Neglect A Review of Recent Findings with Implications Desmond Runyan, MD, DrPH The University of North Carolina at Chapel Hill 1

2. Overview of LONGSCAN Planning grant funded in 1989 Congressionally mandated Intended to address antecedents and consequences Planning grants to UNC and JPA of Chicago Solution to which type of sample: yes LONGitudinal Studies of Child Abuse & Neglect 5 distinct studies (East, South, Midwest, Northwest, & Southwest) 2

3. Each site has integrity as an independent study Collective efforts magnify impact Measurement & data coordinated at UNC coordinating center Common measures, coding, training, data entry Consortium governance agreement Committees for governance, measurement, analysis, and publications/dissemination For more information, see Runyan et al. 1998 Violence & Aggression

4. Current Status Data collection still on-going for 4 of 5 sites - Youth now 14 - 22 years old Data archived with the National Data Archive on Child Abuse and Neglect (NDACAN) - Age 4, 6, 8, and 12 interviews - Includes CPS record reviews - Over 130 scientific papers - Over 25 dissertations 4

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6. Data Collected (Baseline to age 18) InterviewsBaseline*4681214+ 16+18+ Child--116611761074895872721452 Caregiver--124712251130956925752283 Child or Caregiver 1354125012361140976947789472 6 Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18.

7. Data Collected (Baseline to age 18) InterviewsBaseline*4681214+ 16+18+ Site East282237255237190197162101 Midwest24522322521618117391-- South243221222190177176130174 Southwest330319299274236216217106 Northwest25425023522319218518991 7 Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18.

8. Sample Demographics Child DemographicsBaseline % Male48.5 % Caucasian26.2 % African American 53.3 % Other Race20.5 8

9. Measurement Guided by Social-Developmental-Ecological Theory (NRC, 1993; Bronfenbrenner, 1989; Hawkins & Catalano, 1996). Domains assessed:  Child/Youth: Characteristics, functioning  Caregiver: Characteristic, functioning  Family microsystem: Home environment, functioning  Macrosystem: Neighborhood, school, support 9

10. Measurement Multiple sources & methods Developed “just-in-time measurement batteries for ages 4, 6 and 8 years Reports/ratings/questionnaires (Child/Youth, Caregiver, and Teacher)  Performance (Child/Youth)  Situational tests/samples  Official records (CPS) Presentation of measures  Interview & Audio-Computer Assisted Self Interview (A-CASI) began at age 12 for child 10

11. Exposure of LONGSCAN To Maltreatment

12. # of Maltreatment Records/Referrals per Child (birth through age 14) 12 1 Record (16%) 2 Records (12%) 3 Records (9%) 4 Records (7%) 5 Records (5%) 8-22 Records (12%) 7 Records (3%) 6 Records (4%) Total N = 1354

13. # of Allegations by Maltreatment Type (birth through age 14) 13 # of Allegations Age Based on Baseline Sample (N = 1354)

14. # of Substantiations by Maltreatment Type (birth through age 14) 14 # of Substantiations Age Descriptive Stats (0-14): Total # of substantiations (0-14) = 2282 Total # of physical abuse substantiations (0-14) = 369 Total # of sexual Abuse substantiations (0-14) = 99 Total # of neglect substantiations (0-14) = 1456 Total # of emotional abuse substantiations (0-14) = 358 Frequencies (0-14): 49% have 1 or more substantiations 14% have 1 or more physical abuse substantiations 6% have 1 or more sexual abuse substantiations 41% have 1 or more neglect substantiations 17% have 1 or more emotional abuse substantiations Based on Baseline Sample (N = 1354)

15. Self Report of Abuse (birth through age 12) 15 * Indicators are NOT mutually exclusive (N = 881) ( N = 874) (N = 883)

16. Comparing Substantiations to Child Self-Report (birth through age 12) Psychological Abuse (N = 883) 4.3% 18.6% 7.8% 80.9% 14.2% 3.2% 51.2% 7.7% 33.0% 8.1% 16

17. Maltreatment is one of many disadvantages… and not always the worst disadvantage, experienced by children at risk. Numbers of separations of primary caregivers Exposure to intimate partner violence Verbal aggression Physical aggression Implication: It is important for child protection and other professionals to assess other risk issues

18. Substantiated or Not Substantiation is not a criterion of whether maltreatment has occurred. The outcomes for children reported but not substantiated are similar to those for children reported and substantiated.

19. CPS Assessments CPS workers are more consistent at assessing demographic characteristics than they are at assessing risk issues such as domestic violence, substance use/abuse, parenting skills & child functioning.

20. Intimate Partner Violence At age 8, IPV explains more variance in depression and anxiety than physical or sexual abuse Significant child behavior problems are seen with all types of Intimate Partner Aggression/Violence (verbal, minor & severe violence) and with both genders as perpetrators.

21. Longitudinal Patterns of Aggression persistent longitudinal problems with aggressive behavior are rare, even among maltreated children 6-10% exhibit persistently high or escalating problems 15% remain in the borderline range patterns appear early (by age 4) & are relatively stable (3-4% of children with escalation).

22. Adverse Childhood Experiences in LONGSCAN VariablePrevalence % Psychological maltreatment25.3 Physical abuse23.2 Sexual abuse10.8 Caregiver problem drinking16.9 Caregiver depression32.3 Caregiver treated violently7.9 Criminal behavior in the household13.4

23. Relationship between childhood exposures & illness requiring medical attention # of ACE PrevalenceAdjusted OR (95% CI) 04.7%1 17.9%1.72 (0.88 - 3.35) 26.6%1.36 (0.62 – 2.96) 36.3%1.20 (0.45 – 3.20) ≥ 413.6%2.83 (1.10 – 7.31)

24. Association of adverse childhood experiences with child health Experiencing 5 or more adverse exposures associated with Somatic complaints reported by caregiver or either child or caregiver Any health complaint Increased ACE’s did not appear to influence reported somatic complaints or poor health (no dose effect)

25. Suicidality Among maltreated children as young as age 8 as many as 20% have suicidal thoughts. Suicidal thoughts co-occurred with children who were acting out or aggressive. Parents & teachers are rarely aware of the suicidal thoughts. Children with suicidal thoughts are at elevated risk for very early risk behaviors such as substance use, delinquency and early sexual activity. Implications: Mental health/behavioral assessments of children involved in child protection/child welfare services should include assessment for thoughts of suicide and self-harm.

26. Maltreatment characteristics Maltreatment severity, timing, type & chronicity determine the extent of social, emotional & behavioral problems experienced by maltreated children/youth. Implications: Adequate assessment requires that the CPS/CWS workers assess the characteristics of the abuse/neglect (reported and substantiated).

27. Foster Care Implications Young children (3.5 yrs of age or younger) who are removed from home & then reunified have: Fewer resources (e.g., less healthy & educated caregivers, lower income, less likely to receive mental health services), More exposure to violence (witnessed and direct victimization), More unstable environments, & More behavior problems.

28. Foster Care Adoption Children adopted from foster care are more likely to: Remain with the same caregiver over time, Have more resources (healthy, educated caregivers, higher incomes), Be exposed to less violence, Have fewer behavior problems, Have more disruptive diagnoses & symptoms at age 14. Implication: These data suggest that adopted youth have a difficult time transitioning during early adolescence.

29. Outcomes children who are maltreated & removed at least once experience high rates of subsequent maltreatment, & other adversities (i.e., changing caregivers, moves, witnessed violence). As children/youth get older, they have numerous social, emotional and behavioral problems including: poor social/peer relationships, poor academic performance, and internalizing problems aggressive & delinquent tendencies.

30. Outcomes 2: Children who experience verbal aggression from parent/caregiver(s) have: significantly lower verbal communication skills, are more likely to be angry & post traumatic stress symptoms. Any in-home aggression/violence (verbal or physical) regardless of whether the perpetrator is male or female, has negative consequences for the children in the home. Implications: workers should assess parent/caregiver verbal aggression and physical aggression/violence towards each other and towards their children.

31. Presentation: ISPCAN: Honolulu September 28, 2010

32. Authors Diana J. English, PhD U. Washington J. Christopher Graham, PhD U Washington Jon M. Hussey, PhD U North Carolina Richard Thompson, PhD JPA Chicago Howard Dubowitz, MD U Maryland Desmond K. Runyan, MD, DrPH U North Carolina

33. Study Overview  Objective: Examine prospective risk factors of sexual abuse in young children  Method: Utilizing an ecological model of maltreatment, examine risk factors prior to reports of sexual abuse of children ages 4- 12

34. Measurement Guided by Social-Developmental-Ecological Theory (NRC, 1993; Bronfenbrenner, 1989; Hawkins & Catalano, 1996). Domains assessed:  Child/Youth: Characteristics, functioning  Caregiver: Characteristic, functioning  Family microsystem: Home environment, functioning  Macrosystem: Neighborhood, school, support 34

35. Measurement Multiple sources & methods Developed “just-in-time measurement batteries for ages 4, 6 and 8 years Reports/ratings/questionnaires (Child/Youth, Caregiver, and Teacher)  Performance (Child/Youth)  Situational tests/samples  Official records (CPS) Presentation of measures  Interview & Audio-Computer Assisted Self Interview (A-CASI) began at age 12 for child 35

36. Prior Research 2009 – N=78,120 confirmed victims of sexual abuse, with about 40,000 of those children under the age of 12. (Verify) Sexual abuse estimates  20% girls  16% boys (Putnam, 2003; Finkelhor, 1994; Anderson et al., 1993).  Rates differ by age agroup: 15/1000 for 2-5 year olds 53/1000 for 6-12 year olds 168/1000 for 13-17 year olds.

37. Prior Research Children who experience CSA have been shown to be at increased risk for psychosocial, developmental, emotional and behavior problems Young victims of CSA have been shown to exhibit phobias and irrational fears, developmental delays, increased levels of anxiety and anger, internalizing and externalizing problems

38. Prior Research Research identified risk factors tend to fall into five categories:  Child characteristics  Parent characteristics  Family functioning  Extra-familial characteristics  Community ecology and demographics

39. Prior Research Small samples Recall of past experiences, Examination of single variables in isolation. Few studies have focused on predictors of CSA in early childhood.

40. Sample N=68/865 children reported for sexual abuse between ages 5 – 12 (7.9% of LONGSCAN children) for a total of 91 times (ranging from 1-5 reports).

41. Independent Variables Examined Gender Maternal history of victimization Maternal depression Weeks of maternal separation at birth Mother or Partner with history of incarceration in life events scale

42. Dependent Variables Reports of child sexual abuse allegations abstracted from DSS records  mMCS coding by trained reviewers Self-report of child sexual abuse by a family member

43. Sexual Abuse Predictive Model PredictorsBS.E.pOR Child Gender (girl =1).866.280.0022.378 Race (Caucasian = 1).968.274.0002.634 Number of Physical Abuse reports Pre-Visit 4.345.140.0131.412 Mother sexually abused as teen.576.282.0411.778 CES-D total score (maternal depression).024.011.0321.024 Number of weeks child separated from mother (birth to age 4).010.004.0081.010 Respondent or spouse/partner spent time in jail or prison (w/in last year.822.376.0292.274 Constant (Nagelkerke R-Sq=.146)-5.031.559.000.007

44. Implications Ecological model of maltreatment is a theory basis for predictors ofearly child sexual abuse. Child characteristics, maltreatment experience, caregiver characteristics and parental/family functioning all predictive of subsequent sexual abuse.

45. Implications This study confirms earlier research regarding physical abuse reports prior to Age 12, extends the finding back to Age 4, and suggests that the number of physical abuse reports is also an important predictor for sexual abuse.

46. Implications Caregiver sexual abuse history is an important predictor for sexual abuse of young children as it is for adolescent children. Maternal depression & involvement with the criminal justice system predict risk of sexual abuse reports for young, white, female children.

47. Limitations Use of CPS records as a source of report. Minimized by using reports and by standardized coding of case records. However, when children were asked at age 12, nearly 4 times more reported being sexually abused

48. Contact data Drunyan@med.unc.edu www.iprc.unc.edu/longscan 48