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Intergenerational childhood maltreatment continuity: examining caregiver psychosocial mechanisms, timing and severity characteristics, and dyadic clinical intervention
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Content
Intergenerational Childhood Maltreatment Continuity: Examining Caregiver Psychosocial
Mechanisms, Timing and Severity Characteristics, and Dyadic Clinical Intervention
Hannah Leigh Fritz, M.A.
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PSYCHOLOGY)
December 2024
INTERGENERATIONAL CHILDHOOD MALTREATMENT
ii
Acknowledgements
This dissertation has been supported by funding from the National Institutes of Health
Grants R01HD098161-01A1 (Negriff, Principal Investigator), R01HD39129 and R01DA024569
(Trickett, Principal Investigator), and the Alcoholic Beverage Medical Research Foundation
Research Grant (Gordis, Principal Investigator).
First, I would like to express gratitude to my dissertation committee members, Drs. Sonya
Negriff, Gayla Margolin, Daniel Hackman, Santiago Morales, and Darby Saxbe. Thank you for
your continued support and guidance as this project took shape. I would also like to thank the
faculty and research assistants of the Young Adolescent Project (YAP), in particular, Drs. Juye Ji,
Melissa Peckins, Julie Cederbaum, and Kristopher Stevens. To the original visionaries behind
YAP, Drs. Penelope Trickett and Ferol Mennen, you started something that has truly made an
impact and it has been an honor to be part of its lineage. Of course, I would like to thank the YAP
participants who have shared their families and most vulnerable stories over these last 22 years
so that we can learn how best to disrupt the intergenerational cycle of childhood maltreatment.
To my research advisor, Dr. Sonya Negriff, I truly cannot thank you enough. Your
exceptional guidance, consistency, patience, humor, encouragement, and perseverance have
made this dissertation possible and developed me into the researcher I am today. Your
willingness to take me under your wing has shaped not only my graduate school experience, but
also the trajectory of my future career. To Dr. Gayla Margolin, my clinical advisor, thank you for
taking the time to truly understand me and the things that inspire me. Your influence on the way I
think about families, couples, systems, and the human condition has been deeply profound.
I would also like to thank the mentors and collaborators whose investment in me through
the years have cumulatively brought me to this stage of my career. Dr. David Schwartz, thank
INTERGENERATIONAL CHILDHOOD MALTREATMENT
iii
you for taking a chance on me and unselfishly supporting my professional interests. And thank
you to my lab mates in the Social Development Lab, Yana Ryjova and Annemarie Kelleghan,
without whom I would have been lost early on. The incredible team at the UCLA Stress, Trauma,
and Resilience Clinic and Family Development Program, Drs. Catherine Mogil, Blanca Orellana,
Nastassia Hajal, and Karol Grotkowski Reed, for providing me with the opportunity to bloom
into a true clinical scientist. Karol, your friendship and advocacy are unparalleled. My mentors at
Lewis and Clark College who introduced me to clinical psychology and began encouraging me
to pursue this career even before I understood why it would be such a perfect fit: Drs. Jerusha
Detweiler-Bedell and Tom Schoeneman. And to Steve Breschia and Doc Shannon, who long ago
took it upon themselves to advocate for me. Your belief in me continues to reverberate
throughout all of my work.
To my incredible community of friends and confidants, you have made this graduate
school journey a highlight of my life, even amidst a global pandemic. Cassie Gonzales and Laura
Fenton, there are no words to express how lucky I am to have found lifelong friendship in this
cohort with you. You have shaped my graduate school experience so completely that it is
impossible for me to imagine it any other way. Annie Kahane, thank you for the dog walks and
patient listening. To Camp Winnarainbow and Jahanara Romney for tending my spirit and
teaching me how to pray. Sam Barkin, I catch glimpses of your soulful mischievousness in the
eyes of the children I work with. We cross this finish line together. Lorena Dame, you have
provided me with a depth of friendship that I have always longed for, it is deeply grounding and
restorative. And, of course, to the Femme Affirmation Station, for celebrating my wins and
showing me the power of the love that chosen family can offer.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
iv
To my partner John Hartmann, thank you for believing in me and putting up with my
unrelenting process of thinking aloud about this dissertation in our little apartment. Your love,
constant encouragement, dinner table consults, adventures, and morning coffees have kept me
nourished and inspired. Kate Fritz, I cherish our sisterhood. Thank you for your fierce love and
endless humor. To my dad, Jack Fritz, for teaching me to visualize success and then dive in with
an unwavering work ethic. And to my mom, Tommie Smith, thank you for teaching me the
importance of becoming friends with my mentors, the connections and conversations have been
so rich and rewarding. Thank you for always fueling my curiosity and showing me how
interesting this life can be if you’re willing to ask the hard questions.
And lastly, thank you to all of the children, families, and couples who have trusted me
with the care of their most important relationships. Your tenacity and tenderness are daily
reminders of the incredible resilience of the human spirit.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
v
Table of Contents
Acknowledgements................................................................................................................ii
List of Tables..........................................................................................................................vii
List of Figures........................................................................................................................viii
General Introduction ..............................................................................................................1
Note on Terminology ...................................................................................................5
References....................................................................................................................6
Paper 1: Trajectories of Caregiver Adulthood Risk as Mechanisms of Intergenerational
Childhood Maltreatment Continuity......................................................................................9
Introduction..................................................................................................................10
Method .........................................................................................................................24
Results..........................................................................................................................31
Discussion....................................................................................................................34
References....................................................................................................................42
Tables & Figures..........................................................................................................54
Paper 2: Intergenerational Consequences of Childhood Emotional Abuse: The Role of
Chronicity, Severity, and Age of Onset..................................................................................63
Introduction..................................................................................................................64
Method .........................................................................................................................74
Results..........................................................................................................................81
Discussion....................................................................................................................83
References....................................................................................................................91
Tables & Figures..........................................................................................................108
Paper 3: Interrupting the Cycle of Violence: Evidence-Based Dyadic Interventions to Mitigate
Risk for Intergenerational Childhood Maltreatment Continuity............................................115
What is Childhood Maltreatment and Intergenerational Maltreatment Continuity? ...116
Psychosocial Risk Factors: Targets for Intervention....................................................118
Benefits of Dyadic Intervention...................................................................................119
Method and Description of Review.............................................................................121
Dyadic Interventions for Intergenerational Childhood Maltreatment .........................123
Minding the Baby ..............................................................................................123
Promoting First Relationships ...........................................................................125
Child-Parent Psychotherapy...............................................................................127
Parent-Child Interaction Therapy ......................................................................129
Multisystemic Therapy ......................................................................................131
Considerations for Intergenerational Maltreatment Intervention ................................132
Integrating Emerging Evidence in Clinical Practice....................................................133
Conclusion ...................................................................................................................134
Table.............................................................................................................................136
References....................................................................................................................138
INTERGENERATIONAL CHILDHOOD MALTREATMENT
vi
General Discussion ................................................................................................................158
Contributions to the Literature.....................................................................................159
Limitations and Future Directions...............................................................................161
Conclusion ...................................................................................................................163
References....................................................................................................................165
Appendix A............................................................................................................................166
Appendix B............................................................................................................................170
Appendix C: Measures...........................................................................................................175
Childhood Trauma Interview - Screen.........................................................................175
Childhood Trauma Interview – Sexual Abuse .............................................................178
Childhood Trauma Interview – Physical Abuse...........................................................180
Childhood Trauma Interview – Emotional Abuse .......................................................181
Childhood Trauma Interview – Physical Neglect ........................................................183
Beck Depression Inventory..........................................................................................185
Social Support Questionnaire ......................................................................................189
Youth Self Report, Part 2 .............................................................................................192
INTERGENERATIONAL CHILDHOOD MALTREATMENT
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List of Tables
Paper 1
Table 1. Sample Sociodemographic Characteristics (T2) ...........................................56
Table 2. Missing Value Analysis for Caregiver Risk Variables ...................................57
Table 3. Prevalence of Childhood Maltreatment Types in the Study Sample..............58
Table 4. Descriptive Statistics for Caregiver Risk Variables .......................................59
Table 5. Correlations between Study Variables............................................................60
Table 6. Significant Direct and Indirect Effects from Mediation Model .....................61
Paper 2
Table 1. Sample Characteristics for Caregivers (T3) and Adolescents (T4)................108
Table 2. Descriptive Statistics for Study Variables......................................................109
Table 3. Correlations between Study Variables............................................................110
Table 4. Model Fit Indices for Latent Profile Analysis of Caregiver Emotional
Abuse Characteristics.............................................................................................111
Table 5. Significant Direct and Indirect Effects from Mediation Model .....................114
Paper 3
Table 1. Evidence-Based Intervention Design, Intervention Targets, Outcomes, and
Implementation Challenges...................................................................................108
Appendix A
Table A1. Significant Effects from the Mediation Path Model with Caregiver Any
Childhood Maltreatment........................................................................................167
Table A2. Nonsignificant Effects from the Mediation Path Model with Caregiver
Any Childhood Maltreatment.................................................................................168
Appendix B
Table B1. Nonsignificant Direct and Indirect Effects from Mediation Model ............170
INTERGENERATIONAL CHILDHOOD MALTREATMENT
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List of Figures
Paper 1
Figure 1 ........................................................................................................................62
Paper 2
Figure 1 ........................................................................................................................112
Figure 2 ........................................................................................................................113
Appendix A
Figure A1 .....................................................................................................................166
INTERGENERATIONAL CHILDHOOD MALTREATMENT
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General Introduction
Childhood maltreatment (i.e., childhood abuse and neglect) impacts approximately 1 in 7
children in the United States, with more than 3.5 million children referred to Child Protective
Services annually (Centers for Disease Control and Prevention, 2022; Gilbert et al., 2009; U.S.
Department of Health & Human Services, 2022). The total lifetime economic burden associated
with childhood maltreatment is estimated at $592 billion, placing this issue among the highest
cost public health concerns facing the nation (Centers for Disease Control and Prevention, 2022).
Childhood maltreatment refers to all forms of physical and/or emotional abuse, sexual abuse, and
emotional and physical neglect resulting in actual or potential harm to a child’s health, survival,
or dignity committed by an adult in a position of caretaking responsibility or power (World
Health Organization, 2022). Longitudinal outcomes among affected individuals include
significantly higher risk for mental health problems, substance use, delinquency and
incarceration, intimate partner violence, underage parenting, social isolation, and poor physical
health outcomes across the lifespan (Hussey et al., 2006; Keyes et al., 2012; Norman et al., 2012;
Smith & Thornberry, 1995; Tonmyr et al., 2011; Vachon et al., 2015; Wegman & Stetler, 2009).
These concerning prevalence rates and deleterious sequelae have motivated substantial research
to identify the individual and environmental factors that confer risk for childhood maltreatment
as well as those that may be most responsive to prevention and intervention.
Critically, the negative impacts of childhood maltreatment are not limited to those
directly exposed but are also present among the children of those affected. Children of caregivers
with maltreatment histories are at increased risk of emotional and behavioral problems and are
significantly more likely to be maltreated themselves (Brodsky et al., 2008; Collishaw et al.,
2007; Doi et al., 2021; Islam et al., 2022; Madigan et al., 2019; Rijlaarsdam et al., 2014; Su et
INTERGENERATIONAL CHILDHOOD MALTREATMENT
2
al., 2022; Zvara et al., 2017). In fact, a caregiver’s history of childhood maltreatment is one of
the most consistent predictors of maltreatment among their children, a pattern referred to as the
“cycle of maltreatment” (Berlin et al., 2011; Madigan et al., 2019; Thornberry et al., 2012;
Thornberry & Henry, 2012). Two approaches to examining this intergenerational pattern have
emerged in the literature. The first is intergenerational transmission, in which a maltreated
caregiver becomes the perpetrator of their child’s maltreatment (Widom, 1989). The second and
more contemporary approach, intergenerational continuity, does not necessarily implicate the
caregiver as the perpetrator of the child’s maltreatment. Rather, the caregiver’s childhood
maltreatment precipitates a cascade of risk factors across development and into adulthood that
may negatively impact their subsequent parenting practices, mental health, and contextual risk
factors (e.g., social and economic resources) that may increase the likelihood that their child(ren)
will experience maltreatment as well (Berlin et al., 2011).
In order to develop and implement effective interventions, more research is needed to
understand two critical aspects of intergenerational maltreatment: (1) the attributes of caregiver
childhood maltreatment experiences that may confer greatest risk for intergenerational
maltreatment, including type (i.e., sexual abuse, physical abuse, emotional abuse, and physical
neglect), chronicity, severity, and age of onset, and (2) the potentially modifiable psychosocial
risk factors in the child-rearing environment that may serve as mechanisms of intergenerational
maltreatment continuity. The purpose of this dissertation is to expand and deepen our
understanding of these two pivotal areas of intergenerational continuity - caregiver maltreatment
attributes and risk mechanisms - using methodology that accounts for the ways that these
complex experiences arise in the lives of those affected. The data are from the Young Adolescent
Project (YAP), a multidisciplinary collaboration at the University of Southern California
INTERGENERATIONAL CHILDHOOD MALTREATMENT
3
exploring the longitudinal consequences of childhood maltreatment (Negriff et al., 2019). The
stewardship of these data and relationships with the original participants have been maintained
for 22 years, with ongoing data collection, research collaboration, and graduate student
mentorship across that span of time.
The first study in this dissertation addresses some of the most critical psychosocial risk
mechanisms of intergenerational continuity: caregiver depression, lack of social support, and
economic insecurity. This study uses latent growth curve modeling to explore trajectories of
these risk mechanisms among caregivers across their child’s development (i.e., the child-rearing
period). Trajectories of caregiver depression, lack of social support, and economic insecurity are
then tested as simultaneous mediators in the intergenerational continuity of specific childhood
maltreatment types between caregivers and their children. The purpose of this study is to identify
the unique and relative contributions of each caregiver childhood maltreatment type on caregiver
adulthood risk trajectories that may impact parenting and the child-rearing environment and
incur risk for specific child maltreatment experiences. The second study explores the
intergenerational implications of childhood emotional abuse, a relatively understudied
maltreatment type with critical and often underestimated individual and intergenerational
implications. First, latent profile analysis is used to identify subgroups of caregivers based on the
chronicity, severity, and age of onset of their self-reported experiences of emotional abuse during
childhood. Profiles of caregiver emotional abuse are then tested as predictors of their children’s
polyvictimization (e.g., multi-type maltreatment) and subsequent behavioral and emotional
problems among those same children in adolescence. This study is intended to contribute a more
comprehensive understanding of the overlap between timing and severity characteristics of
childhood emotional abuse experiences, and to determine how certain patterns of co-occurrence
INTERGENERATIONAL CHILDHOOD MALTREATMENT
4
in these characteristics may precipitate a cascade of intergenerational maltreatment and
detrimental behavioral health outcomes.
An overarching goal of this dissertation is to inform intervention and improve quality of
life and health outcomes among individuals and family systems experiencing the adverse impacts
of maltreatment. As such, the third study is a narrative review of the literature that synthesizes
the extant scientific evidence regarding family-centered approaches and clinical best practices
for disrupting the intergenerational cycle of maltreatment. This paper is written for clinicians
tasked with evaluating, selecting, and implementing interventions from the variety of available
protocols. It provides a detailed review of several dyadic caregiver-child interventions with
substantial empirical support demonstrating their effectiveness in mitigating risk for
intergenerational maltreatment.
As a whole, the dissertation has three main objectives: 1) to support increased sensitivity
in identification of individuals and families at greatest risk for intergenerational maltreatment
continuity based on the type, as well as timing and severity characteristics, of their maltreatment
experiences, 2) to provide direction toward the salient and influential risk factors that may be
most critical to target with intervention, and 3) to guide clinicians in the integration of science
and practice as they work directly with families toward recovery in the complex aftermath of
maltreatment.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
5
Note on Terminology
Caregiving relationships and family constellations come in many different forms,
particularly among families with maltreatment experiences and child welfare involvement.
Throughout this dissertation, care has been taken to use inclusive language that encompasses and
represents the diversity of these relationships. The following definitions are provided to orient
the reader.
Caregiver: An adult in a position of primary responsibility to provide emotional and physical
care to a child. This may refer to biological parents, adoptive families, kin-care
arrangements, and non-kin foster caregivers of any sex and gender. When used in relation
to a child (e.g., “their child,” “caregiver-child relationship”) this implies a primary
caretaking role with the child, but does not necessarily indicate a biological relationship.
Caregiver stability and varying types are accounted for in quantitative analyses.
Parent: A biological parent. This does not automatically denote caretaking responsibility.
Parenting: Acts of child-rearing by a primary caregiver, including biological and non-biological
caregivers of any sex and gender.
Parenthood: The period during which an adult has primary caretaking responsibility of a child,
includes any type of caregiver.
Family: Any constellation of caregiver(s) and child(ren). This may include biological and nonbiological caregivers, single or multiple caregivers, and single or multiple children with
the same or different biological parents.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
6
References
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maltreatment: mediating mechanisms and implications for prevention. Child
Development, 82(1), 162–176. https://doi.org/10.1111/j.1467-8624.2010.01547.x
Brodsky, B. S., Mann, J. J., Stanley, B., Tin, A., Oquendo, M., & Birmaher, B. (2008). Familial
transmission of suicidal behavior: mediating the relationship between childhood abuse
and offspring suicide attempts. The Journal of Clinical Psychiatry, 69(4), 584–596.
https://doi.org/10.4088/JCP.v69n0410
Centers for Disease Control and Prevention. (2022). Fast facts: Preventing child abuse &
neglect. National Center for Injury Prevention and Control, Division of Violence
Prevention. https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html
Collishaw, S., Dunn, J., O’connor, T. G., & Golding, J. (2007). Maternal childhood abuse and
offspring adjustment over time. Development and Psychopathology, 19(2), 367-383.
10.1017/S0954579407070186
Doi, S., Fujiwara, T., & Isumi, A. (2021). Association between maternal adverse childhood
experiences and mental health problems in offspring: An intergenerational study.
Development and Psychopathology, 33(3), 1041–1058.
https://doi.org/10.1017/S0954579420000334
Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden
and consequences of child maltreatment in high-income countries. The Lancet,
373(9657), 68–81. https://doi.org/10.1016/S0140-6736(08)61706-7
Hussey, J. M., Chang, J. J., & Kotch, J. B. (2006). Child Maltreatment in the United States:
Prevalence, Risk Factors, and Adolescent Health Consequences. Pediatrics, 118(3), 933–
942. https://doi.org/10.1542/peds.2005-2452
Islam, S., Jaffee, S. R., & Widom, C. S. (2022). Breaking the cycle of intergenerational
childhood maltreatment: Effects on offspring mental health. Child Maltreatment, 28(1),
119-129. https://doi.org/10.1177/10775595211067205
Keyes, K. M., Eaton, N. R., Krueger, R. F., Mclaughlin, K. A., Wall, M. M., Grant, B. F., &
Hasin, D. S. (2012). Childhood maltreatment and the structure of common psychiatric
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Madigan, S., Cyr, C., Eirich, R., Fearon, R. M. P., Ly, A., Rash, C., Poole, J. C., & Alink, L. R.
A. (2019). Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the
intergenerational transmission of child maltreatment. Development and Psychopathology,
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Negriff, S., Gordis, E. B., Susman, E. J., Kim, K., Peckins, M. K., Schneiderman, J. U., &
Mennen, F. E. (2019). The Young Adolescent Project: A longitudinal study of the effects
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Thornberry, T. P., Knight, K. E., & Lovegrove, P. J. (2012). Does maltreatment beget
maltreatment? A systematic review of the intergenerational literature. Trauma, Violence,
& Abuse, 13(3), 135–152. https://doi.org/10.1177/1524838012447697
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emotional/psychological child maltreatment: A review. Child Abuse & Neglect, 35(10),
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on medical outcomes in adulthood. Psychosomatic Medicine, 71(8), 805–812.
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https://doi.org/10.1126/science.2704995
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0trust%20or%20power.
Zvara, B. J., Mills-Koonce, R., Carmody, K. A., Cox, M., & The Family Life Project Key
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Journal of Family Violence, 32(2), 231–242. https://doi.org/10.1007/S10896-016-9876-
1/FIGURES/1
INTERGENERATIONAL CHILDHOOD MALTREATMENT
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Paper 1
Trajectories of Caregiver Adulthood Risk as Mechanisms of Intergenerational Childhood
Maltreatment Continuity
Hannah Leigh Fritz, M.A. and Sonya Negriff, Ph.D.
University of Southern California
INTERGENERATIONAL CHILDHOOD MALTREATMENT
10
Trajectories of Caregiver Adulthood Risk as Mechanisms of Intergenerational Childhood
Maltreatment Continuity
Childhood maltreatment, encompassing abuse and neglect, is associated with extensive
adverse outcomes in adulthood, including poor mental and physical health, substance abuse,
social isolation, intimate partner revictimization, and economic instability (Adams et al., 2018;
Bunting et al., 2018; Cherney et al., 2020; Currie & Spatz Widom, 2010; McCabe et al., 2018;
McMahon et al., 2015; Mersky & Topitzes, 2010; Mills et al., 2013; Ney, 1988; Pinto Pereira et
al., 2017; Renner & Slack, 2006; Shin et al., 2020; Struck et al., 2020; Widom, 1998). Moreover,
children with caregivers who have childhood maltreatment histories face a heightened risk of
abuse and neglect themselves, a pattern referred to as intergenerational continuity of
maltreatment (Bartlett et al., 2017; Dixon et al., 2005; Madigan et al., 2019; Widom & Wilson,
2015).
Prior research has primarily focused on two aspects of intergenerational maltreatment
continuity: (1) the attributes of caregiver childhood maltreatment experiences such as type (i.e.,
sexual, physical, and emotional abuse, and physical neglect) and (2) the risk mechanisms that
may explain the link between caregiver and child maltreatment. Exploring these two areas of
intergenerational maltreatment has increased the ability to identify caregiver-child dyads most at
risk, and to tailor interventions that aim to disrupt this deleterious cycle. However, prior studies
have mostly examined caregiver maltreatment types separately from one another, limiting
understanding of both their unique and relative contributions to intergenerational processes
(Berlin et al., 2011; Berzenski, 2019; Martoccio et al., 2022; Zuravin et al., 1996). Research on
risk mechanisms has highlighted caregiver adulthood psychosocial risk factors including mental
health, economic insecurity, and social support (Berlin et al., 2011; Choi et al., 2019; Conrad-
INTERGENERATIONAL CHILDHOOD MALTREATMENT
11
Hiebner & Byram, 2020; Egeland et al., 1988; Thornberry et al., 2013). Yet little is known about
how trajectories of caregiver risk across the child-rearing period (e.g., decreasing social support)
may affect intergenerational continuity of maltreatment.
The aims of the current study were a) to identify trajectories of caregiver adulthood
depressive symptoms, social support, and economic insecurity across the child-rearing period,
and b) to test the initial report of these risk mechanisms and their trajectories as competing
mediators in the relationship between caregiver and child childhood maltreatment types. The
results inform intervention in two critical ways. First, they may enhance our understanding of the
pathways from specific caregiver childhood maltreatment types to child maltreatment
experiences, facilitating increased sensitivity in the identification of caregiver-child dyads at risk
for intergenerational continuity. Second, by identifying mechanisms through which specific
maltreatment experiences confer intergenerational risk, which may aid in the selection and
delivery of evidence-based interventions tailored to individuals’ specific constellation of
maltreatment experiences and caregiver risk factors. Given the limited availability of mental
health and social services in the United States, and the barriers to care faced by many families
most in need of intervention (Cohen Veterans Network, 2018; Mustillo et al., 2011), our goal was
to provide further information to streamline assessment, referral, and treatment recommendation
processes for clinicians and community health agencies.
Maltreatment Type and Intergenerational Maltreatment Continuity
Expanding on prior literature demonstrating the association between caregiver and child
experiences of childhood maltreatment (Madigan et al., 2019), research has concentrated on
uncovering the intergenerational implications of caregiver experiences of specific maltreatment
types (Madigan et al., 2019). There is general consensus in the literature that experiences of
INTERGENERATIONAL CHILDHOOD MALTREATMENT
12
childhood sexual and physical abuse among caregivers significantly heighten the risk for
intergenerational maltreatment continuity (Berlin et al., 2011; Berzenski, 2019; Dixon et al.,
2005; Ertem et al., 2000; Greene et al., 2020; Lange et al., 2019; Madigan et al., 2019; Martoccio
et al., 2022; Milner et al., 1990; Pears & Capaldi, 2001; Widom et al., 2015; Zuravin et al.,
1996). Recent estimates suggest that children of caregivers with histories of physical abuse and
sexual abuse are, respectively, 2 times and 2.26 times more likely to experience maltreatment
themselves compared to children with nonmaltreated caregivers (Martoccio et al., 2022).
Likewise, caregivers’ experiences of childhood physical neglect appear to be associated with
perpetration of maltreatment against their own children (Bartlett et al., 2017; Bartlett &
Easterbrooks, 2015; Ben-David et al., 2015; Kim, 2009; Schulz et al., 2021; St-Laurent et al.,
2019; Widom et al., 2015). The influence of emotional abuse on intergenerational maltreatment
has been explored to a lesser extent, though its importance should not be underestimated (Dye,
2020; Greene et al., 2020; Madigan et al., 2019). For instance, witnessing household violence
during childhood, a form of emotional abuse, may be linked with increased risk of childhood
maltreatment in the subsequent generation (Greene et al., 2020). Additional research is necessary
to comprehensively understand the full scope of emotionally abusive experiences (e.g.,
witnessing intimate partner violence, parental negativity and hostility, parental substance use,
etc.), and their contributions to intergenerational sequelae.
While extensive prior research has focused on the impact of caregiver maltreatment types
on intergenerational maltreatment, broadly, few studies have explored how they may incur risk
for specific maltreatment types among their children. Notable exceptions include studies
exploring the continuity of a single maltreatment type across generations (i.e., both caregiver and
child experienced the same type of maltreatment), which have demonstrated type-to-type
INTERGENERATIONAL CHILDHOOD MALTREATMENT
13
continuity of sexual abuse, physical abuse, and physical neglect (Bartlett et al., 2017; Borelli et
al., 2019; Ertem et al., 2000; Glasser et al., 2001; Herrenkohl et al., 2013; Kim, 2009;
McCloskey & Bailey, 2000; Yang et al., 2018), and a study that identified a relationship between
caregiver physical abuse and child physical neglect (Yang et al., 2018). This specificity
framework, which examines intergenerational associations between caregiver and child
maltreatment types, is imperative for developing a meaningful understanding of how these
patterns may unfold across two or more generations and potentially contribute to
multigenerational patterns. Having evidence at this level of specificity will aid clinicians in
identifying at-risk caregiver-child dyads in a variety of family constellations in adult, child, and
family settings.
Despite several studies that have investigated risk for intergenerational maltreatment
based on caregiver and/or their child’s maltreatment type, a significant limitation of the extant
literature is that much of this work examines only one maltreatment type at a time. This approach
hinders the ability to account for potential co-occurrence between types in order to isolate the
relative contribution of each. The present study aims to enhance our current understanding by
examining type-to-type as well as cross-type associations in a single statistical model. This will
enable identification of the intergenerational impact of each individual type, while accounting for
the presence of other maltreatment types.
Mechanisms of Intergenerational Maltreatment Continuity
Given the consistent evidence for intergenerational maltreatment continuity, research
efforts have increasingly focused on determining the risk mechanisms underlying this process to
identify modifiable targets for intervention (Berlin et al., 2011; Choi et al., 2019; ConradHiebner & Byram, 2020; St-Laurent et al., 2019; Tracy et al., 2018). Ecological systems theory
INTERGENERATIONAL CHILDHOOD MALTREATMENT
14
argues that maltreatment is the product of the interactions between multiple systems that
negatively impact the child-rearing environment and parenting practices in ways that increase
risk for abuse and neglect (Belsky, 1980; Cicchetti & Toth, 2005). From this perspective, familylevel risk factors within the microsystem, such as caregiver psychosocial resources, have been
posited to have the most direct impact on child maltreatment (Belsky, 1980). Among these
family-level psychosocial risk factors, caregiver depression, lack of social support, and economic
insecurity stand out as extensively documented mechanisms of intergenerational maltreatment
continuity (Berlin et al., 2011; Choi et al., 2019; Conrad-Hiebner & Byram, 2020; Currie &
Spatz Widom, 2010; Dixon et al., 2005; Egeland et al., 1988; Horan & Widom, 2015; Madigan et
al., 2019; Schofield et al., 2013; St-Laurent et al., 2019; Thompson, 2006; Thornberry et al.,
2013; Tracy et al., 2018).
Importantly, these psychosocial risk factors may not be stable over time, but may show
increasing or decreasing trajectories from adolescence through middle adulthood that may have
implications for intergenerational maltreatment risk. In the general population, depressive
symptoms appear to peak in late adolescence and tend to follow a slow but steady decline across
early and middle adulthood (Galambos et al., 2006; Schubert et al., 2017; Sutin et al., 2013).
Evidence also suggests changes in the number and quality of social support relationships across
adulthood. The convoy model of social relations suggests that individuals are surrounded by a
network of relationships that move with them throughout the life course, offering varying levels
of support and closeness (Antonucci et al., 2014). The social relationships, or groups of
relationships (e.g., family, peer group, romantic partner), that provide the most support may
change in structure, number, and/or amount of support to the individual over time (Antonucci et
al., 2014; Galambos et al., 2018; Levitt et al., 1993). In addition to the number, the quality of
INTERGENERATIONAL CHILDHOOD MALTREATMENT
15
supportive relationships may fluctuate across the lifespan and appears to be critical to a variety
of biopsychosocial outcomes (Antonucci et al., 2014). Furthermore, early adulthood can be a
particularly dynamic time in terms of changes in economic circumstance due to developmentally
appropriate life transition activities like joining the workforce, independent living costs, childrearing, and educational debt, which may stabilize in middle adulthood (Cherney et al., 2020;
Serido et al., 2013).
Adverse childhood experiences, such as maltreatment, may disrupt these typical
trajectories and/or the initial severity from which maltreated individuals begin these trajectories
(Caliso & Milner, 1994; Colman & Widom, 2004; Dion et al., 2016; Horan & Widom, 2015;
Pitzer & Fingerman, 2010; Sperry & Widom, 2013; Widom, 1998). For example, individuals
with histories of childhood abuse and neglect have been shown to follow a similar curvilinear
trajectory of psychological distress (i.e., anxiety, depression, aggressiveness, and cognitive
problems) from age 14-24 years as nonmaltreated peers, however, those with maltreatment report
higher symptoms at baseline and across the 10-year period from adolescence to early adulthood
(Dion et al., 2016). Maltreated individuals are also more likely than their nonmaltreated
counterparts to experience low and decreasing social support from early through middle
adulthood and may have particular difficulty establishing intimate adult relationships, often a
critical source of social support in the early adulthood period (Colman & Widom, 2004;
Galambos et al., 2018; Horan & Widom, 2015; Mullen et al., 1994). To our knowledge, there are
no studies to-date that directly examine longitudinal trajectories of economic insecurity among
maltreated individuals. However, childhood maltreatment has been linked with a wide range of
detrimental economic outcomes including significantly lower income, rates of employment, and
educational attainment, as well as higher rates of menial or semi-skilled occupation in early and
INTERGENERATIONAL CHILDHOOD MALTREATMENT
16
middle adulthood as compared to their non-maltreated counterparts (Currie & Widom, 2010;
Widom, 1998). Despite the potential for change across adulthood, prior studies exploring
caregiver psychosocial risk mechanisms largely rely on measures of symptoms and stressors at a
single timepoint (Dion et al., 2016; Horan & Widom, 2015), lacking consideration of how
trajectories of caregiver risk across the child-rearing period may contribute to intergenerational
maltreatment.
Maltreatment Types and Mechanisms of Intergenerational Continuity
Childhood Maltreatment Type and Psychosocial Sequelae in Adulthood
Prior studies implementing the specificity model of childhood maltreatment have
elucidated pathways from individual childhood maltreatment types to adverse outcomes in
adulthood. Among these adverse outcomes are mental health problems, economic hardship, and
insufficient social support, the primary psychosocial risk mechanisms for intergenerational
maltreatment continuity. For example, childhood sexual, physical, and emotional abuse, and
physical neglect have each been individually implicated in the development of depression in
adulthood (Adams et al., 2018; Ahuja et al., 2023; Christ et al., 2019; Crow et al., 2014; Dias et
al., 2014; Dye, 2020; Jung & Soo, 2023; Madigan et al., 2019; McCabe et al., 2018; Mustillo et
al., 2011; Paolucci et al., 2001; Pinto Pereira et al., 2017; Powers et al., 2009; Schiff et al., 2014;
Schuck & Widom, 2021; Struck et al., 2020; Wang et al., 2023). Childhood emotional abuse
stands out above the other maltreatment types due to its robust association with adulthood
depression, even when accounting for other types of abuse (Bifulco et al., 2002a; Christ et al.,
2019; Powers et al., 2009). Physical and emotional abuse have also been linked with lower social
support and impaired social relationships in adulthood (Berzenski, 2019; Ebbert et al., 2019;
Gayer-Anderson et al., 2015). While children with histories of physical abuse may be more likely
INTERGENERATIONAL CHILDHOOD MALTREATMENT
17
to seek non-parental adult social support than non-abused children, these relationships may be
lacking in terms of closeness and frequency of contact, suggesting that physically abused
individuals may lack sufficient quality familial and extrafamilial social networks (Horan &
Widom, 2015; Weber Ku et al., 2021).
Furthermore, adults who experienced childhood physical neglect are found to be at higher
risk of economic insecurity in early and middle adulthood, including financial hardship, housing
instability, food insecurity, and unemployment (Currie & Widom, 2010; Pinto Pereira et al.,
2017; Schuck & Widom, 2021). Childhood physical abuse has also been implicated in adulthood
socioeconomic challenges, such as educational attainment and employment status, potentially
exacerbating economic insecurity (Lansford et al., 2021; Widom, 1998). The evidence regarding
sexual abuse and adulthood economic circumstance is somewhat mixed. Some studies report
lower earnings, higher government income support, lower employment rates, and declining
socioeconomic status across adulthood (Hyman, 2000; Mullen et al., 1994; Pinto Pereira et al.,
2017; Tanaka et al., 2017; Widom, 1998), while others find no association with these economic
outcomes when controlling for socioeconomic status in the family of origin (Fergusson et al.,
2013; Strøm et al., 2013). Undoubtedly, further clarification is needed around the relative
contributions of each caregiver maltreatment type on adulthood psychosocial outcomes that may
affect caregiving.
Caregiver Adulthood Risk and Child Maltreatment Type
Many of the adverse adulthood outcomes of childhood maltreatment are also mechanisms
of risk that increase the likelihood of intergenerational childhood maltreatment. Several studies
have identified the role of specific adulthood risk factors in perpetuating or increasing the risk
for particular types of maltreatment among their children. Caregiver depression, for instance, has
INTERGENERATIONAL CHILDHOOD MALTREATMENT
18
been linked to child physical neglect (Lee et al., 2012; Shanahan et al., 2017). Both the presence
and absence of caregiver social support have been associated with subsequent childhood
maltreatment, predominantly physical abuse (Bifulco et al., 2002b; Martin et al., 2012; PriceWolf, 2015). While lower levels of social support and interpersonal functioning among
caregivers have been linked with increased risk, higher levels of social support may act as a
protective factor for child physical abuse (Pitzer & Fingerman, 2010; Price-Wolf, 2015).
Economic insecurity within the family context has also been identified as a risk factor for
some child maltreatment types. Various theories propose mechanisms through which economic
insecurity may increase this risk, including heightened caregiver stress, insufficient funds to
provide basic needs, and lack of supervision due to work-related burdens (Conger et al., 2010;
Conrad-Hiebner & Byram, 2020). More specifically, a relationship has been found between
economic insecurity and higher rates of child physical and emotional abuse, as well as physical
neglect (Berger et al., 2017; Black et al., 2001; Bullinger et al., 2021; Raissian & Bullinger,
2017; Stith et al., 2009). Furthermore, longitudinal studies have demonstrated that persistent
economic insecurity across the child-rearing period, decreasing income, and irregular earnings
over time may increase risk of harsh parental disciplining and child physical abuse (Cai, 2022;
Conrad et al., 2019).
Intergenerational Mechanisms for Specific Maltreatment Types
Though limited, some empirical evidence suggests that certain caregiver psychosocial
risk mechanisms serve as mediators in the intergenerational continuity of specific maltreatment
types. For example, the association between caregiver childhood sexual abuse and child
childhood maltreatment (i.e., not specific to type) appears to be mediated by caregiver
depression, while caregiver physical abuse has been shown to be associated with child
INTERGENERATIONAL CHILDHOOD MALTREATMENT
19
maltreatment via both caregiver depression and, separately, lack of social support (Berlin et al.,
2011; Crouch et al., 2001; De Paúl & Domenech, 2000; Dittmann et al., 2023). A recent study
with repeated measurements of psychosocial mechanisms revealed that composite scores of a)
physical and sexual abuse and b) emotional abuse and physical neglect were associated with
adulthood maltreatment potential, and this association was mediated by biological mothers’
postpartum depression that persisted across early parenthood (Dittmann et al., 2023). Notably,
this study collapsed physical and sexual abuse into a single measure, and emotional abuse and
physical neglect into another, testing the contribution of these composite measures in separate
models. Furthermore, studies exploring both caregiver and child maltreatment type found that
caregiver depressive symptoms mediated the type-to-type associations between caregiver-child
physical abuse (Yang et al., 2018) and caregiver-child emotional abuse (Gong et al., 2024).
Caregiver-child physical abuse was also, separately, mediated by lack of social support (Caliso &
Milner, 1994). Additionally, Yang and colleagues (2018) demonstrated caregiver depressive
symptoms as a mechanism in the relationship between caregiver physical neglect and child
physical abuse.
Although much of the existing research has emphasized caregiver depression as a
primary mechanism of interest, it is important to examine multiple mechanisms simultaneously
to distinguish their relative contributions to intergenerational continuity. For example, recent
findings suggest that, when tested as competing mediators, caregiver adulthood adversities (i.e.,
financial difficulties, death of a loved one, serious illness, poor social support) may explain the
relationship between caregiver and child maltreatment beyond the influence of caregiver
depression (Berlin et al., 2011; Negriff et al., 2023; St-Laurent et al., 2019), further emphasizing
the need for direct comparison of multiple risk mechanisms in a single intergenerational model.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
20
Understanding the distinct and relative roles of caregiver psychosocial risk mechanisms is crucial
for research aimed at informing more effective and efficient interventions. This knowledge will
enable researchers and clinicians to identify priority targets for intervention, even in situations
where risk factors frequently co-occur, as is often the case in communities with elevated burden
of psychosocial determinants of childhood maltreatment (Gilbert et al., 2009).
The Current Study
The purpose of the current study was to address gaps in the previous literature by
identifying the unique and relative contributions of three prominent caregiver psychosocial risk
mechanisms to the intergenerational continuity of specific maltreatment types. We sought to test
initial self-report and change over time in caregiver (Generation 1, G1) depressive symptoms,
social support, and economic insecurity across the child-rearing period as competing mediators
in the relationship between caregiver (G1) and child (Generation 2, G2) sexual abuse, physical
abuse, emotional abuse, and physical neglect. First, we used latent growth curve modeling to
analyze the initial report (intercept) and trajectory of change over time (slope) for the caregiver
adulthood risk factors. We then used path modeling to test the indirect effects between all four
caregiver and child childhood maltreatment types via the intercept and slope of the caregiver risk
mechanisms extracted from the latent growth curve models.
These analyses were designed to offer both methodological and clinical insights to the
existing literature. Methodologically, we compared the effectiveness of using the initial report of
caregiver risk against trajectories of risk over time as competing mediators. Our aim was to
determine whether our understanding of intergenerational continuity may benefit from
considering change over time in these risk mechanisms versus the conventional approach of
using a single timepoint measurement of risk. Clinically, we sought to inform appropriate
INTERGENERATIONAL CHILDHOOD MALTREATMENT
21
selection and adaptation of evidence-based interventions based on specific prior experiences of
caregivers and/or children. Initial screening, identification of high-risk caregiver-child dyads, and
provision of referrals for prevention/intervention programs often take place in routine primary
care appointments or emergency department settings. Our hope is that the current exploration of
specific maltreatment types will aid clinicians in these fast-paced environments by simplifying
risk assessment and referral protocols1
. Once engaged in prevention/intervention, a considerable
amount of background detail is gathered for the purpose of case conceptualization and treatment
planning. In this context, a more nuanced understanding of the mechanistic pathways from
specific types of caregiver maltreatment to child maltreatment is incredibly useful.
Given the substantial evidence supporting the link between caregiver emotional abuse
and later adulthood depression, even when considering sexual and physical abuse (Ahuja et al.,
2023; Bifulco et al., 2002a; Christ et al., 2019; Crow et al., 2014; Dias et al., 2014; Dion et al.,
2016; Dittmann et al., 2023; Dye, 2020; Gong et al., 2024; McCabe et al., 2018; Mustillo et al.,
2011; Powers et al., 2009; Schiff et al., 2014; Struck et al., 2020; Wang et al., 2023), as well as
the association between caregiver depression and child physical neglect (Lee et al., 2012;
Shanahan et al., 2017), we hypothesized an indirect pathway from caregiver (G1) emotional
abuse to child (G2) physical neglect via caregiver (G1) adulthood depressive symptoms.
Although there is considerable evidence to support an association between economic insecurity
and child physical neglect, we did not hypothesize this association due to prior literature
1 To be effective in these medical settings with limited patient-provider interaction time, screening instruments must
be quick and generate an efficient sequence of steps to appropriate referrals. In this context, knowledge of the
intergenerational consequences of any caregiver maltreatment, regardless of type, is valuable as it can further
simplify intergenerational maltreatment risk screening to a single question (i.e., presence/absence of any caregiver
childhood maltreatment) that is feasible to assess during a routine visit. For this reason, we conducted a second path
model to test the association between a binary variable of any caregiver childhood maltreatment (0 = no
maltreatment; 1 = maltreatment) and the four child maltreatment types, mediated by the same caregiver risk
mechanisms. This model is provided in Figure A1 in Appendix A. Significant direct and indirect effects are in Table
A1, nonsignificant effects are in Table A2.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
22
demonstrating that, even in a highly impoverished sample, caregiver depression appears to drive
risk for child physical neglect (Shanahan et al., 2017). Therefore, we anticipated that the variance
in child physical neglect would be accounted for by caregiver depression when tested
simultaneously with economic insecurity. Furthermore, previous research indicates that caregiver
experiences of any childhood maltreatment, regardless of type, is associated with a pattern of
depressive symptoms across early adulthood that follows a similar trajectory as symptoms
among individuals without maltreatment, but is significantly higher at baseline (Dion et al.,
2016; Dittmann et al., 2023). Therefore, we expected the association between caregiver
emotional abuse and child physical neglect to be mediated by high initial report (intercept) of
depressive symptoms (H1). Given the lack of evidence regarding stability or change over time in
depressive symptoms among maltreated individuals in middle adulthood, we did not have any a
priori hypotheses regarding mediation through depressive symptom slope.
We also hypothesized that caregiver social support in adulthood would mediate the typeto-type association of caregiver-child physical abuse (H2a) as well as the relationship between
caregiver emotional abuse to child physical abuse (H2b), each. Prior literature suggests that
childhood maltreatment (regardless of type) is associated with lower overall as well as
decreasing social support across early and middle adulthood (Dion et al., 2016). We
hypothesized that these intergenerational associations between caregiver physical abuse and
emotional abuse with child physical abuse would be mediated through the intercept and/or slope
of caregiver social support.
Finally, childhood physical neglect has been linked with adulthood economic insecurities,
including unemployment and need for public income assistance (Pinto Pereira et al., 2017;
Schuck & Widom, 2021) which, when experienced by caregivers, may in turn increase risk for
INTERGENERATIONAL CHILDHOOD MALTREATMENT
23
physical abuse among their children (Berger et al., 2017; Black et al., 2001; Bullinger et al.,
2021; Raissian & Bullinger, 2017; Stith et al., 2009). In particular, both low cumulative financial
resources and decreasing income among caregivers across adulthood may be deleterious for child
physical abuse (Cai, 2022; Conrad et al., 2019). The present study used household income per
capita as the measure of economic insecurity given it has been shown to be an acceptable proxy
for family-level economic hardship (Datta & Meerman, 1980). Household income per capita –
shortened to household income – is used subsequently in this paper to indicate economic
hardship. We hypothesized an association between caregiver (G1) physical neglect and child
(G2) physical abuse via low initial (intercept), and separately decreasing (slope; H3b) household
income per capita (i.e., high initial [H3a] and increasing [H3b] economic insecurity). Due to the
inconsistent prior literature regarding the association between childhood sexual abuse and
adulthood economic insecurity, we did not have any a priori hypotheses regarding this
association. Furthermore, although there is some evidence of a link between caregiver childhood
physical abuse and subsequent lower economic stability (Lansford et al., 2021), we anticipated
that, consistent with prior literature (Caliso & Milner, 1994), mediation of the type-to-type
pathway from caregiver to child physical abuse would be accounted for by lower social support,
rendering mediation via economic insecurity nonsignificant.
H1: G1 Emotional Abuse ® G1 Depressive Symptom Intercept ® G2 Physical Neglect
H2a: G1 Physical Abuse ® G1 Social Support Intercept and/or Slope ® G2 Physical Abuse
H2b: G1 Emotional Abuse ® G1 Social Support Intercept and/or slope ® G2 Physical Abuse
H3a: G1 Physical Neglect ® G1 Household Income Intercept ® G2 Physical Abuse
H3b: G1 Physical Neglect ® G1 Household Income Slope ® G2 Physical Abuse
INTERGENERATIONAL CHILDHOOD MALTREATMENT
24
Method
Participants
Data for this study came from the Young Adolescent Project (Negriff et al., 2019), an
ongoing longitudinal study examining the effects of childhood maltreatment on development in
adolescence and emerging adulthood. Children (G2; n = 454, 53% male) and a primary caregiver
(G1) were enrolled in the study. Data for the current analyses were drawn from T2 (2003-2006),
T3 (2005-2008), and T4 (2009-2012), which occurred an average of 1, 2.5, and 7.2 years after
enrollment, respectively. G1 data were from T2 (n = 208, Mage = 40.1 years, SD = 10.1 years,
95.1% female), T3 (n = 259, Mage = 42.0 years, SD = 10.0 years, 91.4% female), and T4 (n =
249, Mage = 43.6 years, SD = 6.3 years, 90.0% female). G2 data were from T4 (n = 351, Mage =
18.3 years, SD = 1.5, 49.3% female). All caregiver types (i.e., biological parent, kin care, and
foster care/other) were included in the study sample. Depressive symptoms, lack of social
support, and economic insecurity (i.e., caregiver risk mechanisms in the present study) can
emerge during parenthood among both biological and non-biological caregivers, including kin
and non-kin foster caregivers, especially among caregivers with histories of childhood
maltreatment (Cole & Eamon, 2007; Ehrle & Geen, 2002; Evenson & Simon, 2005; Pinto et al.,
2020; Sharda et al., 2019; Whenan et al., 2009). This highlights the importance of considering
multiple types of caregivers and factors within the parenting and child-rearing environment,
irrespective of the caregiver-child relationship. Inclusion criteria for the study sample were 1)
stable caregiver as defined by the child having the same primary caregiver from age 1 year to T4,
and 2) complete data for caregiver childhood maltreatment experience assessed at T3. For G2
siblings (37 sibling pairs and 2 sibling trios; nsiblings = 80) with the same stable primary caregiver,
a single G1 self-report assessment was completed and used for all G2 siblings within the same
INTERGENERATIONAL CHILDHOOD MALTREATMENT
25
family. Characteristics of the final study sample (ndyads = 247, 53.4% G2 male, 95.1% G1 female;
71.4% biological parent, 18.7% kin care, 9.9% foster care/other) are presented in Table 1.
Recruitment
The sample consisted of child (G2) participants with histories of childhood maltreatment
documented by Department of Children and Family Services (DCFS) case record, a
demographically similar child comparison group, and their caregivers. The child welfareinvolved participants were recruited at baseline from DCFS open cases in Los Angeles County,
California. Recruitment inclusion criteria were (1) a new referral to DCFS for any type of G2
maltreatment within the month prior to initial recruitment contact, (2) G2 age of 9-12 years, (3)
G2 race/ethnicity of African American, Latinx, or non-Latino white, and (4) G2 residing in one
of 10 zip codes in Los Angeles County at the time of referral. Potential participants were
contacted via mail with the approval of the University of Southern California’s Institutional
Review Board and DCFS. Of the families contacted, 77% agreed to participate. The comparison
group was recruited via mail using school lists of children ages 9-12 years who were living in the
same 10 zip codes as those in the child welfare-involved sample. Approximately 50% of the
comparison families agreed to participate.
Retention
Sample retention between timepoints was high, particularly for this high-risk, child
welfare-involved population: between T1 and T2, 86%; T1 – T3, 71%; and T1 – T4, 78%. G2
participants not retained at T2 were more likely to have been involved with child welfare at T1,
at T3 were more likely to be Latinx, and at T4 were more likely to be male and to have been
child welfare-involved at T1.
Procedures
INTERGENERATIONAL CHILDHOOD MALTREATMENT
26
All waves of assessment were conducted in a research lab at the University of Southern
California. Caregiver and/or child consent and/or assent were obtained prior to participation in a
4-hour protocol which included administration of questionnaires and laboratory tasks.
Participants were paid for participation in accordance with the National Institutes of Health
standard compensation rate for healthy volunteers. All procedures were reviewed and approved
by the University of Southern California’s Institutional Review Board.
Measures
Self-Reported Childhood Maltreatment
The Childhood Trauma Interview (CTI) was used to assess self-reported maltreatment
(Noll et al., 2003) including sexual abuse, physical abuse, emotional abuse, and physical neglect
for both G1 and G2. All G1 and G2 participants reported on experiences of childhood
maltreatment regardless of recruitment group (i.e., child welfare-involved or comparison). The
CTI was administered by a trained research assistant in interview format beginning with
screening questions for 19 different potentially traumatic experiences. For each type of
maltreatment endorsed from the screening questions, follow-up assessments were administered
to obtain more detail regarding the experience(s). The CTI was only administered to G1 at T3,
therefore, G1 maltreatment data were from this timepoint. G2 CTI data is available at both T3
and T4. G2 data for this study were drawn from T4 due to a larger sample size at this wave and
the ability to capture maltreatment experiences throughout the course of childhood and
adolescence.
G1 and G2 Maltreatment Type. Sexual abuse was assessed with two questions (e.g.,
“Has anyone ever done something sexually to you that you didn’t want?”). Physical abuse was
assessed with one question (i.e., “Have you ever been hit, beaten, or physical mistreated by any
INTERGENERATIONAL CHILDHOOD MALTREATMENT
27
adults?”). Emotional abuse was assessed with five questions covering experiences of negativity
or hostility directed at the participant, exposure to domestic or other family violence,
inappropriate caregiver interference with relationships, inappropriate expectations of child,
caregiver threats of injury to self or child, confinement and/or isolation, caregiver serious mental
illness, child blamed for adult problems, and caregiver substance use (e.g., “Have there ever been
times when the adults that take care of you said mean or insulting things to you, put you down,
or told you that you were no good?”). Physical neglect included six questions regarding
experiences of caregiver failure to provide food, shelter, clothing, medical care, supervision, and
education as well as lack of child hygiene (e.g., shelter did not have a place to bathe), or
exposure to illegal activity (e.g., caregiver providing alcohol or drugs to the child). For example,
“Have there been times when you did not have enough to eat, did not have clothes, medicine or
medical attention, or didn’t have a place to sleep?” For maltreatment types with more than one
question, participants who endorsed any of the items were coded as having experienced that type
of maltreatment. Only G1 childhood maltreatment experiences prior to 18 years of age were
included in the study sample. For both G1 and G2, a binary variable was coded for each
maltreatment type indicating presence (1) or absence (0) of sexual abuse, physical abuse,
emotional abuse, and physical neglect.
G1 Depressive Symptoms
The Beck Depression Inventory (BDI) was used to measure G1 self-report depressive
symptoms in the past 7 days (Beck et al., 1996). Twenty-one items are scored on a 0 - 3 scale,
higher scores indicate greater symptom severity. The BDI has been widely used with both
psychiatric and non-psychiatric populations and has been shown to have high internal
consistency (Beck et al., 1996). The BDI was administered to G1 participants at T2 (sample α =
INTERGENERATIONAL CHILDHOOD MALTREATMENT
28
.89), T3 (α = .87), and T4 (α = .92). Total scores (range 0 - 63) at each of these three timepoints
were used in the current study.
G1 Social Support
Social support was assessed with the Social Support Questionnaire (SSQ; Sarason et al.,
1983). G1 participants listed individuals in their social support network and respond (yes/no) to
23 items about the types of support they receive from and provide to each individual listed. The
items assess for three types of social support: emotional (8 items total; 4 receiving, 4 providing),
tangible (6 items total; 3 receiving, 3 providing), and informational (8 items total; 4 receiving, 4
providing). The emotional support items assess support such as talking about personal problems,
having fun together, and sharing positive or negative news (e.g., “I can talk to this person about
personal concerns”). Tangible support assesses financial, emergency, and childcare support (e.g.,
“I can count on help from this person in an emergency”). The informational support items assess
support such as providing advice regarding personal problems and child rearing (e.g., “I talk to
this person about problems with my children”). For this analysis we used the items that pertain to
receiving support, and summed a total score of the number of individuals in the participant’s
social support network for whom they endorse at least one item from each of the three types of
support - emotional, tangible, and informational. This measure was intended to capture both
quantity and quality of perceived social support (Antonucci et al., 1997, Antonucci et al., 2014).
The SSQ was administered to G1 participants at T2 and T3 and the sum scores from each of
these timepoints were used in this study.
G1 Household Income Per Capita
Household income per capita was used as the measure of economic insecurity due to
prior literature suggesting that household income measures that account for family size indicate
INTERGENERATIONAL CHILDHOOD MALTREATMENT
29
overall household economic resources and strains (Datta & Meerman, 1980). G1 participants
completed a demographics survey at T2, T3, and T4 that included items assessing household
income and family size. Household income was assessed with one item (“Please indicate your
household gross [before taxes] income”) rated on a 12-point scale (1 = under $4,999, 2 = $5,000-
9,999, … 11 = %100,00-119,999, 12 = over $120,000). Family size was assessed by asking G1
participants to report the number of children living in the home. Household income per capita
(i.e., “household income” for the remainder of the paper) was calculated as the household
income divided by the number of children living in the home.
Covariates
Caregiver type was obtained from G1 participant report on their status as the biological
caregiver of the G2 participant by responding yes/no to “Are you [G2 participant’s name]’s
biological parent?” A binary variable was coded to distinguish between biological caregivers (0)
and non-biological caregivers (1). G2 age at T2 was calculated as the difference between the G2
participant reported birthdate and date of T2 data collection. G2 sex was obtained via G2 selfreport during T2 assessment.
Data Analysis
The aim of this study was to examine the mediating effect of initial level and withinperson change/stability over time of three caregiver risk variables (depressive symptoms, social
support, and household income) in the intergenerational association between caregiver (G1) and
child (G2) childhood maltreatment types. A two-step analytic approach was used to address this
aim. First, latent growth curve analyses were conducted with G1 depressive symptoms (T2, T3,
and T4) and, separately, with G1 household income (T2, T3, and T4). For both models, time was
anchored at T2, and time coded to account for differing time intervals between timepoints.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
30
Intercepts and slopes for each G1 participant were extracted for use in the subsequent mediation
model. For the third caregiver risk variable, G1 social support, latent growth curve analysis was
not possible due to availability of only two timepoints of data. The G1 social support total scores
at T2 were used as intercepts and a change score between T2 and T3 social support total scores
were used as slopes in subsequent analyses. Descriptive statistics were used to analyze the mean
at T2 (intercept proxy) and mean T3-T2 change (slope proxy) for the overall sample. A pairedsample t-test was conducted to determine if the means of T2 and T3 social support differed
significantly (slope variability proxy).
In the second step, a path model was specified to test the mediating effect of initial report
and change over time among the three caregiver risk variables in the association between G1 and
G2 maltreatment types. G1 sexual abuse, physical abuse, emotional abuse, and physical neglect
were included as independent variables; and G2 sexual abuse, physical abuse, emotional abuse,
and physical neglect were entered as dependent variables. Extracted slopes and intercepts from
the latent growth curve models for depressive symptoms and household income, as well as T2
social support and social support change score were included as mediators. All direct and indirect
effects between G1 maltreatment types to G1 risk mechanisms, G1 risk mechanisms to G2
maltreatment types, and G1 maltreatment types to G2 maltreatment types, were included in the
model. G2 sex, G2 age at T2, and caregiver type were included as covariates on G2 child
maltreatment types.2 Significant direct and indirect effects were determined using bootstrapped
95% confidence intervals.
2 Analysis was conducted in Mplus Version 8 (Muthén & Muthén, 2012). The path model was also run with TYPE =
COMPLEX to account for non-independence in the sample due to siblings. Results were consistent with the path
model without TYPE = COMPLEX. Results presented herein are from the more parsimonious model without TYPE
= COMPLEX.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
31
We used established guidelines regarding model fit indices for the latent growth curve
models and the mediation path model, including Comparative Fit Index (CFI), Tucker-Lewis
Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean
Square Residual (SRMR) to ensure the model adequately represents the observed data (Hu &
Bentler, 1998; Kline, 2023). Generally, good fit is indicated by CFI close to or above 0.95, TLI
values close to or above 0.90, RMSEA values close to or below 0.06 (0.01 is considered
excellent, 0.08 is considered mediocre), and SRMR values close to or below 0.08 (Hu & Bentler,
1998; Kline, 2023).
Results
Missing Data
Missing values at the item- and variable-level among the mediating G1 risk variables are
reported in Table 2. Multiple imputation was conducted in SPSS Version 28 (IBM Corp., 2021)
to address missingness, first imputed at the item level and then at the variable level, as
applicable. The path models were conducted in Mplus Version 8 (Muthén & Muthén, 2012).
Remaining missingness in the G2 childhood maltreatment variables was addressed with Full
Information Maximum Likelihood, and nonnormality was addressed with estimation of robust
standard errors (Burchinal et al., 2006; Lee et al., 2019)
Descriptive Statistics
Descriptive statistics were examined for all G1 and G2 childhood maltreatment types as
well as G1 depressive symptoms, social support, and household income (i.e., caregiver risk
variables; see Tables 3 and 4). Fifty three percent (53.0%) of G1 and 57.8% of G2 participants
reported at least one type of childhood maltreatment. Emotional abuse was the most prevalent
maltreatment type for both G1 (T3; 41.4%) and G2 (T4; 27.1%) participants, followed by
INTERGENERATIONAL CHILDHOOD MALTREATMENT
32
physical abuse (G1, 19.3%; G2, 15.2%), physical neglect (G1, 18.9%; G2, 14.3%), and sexual
abuse (G1, 12.9%; G2, 8.1%). In terms of G1 risk, no considerable difference existed in the
means and standard deviations for the population from T2 to T4.
Correlations between study variables are presented in Table 5. All G1 maltreatment types
were positively associated with one another, as were all G2 maltreatment types.
Intergenerationally, G1 physical abuse was positively correlated with G2 sexual and physical
abuse, and G1 emotional abuse with G2 sexual abuse, emotional abuse, and physical neglect. G1
physical neglect was positively correlated with all G2 maltreatment types. In terms of
correlations between the G1 risk variables, all timepoints within each measure were positively
associated (e.g., T2 G1 depressive symptoms with T3 G1 depressive symptoms) except for T2
and T4 G1 household income which were not significantly correlated.
Latent Growth Curve Models
Depressive Symptoms
The model fit the data well (χ2 = 4.35(1), p = 0.04; RMSEA = 0.099; CFI = .99; TLI =
.96; SRMR = 0.03). The intercept (T2) mean for the depressive symptom scale was 7.21 (p =
.01) and there was significant variability in scores across individuals (s00 = 28.27, p < .001)3
. On
average, scores increased by .083 at each subsequent timepoint, but this increase was not
significant (p = .25). Slopes did, however, significantly vary (s11 = -1.24, p = .01), suggesting
variability in individuals’ change over time in depressive symptoms. Finally, intercepts and
slopes were positively correlated (s01 = 2.01, p = .01), indicating that higher depressive
symptoms at baseline (T2) was associated with increasing depressive symptoms over time.
Household Income Per Capita
3 Unstandardized parameter estimates are provided for the latent growth curve models for ease of interpretability.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
33
Model fit for the household income latent growth curve model was also adequate (χ2 =
4.675(1), p = 0.031; RMSEA = 0.086; CFI = .976; TLI = .927; SRMR = 0.034). The mean for
the intercept (T2) was 3.95 (p < .001; approximately $13,167-19,748 annual household
income/child) and .09 for slope (p = .45). Variability in scores across individuals was significant
for intercept (s00= 2.25, p < .001), but not slope (s11 = .018, p = .73), suggesting that participants
household income changed over time at approximately the same rate. The correlation between
intercept and slope was not significant (s01 = 0.10, p = .24), demonstrating that initial income at
T2 was not associated with change over time.
Social Support
The mean for social support at T2 was 4.42 (intercept proxy), and the mean change score
from T2 to T3 was -0.38 (slope proxy). The paired samples t-test comparing the means of social
support at T2 (M = 4.42, SD = 2.68) and T3 (M = 4.13, SD = 2.53) was not significant (t (231) =
1.86, p = .07, Cohen's d = 0.12), indicating that, on average, individuals did not change
significantly in social support over time.
Mediation Path Model
Main Effects
Model fit was good (χ2 = 17.950 (19), p = 0.53; probability RMSEA = 0.00 [90% CI 0.00,
0.05]; CFI = 1.000; TLI = 1.000; SRMR = 0.05). The full model is presented in Figure 1.
Significant direct and indirect effects are presented in Table 64
.
Caregiver Childhood Maltreatment Type on Caregiver Risk Trajectories. There were
significant main effects of G1 physical abuse on household income intercept (b = -.19; 95% CI [-
4 Nonsignificant direct and indirect effects are presented in Table B1 in Appendix B.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
34
0.32, -0.07]; p <.01), household income slope (b = -.19; 95% CI [-0.32, -0.07]; p <.01)5
, and
social support intercept (b = -.14; 95% CI [-0.26, -0.01]; p <.05). The main effect from G1
emotional abuse to G1 depressive symptoms intercept was also significant (b = .22; 95% CI
[0.07, 0.35]; p <.01). No other main effects from G1 maltreatment types to G1 risk variables
were significant.
Caregiver Risk Trajectories on Child Childhood Maltreatment Type. The effect of
G1 depressive symptoms intercept on G2 physical neglect (b = .23; 95% CI [0.02, 0.42]; p <.05)
was significant. Additionally, there were significant effects of G1 social support intercept on G2
physical abuse (b = -.41; 95% CI [-0.71, -0.15]; p <.01), and G1 social support slope on G2
sexual abuse (b = -.35; 95% CI [-0.62, -0.10]; p <.01) and physical abuse (b = -.41; 95% CI [-
0.67, -0.15]; p <.01). There were no other significant main effects from the G1 risk variables to
the G2 maltreatment types.
Indirect Effects
Significant indirect effects were found from G1 emotional abuse to G2 physical neglect
through G1 depressive symptoms intercept (b = .05; 95% CI = [.01, .13]; p <.05). The indirect
path from G1 physical abuse to G2 physical abuse through G1 social support intercept was also
significant (b = .06; 95% CI = [.01, .16]; p <.05). No other significant indirect effects were
found.
Discussion
Overall, the current study demonstrated specific risk pathways from caregiver childhood
maltreatment to child maltreatment via higher caregiver depressive symptoms and lower social
5 Despite the significance of this main effect, the slope parameter estimate for household income from the latent
growth curve model was not significant. Therefore, it is likely that neither of the simple slopes are significant on
their own.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
35
support in adulthood. Caregivers with histories of childhood emotional abuse reported higher
initial depressive symptoms which, in turn, increased risk for physical neglect among their
children. Additionally, children of caregivers with childhood physical abuse were also more
likely to experience physical abuse, and this relationship was mediated through lower initial
report of caregiver social support. These findings are the first to isolate pathways of
intergenerational continuity of specific maltreatment types via caregiver psychosocial risk
mechanisms in the child-rearing environment while accounting for the potentially confounding
contribution of other maltreatment types and family-level mediators.
As anticipated (H1), caregivers’ prior childhood experience of emotional abuse was
related to higher initial report of depressive symptoms in adulthood, which was subsequently
associated with physical neglect among their children. Consistent with prior literature, emotional
abuse was linked with adulthood depression over and above other types of childhood
maltreatment (Dye, 2020; English et al., 2015; Hart et al., 2002; Hart et al., 2022; Hodgdon et al.,
2018; Paul & Eckenrode, 2015; Taillieu et al., 2016). The features of emotional abuse such as
negativity and hostility, psychological control, degradation, and feelings of worthlessness and
being unwanted have been shown to detrimentally impact the development of self-esteem, selfevaluation, and emotional awareness and regulation, which precipitate persistent depressive
symptoms and neglectful parenting (Dye, 2020; Heim et al., 2013; Zhang et al., 2022).
Caregivers who experience elevated depressive symptoms are at increased risk of problematic
substance use, diminished capacity for supervision and involvement with their children, and
unemployment, which cumulatively confer risk for neglectful parenting and failure to provide
basic needs (Amiri, 2022; Brennan et al., 2003; Lee et al., 2012; Paulson et al., 2006). Despite
national estimates suggesting that neglect is the most prevalent type of child maltreatment largely
INTERGENERATIONAL CHILDHOOD MALTREATMENT
36
due to reasons of poverty (Hussey et al., 2006; Sedlak et al., 2010), interestingly, our findings
suggest that caregiver depressive symptoms account for increased risk of child neglect even after
accounting for family-level economic insecurity. Given that our study sample is generally lowincome, these results should be interpreted with appropriate caution. However, they do provide
support for future research into the relative contributions of caregiver mental health and
economic circumstance on child physical neglect.
Our findings also showed that caregiver physical abuse was uniquely associated with
higher initial report of economic insecurity (i.e., lower household income per capita), above and
beyond the contribution of other maltreatment types. This aligns with recent estimates reporting
that, in the United States, individuals with childhood physical abuse are approximately twice as
likely to experience economic insecurity requiring government income assistance during
adulthood (Lansford et al., 2021). However, until the current study, it was unknown if this
association was specific to physical abuse in comparison to other maltreatment types.
Additionally, while both lower financial resources and decreasing income trajectories have been
identified as risk factors for child maltreatment (Black et al., 2001; Cai, 2022; Conrad et al.,
2019; Conrad-Hiebner & Byram, 2020; Stith et al., 2009), we did not find a significant
association between caregiver economic insecurity and child maltreatment among the second
generation. According to the family stress model, family-level economic insecurity escalates
parenting stress and caregiver depressive symptoms, leading to subsequent maltreatment among
their children (Conger et al., 1999; Duncan et al., 2014; Yang, 2015). Complimenting this theory,
our findings demonstrated that, while adulthood economic insecurity is a detrimental
consequence of childhood physical abuse and is highly correlated with both caregiver depressive
INTERGENERATIONAL CHILDHOOD MALTREATMENT
37
symptoms and social support, it appears that caregiver mental health and social support may
explain the increased risk of child maltreatment continuity.
In support of our second hypothesis (H2a), our findings demonstrated a type-to-type
pathway from caregiver to child physical abuse via lower initial report of caregiver social
support. Notably, our model did not support an association between caregiver emotional abuse
and adulthood social support (H2b), likely due to the strong competing association between
caregiver physical abuse and social support outcomes. The current study bolsters and extends
previous literature demonstrating this intergenerational pathway (Caliso & Milner, 1994), by
establishing that initial report of social support, rather than change in social support across the
child-rearing period, may be a more critical link for intergenerational physical abuse. Social
learning theory posits that an individual’s behavior is shaped by the experiences that were
modeled in their own childhood environment (Muller et al., 1995; Widom & Wilson, 2015). This
theoretical framework has long been used to explain why caregivers who were exposed to
childhood maltreatment, and physical abuse in particular, are more likely to replicate the same
detrimental behaviors and environments with their own children (Caliso & Milner, 1994; Muller
et al., 1995). The current study has predominantly focused on identifying risk factors, however,
our findings may also provide support to previous evidence that greater social support serves a
protective function (Schofield et al., 2013; Thornberry et al., 2013). Our findings suggest that
supportive social connections for caregivers during parenthood, likely with individuals from
whom they may be exposed to other models of parenting, may play a key role in the
intergenerational continuity or discontinuity of physical abuse (Caliso & Milner, 1994).
Contrary to our expectations (H3a and H3b), we did not find a relationship between
caregiver childhood physical neglect, economic insecurity, and child physical abuse. This was
INTERGENERATIONAL CHILDHOOD MALTREATMENT
38
somewhat surprising given that previous literature suggests an association between childhood
neglect and financial instability in early and middle adulthood, which subsequently may increase
risk for physical abuse, harsh parenting, and perpetration of violent behavior in adulthood (Cai,
2022; Conrad et al., 2019; Schuck & Widom, 2021). The reason for the current study’s
discordant findings may be due, at least in part, to the measurement of childhood maltreatment
experiences. Shuck & Widom (2021) used substantiated reports from official Child Protective
Services (CPS) case records to demonstrate the association between childhood physical neglect
and economic insecurity. Childhood maltreatment that rises to the level of CPS involvement is
likely more severe, thus leading to greater detrimental impacts in adulthood as compared to selfreported incidents (as in the current study) which may capture a broader range of severity.
Conversely, while Conrad and colleagues (2019) demonstrated that persistent economic
insecurity confers risk for harsh parenting practices, these incidents that may not rise to the level
of physical abuse measured in our study. Alternatively, an association between lower social
support and economic insecurity has been shown in the present study as well as in previous
literature (Curran et al., 2010). It may be that, when analyzed as a competing mediator alongside
caregiver depressive symptoms and social support, the variance in child physical abuse
previously attributed to economic insecurity is better explained by caregiver lack of social
support. Given that economic status is difficult to change (O’Neill et al., 2000), this may have
promising implications for intervention in that addressing the more modifiable risk factors of
caregiver mental health and social support may be most effective in mitigating intergenerational
maltreatment continuity.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
39
Clinical Implications
An overarching goal of this study was to support mental health and social services
targeting intergenerational maltreatment by pinpointing precise risk mechanisms in the
relationships between caregiver and child maltreatment types, thereby facilitating the delivery of
interventions that are best suited to have a lasting impact. Effective intergenerational
interventions aimed at preventing maltreatment continuity requires a multi-pronged approach,
including mental health treatment for maltreated caregivers, parenting support, and simultaneous
efforts to build social support networks for families (Aparicio et al., 2023; Cicchetti & Toth,
2016; Isobel et al., 2019). Our findings suggest that mental health interventions that address
depressive symptoms among caregivers, particularly for those with childhood emotional abuse
experiences, may be most effective in mitigating risk for child physical neglect. Additionally,
strengthening caregivers' social support networks, for example via caregiver support groups or
parenting skills groups, may be particularly important in breaking the cycle of violence
associated with intergenerational physical abuse.
Limitations
This study has some limitations that should be acknowledged. First, the measures of
childhood maltreatment for both caregiver and child were based on self-report rather than official
records. Although our sample included a maltreatment sample with DCFS-documented
maltreatment prior to enrollment in the study, the self-report measure was chosen for two critical
research design reasons: (1) child (G2) childhood maltreatment measured at T4 allowed for selfreport across the full childhood and adolescent period, and (2) caregiver maltreatment was
assessed only at T3 with the self-report measure (i.e., no official report data were available for
caregivers), thus child (G2) self-report was selected in order to maintain consistency between
INTERGENERATIONAL CHILDHOOD MALTREATMENT
40
caregiver and child measures. Despite concern about the effects of recall bias in subjective
measurements of childhood maltreatment, a number of studies have suggested that retrospective
self-report is valid in terms of predicting longitudinal outcomes (Danese & Widom, 2021;
Negriff et al., 2017; Newbury et al., 2018). Future research should consider examining the
intergenerational patterns among those with official reports of maltreatment for both caregivers
and children.
A second limitation is that the mediators (G1 mechanisms of risk) and outcomes (G2
maltreatment types) may have occurred simultaneously. That is, caregiver risk factors cannot be
unequivocally established as chronologically preceding the child maltreatment outcomes. We
sought to address this limitation by measuring and comparing both initial report and change over
time in these mechanisms to identify trajectories of caregiver risk across the child-rearing period.
Accounting for change over time in the mediating mechanisms was intended to capture the
contextual environment in which child maltreatment occurred. Furthermore, our findings suggest
that intergenerational maltreatment processes may be better explained by initial report measured
at a single timepoint, as is customary in most of the previous literature, than by change over time.
To truly address this temporal issue, future studies may consider including only caregiver-child
dyads in which the child maltreatment occurred during, and only during, adolescence.
Unfortunately, the current study did not have sufficient sample size for this approach.
Finally, after exclusion criteria, our study sample of caregivers with childhood sexual
abuse was small (n = 32). While the lack of findings related to caregiver sexual abuse may be
due to the greater influence of other competing maltreatment types and mechanisms, which
would be aligned with our hypotheses and prior research comparing the contribution of multiple
caregiver maltreatment types of adulthood outcomes simultaneously (e.g., Bifulco et al., 2002a;
INTERGENERATIONAL CHILDHOOD MALTREATMENT
41
Christ et al., 2019; Dye, 2020; English et al., 2015; Powers et al., 2009). However, it also may be
that the caregiver sexual abuse sample size in the current study was not sufficient to detect an
effect that may have emerged in a larger sample. Further research is needed to clarify the unique
and relative contribution of childhood sexual abuse on intergenerational patterns of risk and
maltreatment continuity.
Conclusion
Broadly, the results demonstrated specific pathways of risk from caregiver to child
maltreatment types via caregiver psychosocial mechanisms of risk for intergenerational
continuity during the child-rearing period. Caregiver childhood emotional abuse conferred risk
for child physical neglect via higher initial caregiver depressive symptoms, and a type-to-type
intergenerational association was found for caregiver-child physical abuse mediated by lower
initial social support. The present study extended the extant literature by examining multiple
caregiver maltreatment types in the same model, aiming to explicate the relative contributions of
each on intergenerational maltreatment continuity. This study was unique in its use of latent
growth curve modeling to explore and compare initial report and trajectories over time of the
caregiver risk mechanisms with the strongest theoretical support in the existing literature.
Critically, our findings suggest that caregiver risk may not resolve without appropriate
intervention. In combination with the significance of this public health crisis, this finding
clarifies the substantial need for more efficient and effective assessment, prevention, and
intervention processes to address intergenerational childhood maltreatment.
INTERGENERATIONAL CHILDHOOD MALTREATMENT
42
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Table 1
Sample Sociodemographic Characteristics at T2 for Caregivers (G1) and Children (G2)
Note. G1 = caregiver, G2 = child; The discrepancy between the sample size for G1 and G2 is due to the presence of
37 sibling pairs and 2 sibling trios (nsiblings = 80) with the same primary caregiver; G1 participants were, on average,
40.2 years old (SD = 10.1), G2 participants were, on average, 12.1 years old (SD = 1.2).
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Table 2
Missing Value Analysis for Caregiver (G1) Risk Variables
Note. G1 = caregiver; nG1 = 208; Household income per capita was assessed with a single item, item and variable
level are synonymous.
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Table 3
Prevalence of Childhood Maltreatment Types in the Study Sample
Note. G1 = caregiver, G2 = child; nG1 = 208, nG2 = 247.
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59
Table 4
Descriptive Statistics for Caregiver (G1) Risk Variables
Note. G1 = caregiver; nG1 = 208.
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Table 5
Correlations between Study Variables
Note. G1 = caregiver, G2 = child; nG1 = 208, nG2 = 247.
*p < .05. **p < .01. ***p < .001.
G1 Risk
Profile 3
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Table 6
Significant Direct and Indirect Effects from Mediation Model
Note. Standardized effects; G1 = caregiver; G2 = child; nG1 = 208, nG2 = 247; CI = confidence interval.
*p < .05. **p < .01.
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Figure 1
Mediation Path Model
Note: Standardized effects; G1 = caregiver, G2 = child; nG1 = 208, nG2 = 247; Household income = household
income per capita; G1 depressive symptoms and G1 household income slopes and intercepts for each participant
were extracted from separate latent growth curve models, G1 social support intercept = T2 social support (i.e., the
number of individuals from whom the participant receives tangible, emotional, and informational support), G1 social
support intercept = T2-T3 social support change score; covariates were G2 age at T2, G2 sex, and caregiver type;
Only significant effects are included in the figure, significant indirect effects are bolded. See Table 6 for significant
direct and indirect effects, Table B1 in Appendix B presents the nonsignificant direct and indirect effects.
*p < .05. **p < .01.
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Paper 2
Intergenerational Consequences of Childhood Emotional Abuse: The Role of Chronicity,
Severity, and Age of Onset
Hannah Leigh Fritz, M.A. and Sonya Negriff, Ph.D.
University of Southern California
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Intergenerational Consequences of Childhood Emotional Abuse: The Role of Chronicity,
Severity, and Age of Onset
Intergenerational childhood maltreatment continuity is a well-established pattern in which
both a caregiver and their child have experienced abuse or neglect during childhood (Berlin et
al., 2011). Caregiver childhood maltreatment is associated with increased emotional and
behavioral problems among their children, with some studies suggesting that this relationship
may be mediated by the child’s own maltreatment experiences (Gong et al., 2024; LoheideNiesmann et al., 2022; Negriff, 2020; Russotti et al., 2021; Su et al., 2022). Previous literature on
these intergenerational processes predominantly focuses on the impacts of caregiver
maltreatment types involving deliberate physical harm, such as sexual or physical abuse (e.g.,
Bartlett et al., 2017; Bartlett & Easterbrooks, 2015; Ben-David et al., 2015; Berlin et al., 2011;
Berzenski et al., 2014; Borelli et al., 2019; Dixon et al., 2005; Dodge et al., 1995; Dubowitz et
al., 2001; Greene et al., 2020; Pears & Capaldi, 2001; Zuravin et al., 1996). However, childhood
emotional abuse is increasingly recognized as equally, if not more, detrimental than other types
of maltreatment, with significant individual and intergenerational consequences (Dye, 2020;
Gama et al., 2021; Hart et al., 2022; Hodgdon et al., 2018; Khoury et al., 2022; Paul &
Eckenrode, 2015; Rizvi & Fariha, 2017; Spinazzola et al., 2014; Sroufe et al., 2005). In addition
to the type of maltreatment, the chronicity, severity, and age of onset of caregiver childhood
maltreatment also appear to have critical intergenerational impacts, including elevated risk of
polyvictimization (i.e., multi-type maltreatment) as well as psychological and behavioral
problems among the next generation of children (Ben-David et al., 2015; Greene et al., 2020;
Jonson-Reid et al., 2012). The purpose of the current study was to contribute to the literature
regarding the intergenerational implications of childhood emotional abuse by exploring the ways
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in which variations in the characteristics of caregiver emotional abuse may subsequently impact
the wellbeing of their children, including polyvictimization and internalizing and externalizing
symptoms in late adolescence.
Intergenerational Implications of Caregiver Childhood Maltreatment
An extensive and growing body of literature supports an association between caregivers’
experiences of childhood maltreatment and poor psychological and behavioral adjustment among
their children including depressive symptoms, anxiety, and posttraumatic stress, as well as a
range of disruptive externalizing behaviors (Airikka et al., 2023; Babcock Fenerci et al., 2016;
Bödeker et al., 2019; Bravo et al., 2023; Bronfenbrenner & Morris, 2007; Collishaw et al., 2007;
Dubowitz et al., 2001; Esteves et al., 2017; Harris et al., 2023; Khoury et al., 2022; Ma et al.,
2022; Morrel et al., 2003; Myhre et al., 2014; Plant et al., 2017; Plant et al., 2018; Rijlaarsdam et
al., 2014; Su et al., 2022; Van De Ven et al., 2020; Warmingham et al., 2024). These adverse
child outcomes may rise to the level of clinical significance and affect functioning in both home
and school environments (Airikka et al., 2023; Bödeker et al., 2019; Harris et al., 2023). Several
studies have demonstrated that this intergenerational relationship between caregiver childhood
maltreatment and child internalizing and externalizing symptoms may be, at least in part,
explained by the child’s childhood maltreatment experiences (Bosquet Enlow et al., 2018; Bravo
et al., 2023; Islam et al., 2022; Khoury et al., 2022; Ma et al., 2022; Negriff, 2020; Rijlaarsdam
et al., 2014; Russotti et al., 2021; Su et al., 2022; Warmingham et al., 2024). Caregivers’
experiences of childhood maltreatment have cascading detrimental effects on adulthood
psychosocial outcomes including parenting practices, caregiver mental health, social support
resources, and the caregiver-child relationship (Bronfenbrenner & Morris, 2007; Ma et al., 2022;
Savage et al., 2019). These outcomes have all been linked with increased risk for their child’s
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maltreatment and associated behavioral health disturbances across the child’s development
(Bronfenbrenner & Morris, 2007; Ma et al., 2022; Savage et al., 2019).
Most prior studies have focused on infant, toddler, and childhood outcomes among the
children of maltreated caregivers, often excluding adolescents from study samples altogether or
exploring outcomes among a merged sample of adolescents and younger children (Airikka et al.,
2023; Collishaw et al., 2007; Esteves et al., 2017; Harris et al., 2023; Khoury et al., 2022). These
approaches overlook adolescence as a sensitive period for the emergence of internalizing and
externalizing symptoms. Adolescence is characterized by burgeoning autonomy and
responsibility, individuation and identity formation, and the task of establishing increasingly
complex peer and romantic relationships (Erikson, 1980; Ragelienė, 2016). Adolescence is also a
period of heightened vulnerability for the emergence of internalizing and externalizing problems,
which may set the stage for emotional, behavioral, and social maladjustment in adulthood
(Arslan, 2016; Cicchetti, 2016; Ernst & Korelitz, 2009). Additionally, from a developmental and
methodological perspective, adolescents are capable of self-reporting their maltreatment
experiences and behavioral health symptoms, which may diverge from those of caregiver-report
or child protective services (CPS) case records in terms of type, frequency, and severity (Khoury
et al., 2022; Negriff et al., 2017). Some literature suggests that adolescent self-report may serve
as a stronger predictor of subsequent adverse outcomes in adulthood than caregiver-report and
case records, highlighting the utility of using measures of self-reported maltreatment with this
population (Danese & Widom, 2021; Khoury et al., 2022; Negriff et al., 2017; Newbury et al.,
2018). Defining the effects of intergenerational maltreatment continuity on adolescent outcomes
could provide a critical perspective to the literature, especially considering that adolescents are
able to report on their maltreatment experiences across several developmental periods.
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Adolescents whose caregivers have childhood maltreatment histories are also more likely
to have experienced childhood polyvictimization (i.e., multi-type maltreatment) and multiple
CPS reports as compared to younger children and those with nonmaltreated caregivers (Hindley
et al., 2006; McKenzie et al., 2024). Critically, polyvictimization is associated with higher
severity of psychopathology, externalizing behaviors, and substance use in adolescence, and
greater susceptibility to further polyvictimization and psychological distress in adulthood (Anda
et al., 2006; Arata et al., 2005; Arata et al., 2007; Cloitre et al., 2009; Dion et al., 2016; Finkelhor
et al., 2011; Hodgdon et al., 2018; Khoury et al., 2022; Mills et al., 2013; Pears et al., 2008; Soler
et al., 2013; Villodas et al., 2021; Zhang et al., 2022). Across several studies, the estimated
prevalence of polyvictimization among maltreated children ranges from 65-94% (Arata et al.,
2005; Barnett et al., 1993; Bolger & Patterson, 2001; Cicchetti & Rogosch, 1997; Mcgee et al.,
1997). Yet, despite its high prevalence and stronger association with adverse adolescent
outcomes than single-type maltreatment, the potential mediating role of childhood
polyvictimization in the relationship between caregiver childhood maltreatment and adolescent
emotional and behavioral outcomes remains underexplored (Khoury et al., 2022).
Caregiver Childhood Emotional Abuse and Intergenerational Sequelae
Extensive prior work has delineated the consequences of caregiver childhood sexual
abuse, physical abuse, and physical neglect on intergenerational maltreatment and the
development of child and adolescent internalizing and externalizing symptoms (Bartlett et al.,
2017; Bartlett & Easterbrooks, 2015; Ben-David et al., 2015; Berlin et al., 2011; Berzenski et al.,
2014; Borelli et al., 2019; Dixon et al., 2005; Dodge et al., 1995; Dubowitz et al., 2001; Esteves
et al., 2017; Giallo et al., 2020; Greene et al., 2020; Kim, 2009; Lange et al., 2019; Madigan et
al., 2019; Martoccio et al., 2022; Milaniak & Widom, 2015; Milner et al., 1990; Pears & Capaldi,
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2001; Roberts et al., 2004; St-Laurent et al., 2019; Widom et al., 2015; Zuravin et al., 1996). In
contrast, the intergenerational implications of caregiver childhood emotional abuse have received
relatively little attention (English et al., 2015; Hart et al., 2022; Rizvi & Fariha, 2017; Spinazzola
et al., 2014; White et al., 2016). This may stem from the challenge of establishing a consistent
and accurate operational definition across research and clinical settings that distinguishes
between emotional maltreatment and poor or dysfunctional parenting practices that do not rise to
the level of abuse (Gabalda et al., 2009; Hart et al., 2002; Hodgdon & Landers, 2022; Wolfe &
McIsaac, 2011; Wright et al., 2009). Currently, the most widely-accepted definition of emotional
abuse, sometimes interchangeably referred to as psychological maltreatment, includes “acts of
commission (e.g., verbal attacks on the child by a caregiver) and omission (e.g., emotional
unresponsiveness of a caregiver) […that] convey a child is worthless, defective, damaged goods,
unloved, unwanted, endangered, primarily useful in meeting another’s needs, and/or expendable”
(Brassard et al., 2020; Brassard & Donovan, 2006; Hart et al., 2019; Hart & Brassard, 1991;
Trickett et al., 2009).
Unlike physical and sexual abuse, which typically involve overt physical harm, emotional
abuse often lacks visible evidence of harm and has had a relative delay in widespread societal
recognition as a form of maltreatment with significant detrimental effects (Slep et al., 2011;
Trocmé et al., 2011). Inconsistencies in defining and measuring emotional abuse have led to
considerable variations in documented case rates, making its prevalence difficult to establish. For
instance, in 2015, child welfare agencies across different U.S. states reported a very wide range
(0.2% to 44.9%) of recorded maltreatment cases that included an allegation of emotional abuse,
suggesting a marked discrepancy in operationalization and detection (English et al., 2015;
Shpiegel et al., 2013). Additionally, very few of these cases involved emotional abuse as the
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69
primary focus of investigation, which may be indicative of the general diminution of emotional
abuse in comparison to other maltreatment types among child welfare agencies (English et al.,
2015; Shpiegel et al., 2013). There are also discrepancies between rates of official case report
and self-reported emotional abuse, with significantly higher rates arising when individuals report
their own experiences (Everson et al., 2008; Hambrick et al., 2014; Trickett et al., 2009; White et
al., 2016). Despite these discrepancies, both official records and self-report estimates indicate
that emotional abuse is one of the most prevalent maltreatment types, though very likely still
under-reported and under-detected (Baker et al., 2013; Chamberland et al., 2011; English et al.,
2015; Hodgdon & Landers, 2022; Sedlak et al., 2010; Tonmyr et al., 2011; Trickett et al., 2009).
Given its high prevalence, the influence of emotional abuse on intergenerational
maltreatment continuity should not be overlooked. Research investigating the relative impact of
different maltreatment types has consistently shown that the longitudinal consequences of
emotional abuse on individual psychopathology and internalizing and externalizing symptoms
are at least equivalent to, if not more severe than, the sequelae associated with sexual abuse,
physical abuse, and physical neglect (Chamberland et al., 2011; Claussen & Crittenden, 1991;
Dye, 2020; Egeland et al., 1983; English et al., 2015; Erickson et al., 1989; Gama et al., 2021;
Hart et al., 2022; Hodgdon et al., 2018; Hodgdon & Landers, 2022; Paul & Eckenrode, 2015;
Schneider et al., 2005; Spinazzola et al., 2014; Sroufe et al., 2005; Taillieu et al., 2016; Vallati et
al., 2020). Moreover, childhood emotional abuse is associated with adverse parenting outcomes
in adulthood (e.g., hostility toward children, psychological control, psychological unavailability,
insecure caregiver-child attachment), which are themselves associated with intergenerational
maltreatment continuity (Babcock Fenerci et al., 2016; Bailey et al., 2012; Jung & Soo, 2023;
McCabe et al., 2018; McCullough & Shaffer, 2014; Riggs, 2010; Schneider et al., 2005). Though
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limited, studies that explicitly examine the intergenerational consequences of childhood
emotional abuse have shown that these experiences among caregivers increase their child’s
maltreatment risk and adolescent internalizing and externalizing symptoms over and above the
contributions of other maltreatment types (Bailey et al., 2012; Gong et al., 2024; Khoury et al.,
2022; Rizvi & Fariha, 2017). Additionally, caregiver exposure to intimate partner violence in
childhood, a form of emotional abuse, is associated with greater risk of polyvictimization among
children in the next generation (Bailey et al., 2012; Buffarini et al., 2024; Greene et al., 2020).
Further research is warranted to understand how emotional abuse experiences among caregivers
may confer specific risks for intergenerational maltreatment, particularly polyvictimization, and
subsequent adolescent internalizing and externalizing outcomes.
Heterogeneity in the Timing and Severity of Childhood Maltreatment
Variations in the timing and severity of childhood maltreatment experiences contribute to
substantial heterogeneity in the lived experiences and outcomes among those affected (Manly,
2005). Previous research indicates that more chronic and, separately, more severe maltreatment
tend to be associated with greater adverse psychological outcomes across childhood,
adolescence, and adulthood (Ben-David et al., 2015; Capretto, 2020; Jonson-Reid et al., 2012;
Litrownik et al., 2005; Pears et al., 2008). However, evidence regarding the impact of age of
maltreatment onset is somewhat mixed and may depend on the type of maltreatment. For
instance, Adams and colleagues (2018) demonstrated that physical abuse with middle childhood
onset and, separately, sexual abuse with middle childhood or adolescent onset were associated
with greater risk and greater severity of adulthood psychopathology than those same
maltreatment types with onset in other developmental periods. Conversely, Capretto et al. (2020)
identified early childhood onset of sexual abuse and adolescent onset of physical abuse as most
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71
detrimental for adulthood depression and posttraumatic stress symptoms. Furthermore,
maltreatment characteristics are not unrelated, and it has been suggested that their combined
presence (e.g., chronic and severe maltreatment) may portend worse outcomes than each
individually (Manly, 2005).
In addition to detrimental individual-level outcomes, the chronicity, severity, and age of
onset of caregivers’ childhood maltreatment experiences appear to exert important
intergenerational effects on the likelihood of maltreatment and emotional and behavioral
disturbances among their children. For example, greater severity of caregiver childhood
maltreatment has been linked with a higher likelihood of adulthood perpetration of child abuse,
and increased internalizing and externalizing symptoms among their children during adolescence
(Pears & Capaldi, 2001; Plant et al., 2017). A similar relationship between chronic caregiver
maltreatment and elevated risk of child abuse perpetration in adulthood has also been
demonstrated (Ben-David et al., 2015; Milner et al., 1990; Pears & Capaldi, 2001). Like
individual outcomes, the intergenerational implications of age of onset are mixed. Thornberry &
Henry (2012) demonstrated that adolescent onset caregiver childhood maltreatment, compared to
early or middle childhood onset, increased risk of subsequent perpetration of child abuse.
Conversely, Milner and colleagues (1990) identified increased adulthood child abuse potential
among caregivers who experienced maltreatment before the age of 5 years, while those with later
onset showed a lesser increase.
6 Collectively, these age of onset studies suggest that there may be
6 Child abuse potential is a distinct construct from perpetration and prevalence of child maltreatment. However,
validated measures of child abuse potential have been shown to reliably predict abuse perpetration (Milner, 1994;
Milner et al., 1986). Furthermore, not all studies of intergenerational maltreatment require that the maltreated
caregiver becomes the perpetrator of their child’s maltreatment. Intergenerational continuity, the primary construct
in this study, does not differentiate relationships between perpetrator and child (Berlin et al., 2011). It refers purely
to the pattern in which both caregiver and child experience childhood maltreatment, regardless of whether the
child’s maltreatment is committed directly by their maltreated caregiver or by another adult while under the care of
their maltreated caregiver.
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72
elevated risk of intergenerational maltreatment continuity associated with early childhood and/or
adolescent onset caregiver maltreatment. Notably, most prior studies on the characteristics of
caregiver childhood maltreatment in the intergenerational context either do not explore multiple
timing and severity characteristics within specific maltreatment types, or they focus heavily on
physical and sexual abuse. To date, little is known about how the chronicity, severity, and age of
onset of caregivers’ experiences of childhood emotional abuse may contribute to
intergenerational maltreatment continuity and the emotional and behavioral development of their
children.
Given the complexity and heterogeneity of maltreatment experiences, some researchers
have argued that the unit of analysis should be the individual rather than the incidents themselves
(e.g., Rivera et al., 2018; Roesch et al., 2010; Warmingham et al., 2019). Latent profile analysis,
a person-centered approach, can be used to identify subgroups of individuals based on unique
patterns of co-occurrence between specified attributes of reported maltreatment experiences
(Rivera et al., 2018). For example, Capaldi and colleagues (2019) applied this person-centered
approach to explore co-occurrence between physical abuse and severity and their
intergenerational maltreatment contributions. They identified three profiles: (1) no physical
abuse, (2) moderately severe physical abuse, and (3) severe physical abuse. They found evidence
demonstrating increased risk of intergenerational maltreatment continuity among caregiver-child
dyads in the severe physical abuse profile, but not in the moderately severe and no physical
abuse groups (Capaldi et al., 2019). Understanding the co-occurrences between caregiver
maltreatment type and multiple timing and severity characteristics, and the influence that their
clustering may have on intergenerational maltreatment, remains underexplored. Further research
in this area has the potential to provide guidance about the type of intervention protocol and the
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timing of such efforts (e.g., interventions targeting the consequences of severe emotional abuse
in early childhood) that may be most effective in preventing intergenerational maltreatment
continuity.
The Current Study
Emotional abuse is multidimensional, characterized by timing and severity characteristics
that co-occur and cluster in ways that may produce additive or interactive effects on
intergenerational outcomes (Cloitre, 2015; Hodgdon et al., 2018; Paul & Eckenrode, 2015;
Trickett et al., 2009). The purpose of the current study was to explore the role of three
characteristics of caregiver childhood emotional abuse in predicting childhood polyvictimization
and subsequent adolescent internalizing and externalizing symptoms among the next generation
of children. This study had two aims: (1) to identify profiles of caregivers (Generation 1, G1)
based on emotional abuse chronicity, severity, and age of onset using latent profile analysis, and
(2) to examine the intergenerational effects of caregiver (G1) emotional abuse profile
membership on Generation 2 (G2) childhood polyvictimization and subsequent G2 adolescent
internalizing and externalizing symptoms, testing G2 polyvictimization as a potential mediator.
Based on the findings of prior literature using person-centered approaches to identifying
subgroups of individuals on measures of maltreatment type and characteristics (e.g., Capaldi et
al., 2019; Warmingham et al., 2019), we anticipated that the latent profile analysis would yield a
best fitting model with three profiles. Given the exploratory nature of the latent profile analysis,
we did not have a priori hypotheses regarding the specific clusters of emotional abuse
characteristics that might differentiate profiles in the sample. However, because of the evidence
that any of these maltreatment characteristics individually increase risk for intergenerational
consequences, we anticipated that G1 membership in any profile(s) characterized by emotional
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abuse that is chronic, higher severity, and/or early childhood or adolescent onset would be more
likely to predict G2 polyvictimization in comparison with those defined by limited (i.e., not
chronic), lower severity, middle childhood onset, and low/no caregiver emotional abuse.
Additionally, we expected that G2 polyvictimization would be associated with greater G2
adolescent internalizing and externalizing symptoms, mediating the relationship between G1
emotional abuse profile membership and G2 adolescent outcomes.
Method
Participants
Data for this study were drawn from the Young Adolescent Project (Negriff et al., 2019),
an ongoing longitudinal study examining the effects of childhood maltreatment on development
in adolescence and emerging adulthood. Children (G2; n = 454, 53% male) and a primary
caregiver (G1) were enrolled in the study. Data for the current analyses came from the third (T3)
and fourth (T4) wave of data collection (2.5 and 7.2 years after enrollment, respectively). G1
data were from T3 (n = 302, Mage = 42.01 years, SD = 9.99 years, 91.4% female), and G2 data
were from T4 in late adolescence (n = 351, Mage = 18.25 years, SD = 1.47, 50.7% male). All
caregiver types (i.e., 71.4% biological parent, 18.7% kin care, 9.9% foster care/other) were
included in the study sample. Inclusion criteria were 1) stable caregiver as defined by the
adolescent having the same primary caregiver from age 1 year to T4, and 2) complete data for
caregiver childhood emotional abuse experiences assessed at T3. For siblings (35 sibling pairs
and 2 sibling trios) with the same stable primary caregiver, a single G1 self-report assessment
was completed and used for all G2 siblings of the same family. Descriptive statistics for the final
study sample (n = 259 caregiver-child dyads) are presented in Table 1.
Recruitment
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The sample consisted of participants with histories of childhood maltreatment
documented by the Department of Children and Family Services (DCFS) case record and a
demographically similar comparison group. The child welfare-involved participants were
recruited at baseline from DCFS open cases in Los Angeles, California. Recruitment inclusion
criteria were (1) a new referral to DCFS for any type of maltreatment within the month prior to
initial recruitment contact, (2) child age of 9-12 years, (3) child race/ethnicity of African
American, Latinx, or non-Latino white, and (4) child residing in one of 10 zip codes in Los
Angeles County at the time of referral. Potential participants were contacted via mail with the
approval of the University of Southern California’s Institutional Review Board and DCFS. Of the
families contacted, 77% agreed to participate. The comparison group was recruited via mail
using school lists of children ages 9-12 years who were living in the same 10 zip codes as those
in the child welfare-involved sample. Approximately 50% of the comparison families agreed to
participate.
Retention
Sample retention between timepoints was high, particularly for this high risk, child
welfare-involved population: between T1 – T3, 71%; and T1 – T4, 78%. G2 participants not
retained at T3 were more likely to be Latinx, and at T4 were more likely to be male and to have
been involved with child welfare at T1.
Procedures
All waves of assessment were conducted in a research lab at the University of Southern
California. Caregiver and/or participant consent and/or assent were obtained prior to
participation in a 4-hour protocol which included administration of questionnaires and laboratory
tasks. Participants and caregivers were paid for participation in accordance with the National
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Institutes of Health standard compensation rate for healthy volunteers. All procedures were
reviewed and approved by the University of Southern California’s Institutional Review Board.
Measures
Self-Reported Childhood Maltreatment
The Childhood Trauma Interview (CTI) was used to assess self-reported maltreatment
(Noll et al., 2003) including sexual abuse, physical abuse, emotional abuse, and physical neglect
for both G1 and G2. All G1 and G2 participants self-reported experiences of childhood
maltreatment regardless of original recruitment group (i.e., child welfare-involved and
comparison). The CTI was administered by a trained research assistant in interview format
beginning with screening questions for 19 different potentially traumatic experiences. For the
screening questions that the participant endorsed, follow-up questions were given to obtain more
detail regarding the experience(s) including a description, perpetrator, duration, and age at time
of maltreatment. The CTI was only administered to G1 at T3, therefore, G1 maltreatment data
were from this timepoint. G2 CTI data is available at both T3 and T4. G2 data for this study were
drawn from T4 due to a larger sample size at this wave and the ability to capture maltreatment
throughout the course of childhood and adolescence.
Childhood Maltreatment Types. Emotional abuse was assessed with five questions
covering experiences of negativity or hostility directed at the child, exposure to domestic or other
family violence, inappropriate caregiver interference with relationships, inappropriate
expectations of child, caregiver threats of injury to self or child, confinement and/or isolation,
caregiver serious mental illness, child blamed for adult problems, and caregiver substance use
(e.g., “Have there ever been times when the adults that take care of you said mean or insulting
things to you, put you down, or told you that you were no good?”). Sexual abuse was assessed
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with two questions (e.g., “Has anyone ever done something sexually to you that you didn’t
want?”). Physical abuse was assessed with one question (i.e., “Have you ever been hit, beaten, or
physical mistreated by any adults?”). Physical neglect included six questions regarding
experiences of caregiver failure to provide food, shelter, clothing, medical care, supervision, and
education as well as lack of child hygiene (e.g., shelter did not have a place to bathe), or
exposure to illegal activity (e.g., caregiver providing alcohol or drugs to a minor). For example,
“Have there been times when you did not have enough to eat, did not have clothes, medicine or
medical attention, or didn’t have a place to sleep?” For maltreatment types with more than one
question, participants who endorsed any of the items were coded as having experienced that type
of maltreatment.
G1 Emotional Abuse Chronicity. G1 emotional abuse experiences were coded by age
categories that map on to the developmental periods of early childhood (birth - 5 years), middle
childhood (6 - 10 years), and adolescence (11 - 17 years). These age groups were selected based
on prior research that has demonstrated their sensitivity to the developmental effects of the
timing of maltreatment (Capretto, 2020; Sawyer et al., 2018). Only emotional abuse experiences
prior to age 18 were included. G1 participants received a score indicating the presence (1) or
absence (0) of emotional abuse within each age period. A sum score (range 0 - 3) of the number
of age periods during which G1 participants experienced emotional abuse was used for
emotional abuse chronicity: 0 periods = no emotional abuse, 1 period = limited emotional abuse;
and 2 - 3 periods = chronic emotional abuse. This definition of chronicity does not explicitly
measure contiguity (i.e., maltreatment occurring in consecutive developmental periods).
However, 99.6% of the reports in our sample with emotional abuse in more than 1 period were
contiguous.
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G1 Emotional Abuse Age of Onset. Using the G1 age period coding of emotional abuse
(i.e., birth – 5 years, 6 – 10 years, 11 – 17 years), an age of onset variable was coded: 0 = no
emotional abuse, 1 = early childhood onset, 2 = middle childhood onset, and 3 = adolescent
onset.
G1 Emotional Abuse Severity. G1 emotional abuse experiences were coded for severity
using the Maltreatment Classification System (Barnett et al., 1993). From the five emotional
abuse interview questions, fifteen categories (e.g., negativity or hostility, exposure to domestic
violence, confinement or isolation, caregiver substance use) were coded as presence (1) or
absence (0) of endorsement across all emotional abuse experiences reported. The sum of the
number of emotional abuse categories endorsed was used for emotional abuse severity.
G2 Polyvictimization. For G2, a binary variable was coded for each maltreatment type
indicating presence (1) or absence (0) of each of the four maltreatment types assessed: emotional
abuse, sexual abuse, physical abuse, and physical neglect. A G2 polyvictimization score was
calculated as the total number of childhood maltreatment types endorsed (range 0 - 4).
G2 Adolescent Internalizing and Externalizing Symptoms
The Youth Self Report (Achenbach & Rescorla, 2023) was administered to G2
participants at T4. The Youth Self Report is a widely used measure of child-report emotional and
behavioral symptoms that has been shown to have good reliability and validity in use with a
variety of populations (Achenbach & Rescorla, 2023). The internalizing and externalizing
subscales were used in this study. The internalizing subscale consists of 30 items (α = .91) that
assess recent symptoms of anxiety/depression, withdrawal, and somatic complaints. The
externalizing subscale consists of 29 items (α = .90) that assess recent rule-breaking and
aggressive behaviors. Sum scores within each subscale were used in the current study.
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Caregiver Type (Covariate)
G1 participants reported on their status as the primary caregiver of the G2 participant. G1
participants responded yes/no to “Are you [G2 participant’s name]’s biological parent?” A binary
variable was coded to distinguish between biological parents (0) and non-biological caregivers
(1).
Data Analyses
The purpose of this study was 1) to determine profiles of caregivers (G1) based on
chronicity, severity, and age of onset of childhood emotional abuse, and 2) to test G2 childhood
polyvictimization as a mediator in the relationship between G1 emotional abuse profile
membership and G2 internalizing and externalizing symptoms in adolescence. We used a twostep analytic approach conducted in Mplus Version 8 (Muthén & Muthén, 2012).
To address the first aim, latent profile analysis (LPA) was used to identify unobserved, or
latent, subgroups of caregivers in the study sample based on patterns of emotional abuse
chronicity, severity, and age of onset (i.e., three LPA indicators). To determine the best fitting
profile solution, we fit 1 through k profile solutions, increasing the number of profiles until fit
statistics did not improve. Selection of the best-fitting solution was based on Akaike Information
Criterion (AIC; Akaike, 1987), Bayesian Information Criterion (BIC; Schwarz, 1978), sample
size adjusted Bayesian Information Criterion (aBIC; Sclove, 1987), entropy (Celeux &
Soromenho, 1996), and theoretically driven interpretability of profiles (Collins & Lanza, 2009).
Significance of the k – 1 model was tested with the Vuong-Lo-Mendell-Rubin likelihood ratio
test (VLMR; Vuong, 1989), Lo-Mendell-Rubin adjusted likelihood ratio test (LMR; Lo et al.,
2001), and the bootstrapped likelihood ratio test (BLRT; Nylund et al., 2007) to determine
whether the selected profile solution was a better fit than the model with one less profile. Smaller
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values of AIC, BIC, aBIC, and entropy above 0.8 and close to 1, signify a better fitting model
(Akaike, 1987; Celeux & Soromenho, 1996; Schwarz, 1978; Sclove, 1987). Nonsignificant
values of the VLMR, LMR, and BLRT indicate that the k – 1 model is a better fit to the data (Lo
et al., 2001; Nylund et al., 2007; Vuong, 1989).
We then used the classify-analyze approach for predicting distal outcomes from latent
profiles, assigning each G1 participant to the LPA-identified profile for which they had the
highest estimated posterior probability of membership (Nylund-Gibson et al., 2019). For the
second study aim, a path model was constructed with G1 emotional abuse profile assignment
predicting G2 polyvictimization, and G2 polyvictimization predicting G2 adolescent
internalizing and externalizing symptoms (See Figure 2). All direct and indirect effects between
G1 emotional abuse profiles to G2 polyvictimization, G2 polyvictimization to G2 adolescent
internalizing and externalizing symptoms, and G1 emotional abuse profiles to G2 adolescent
internalizing and externalizing symptoms, were included in the model. G2 sex, G2 age at T4, and
caregiver type were included as covariates. Bootstrapped 95% confidence intervals were used to
determine significant direct and indirect effects.
We used established guidelines regarding model fit indices for the mediation path model,
including Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of
Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR) to ensure the
model adequately represents the observed data (Hu & Bentler, 1998; Kline, 2023). Generally,
good fit is indicated by CFI close to or above 0.95, TLI values close to or above 0.90, RMSEA
values close to or below 0.06 (0.01 is considered excellent, 0.08 is considered mediocre), and
SRMR values close to or below 0.08 (Hu & Bentler, 1998; Kline, 2023).
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Missing value analysis was conducted for G2 adolescent internalizing and externalizing
symptoms; 10.4% of G2 participants were missing data on these outcome measures at the item
level. Multiple imputation was used to address missingness at the item-level of the G2 outcome
variables. Remaining missing data at the variable-level was minimal (.77%). Full Information
Maximum Likelihood (FIML) was used to address remaining missingness, and estimation of
robust standard errors was used to address nonnormality of data (Berlin et al., 2011; Lee et al.,
2019; Vermunt & Magidson, 2002).
Results
Descriptive Statistics
Descriptive statistics were examined for G1 emotional abuse chronicity, severity, and age
of onset; G2 polyvictimization; and G2 adolescent internalizing and externalizing symptoms
(See Table 2). Forty two percent (42.5%) of G1 participants reported any childhood emotional
abuse; 26.8% reported limited emotional abuse, and 11.5 % reported chronic emotional abuse;
22.0% reported low severity, 19.5% moderate severity, and 0.8% severe emotional abuse; 18.4%
reported emotional abuse onset in early childhood, 11.9% onset in middle childhood, and 7.8%
adolescent onset emotional abuse. Among G2 participants, 34.9% reported no childhood
maltreatment, 26.7% reported one type, 15.9% reported two types, 14.7% reported three types,
and 7.8% reported four types of maltreatment.
Correlations between study variables are presented in Table 3. All G1 emotional abuse
characteristics (i.e., chronicity, severity, and age of onset) were positively correlated with each
other and with G2 polyvictimization. Additionally, G2 adolescent internalizing and externalizing
symptoms were positively associated with each other and with G2 polyvictimization.
Latent Profile Analysis
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To determine the best-fitting latent profile model, 1 - 4 profiles were fit for caregiver
childhood emotional abuse characteristics (i.e., chronicity, severity, and age of onset). Model fit
indices indicated that the 3-class solution was the best fitting model (See Table 4). Profile 1 (n =
150) was characterized by no emotional abuse; Profile 2 (n = 43) by limited, lower severity,
adolescent onset emotional abuse; and Profile 3 (n = 66) by chronic, higher severity, early
childhood onset emotional abuse. Figure 1 shows a comparison of the unstandardized means of
the characteristics for each profile.
Mediation Path Model
The model fit the data well (χ2 = 15.63 (9), p = 0.08; RMSEA = 0.05; CFI = 0.93; TLI =
0.80; SRMR = 0.06). The full model is presented in Figure 2. Direct and indirect effects are
presented in Table 5.
There were significant direct effects of G1 limited, lower severity, adolescent onset
emotional abuse (Profile 2) on G2 polyvictimization (b = .22; 95% CI [0.07, 0.35]; p <.01), as
well as G1 chronic, higher severity, early childhood onset emotional abuse (Profile 3) on G2
polyvictimization (b = .15; 95% CI [0.02, 0.28]; p <.05). Additionally, there were significant
direct effects between G2 polyvictimization and both G2 adolescent internalizing symptoms (b =
.26; 95% CI [0.11, 0.39]; p <.01) and G2 adolescent externalizing symptoms (b = .24; 95% CI
[0.09, 0.37]; p <.01). No other direct effects were significant.
Four significant indirect effects were found through G2 polyvictimization (mediator): a)
G1 limited, lower severity, adolescent onset emotional abuse (Profile 2) to G2 adolescent
internalizing symptoms (b = .06; 95% CI [0.02, 0.12]; p <.05), b) G1 limited, lower severity,
adolescent onset emotional abuse (Profile 2) to G2 adolescent externalizing symptoms (b = .05;
95% CI [0.02, 0.12]; p <.01), c) G1 chronic, higher severity, early childhood onset emotional
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abuse (Profile 3) to G2 adolescent internalizing symptoms (b = .04; 95% CI [0.01, 0.09]; p
<.05), and d) G1 chronic, higher severity, early childhood onset emotional abuse (Profile 3) to
G2 adolescent externalizing symptoms (b = .04; 95% CI [0.01, 0.09]; p <.05). No other indirect
effects were significant.
Discussion
The present study investigated how characteristics of childhood emotional abuse,
including chronicity, severity, and age of onset co-occur in the lived experiences of affected
individuals. Furthermore, we sought to identify intergenerational pathways of risk from
constellations of caregiver childhood emotional abuse characteristics to their child’s
maltreatment polyvictimization and later adolescent internalizing and externalizing symptoms.
Latent profile analysis identified three subgroups of caregivers in the sample: (1) no childhood
emotional abuse, (2) limited, lower severity, adolescent onset emotional abuse, and (3) chronic,
higher severity, early childhood onset emotional abuse. Caregiver membership in both emotional
abuse groups, in contrast to the no emotional abuse group, was associated with greater childhood
polyvictimization among their children, which predicted subsequent elevation in adolescent
internalizing and externalizing symptoms.
The three-class profile solution fit the data best, supporting our expectations based on a
previous study using person-centered analysis to explore co-occurrence between a single
maltreatment type, physical abuse, and severity which also found three distinct profiles (Capaldi
et al., 2019). In our sample, the first and largest caregiver profile was characterized by no
emotional abuse experiences (Profile 1). This was unsurprising given that most studies that
include nonmaltreated participants in a latent profile analysis with maltreated participants find
that these individuals cluster together into a no/low maltreatment profile (e.g., Capaldi et al.,
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2019; Guastaferro & Bray, 2020; Warmingham et al., 2019; Ziobrowski et al., 2020). The other
two profiles in our sample were characterized by distinct characteristic combinations of
emotional abuse experiences: Profile 2 grouped caregivers with lower severity emotional abuse
that onset during adolescence and was limited to that developmental period, and Profile 3
included caregivers with histories of higher severity emotional abuse that onset in early
childhood and was chronic, spanning across two or more developmental periods. The subgroups
identified in our sample are consistent with prior research suggesting that, in the lived
experiences of maltreated youth, timing and severity characteristics co-occur in complex and
heterogeneous ways (e.g., Jackson et al., 2014). However, the extant literature has largely
examined maltreatment characteristics as distinct constructs (e.g., Capaldi et al., 2019;
Warmingham et al., 2019), lacking sufficient consideration of how timing and severity
characteristics may overlap in actuality. By including chronicity, severity, and age of onset of
childhood emotional abuse simultaneously in the latent profile analysis, this study provides a
more nuanced depiction of the ways in which these experiences actually occur in the lives of
those affected than was previously available.
The latent profile analysis identified a larger number of caregivers in the chronic, early
childhood onset, higher severity emotional abuse profile (Profile 3) than in the adolescent onset,
limited, lower severity profile (Profile 2). This is consistent with other studies suggesting that
emotional abuse is more likely to be chronic than other forms of childhood maltreatment,
possibly due to lower rates of detection in comparison to other maltreatment types where
physical evidence of abuse or neglect may be present (Chamberland et al., 2011; Chamberland et
al., 2012; Hodgdon et al., 2018; Mcgee et al., 1997). Our results also indicated that chronic and
early childhood onset emotional abuse co-occurred with higher severity, which is reasonable
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given that abuse that extends across a larger span of childhood is likely to start earlier in
development, providing more opportunity for escalation in the severity of abuse experiences over
time (Hodgdon et al., 2018; Mcgee et al., 1997). However, there were still a substantial number
of caregivers who experienced adolescent onset emotional abuse that was less severe.
Anecdotally, many of the emotional abuse experiences reported during the adolescent period
were indicative of hostility and negativity from caregivers related to physical appearance (e.g.,
weight, attractiveness), educational attainment and intelligence, and professional/vocational
prospects. It may be that adolescence presents fertile ground for emotional abuse victimization
related to maturation and the imminent transition to adulthood and entrance into society
(Hodgdon & Landers, 2021). Additional research is needed to determine why these youth
experience first-onset emotional abuse in adolescence, and to identify the subtypes of emotional
abuse that may be most prevalent in adolescence.
In terms of intergenerational associations, both caregiver profiles with emotional abuse
were associated with a similar intergenerational cascade of detrimental outcomes among youth in
the next generation. That is, caregiver membership in the chronic, higher severity, early
childhood onset group (Profile 3) and the adolescent onset, limited, lower severity emotional
abuse group (Profile 2) were each linked with their children’s polyvictimization which, in turn,
increased risk for both internalizing and externalizing symptoms in adolescence. Broadly, these
findings are consistent with the previous literature suggesting that caregivers’ childhood
exposure to domestic violence, a form of emotional abuse, is linked with increased risk of their
children experiencing polyvictimization (Bailey et al., 2012; Buffarini et al., 2024; Greene et al.,
2020), as well as several studies demonstrating a strong link between multi-type maltreatment
and greater severity of internalizing and externalizing symptoms in adolescence (Anda et al.,
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2006; Arata et al., 2005; Arata et al., 2007; Cloitre et al., 2009; Dion et al., 2016; Finkelhor et al.,
2011; Hodgdon et al., 2018; Khoury et al., 2022; Mills et al., 2013; Pears et al., 2008; Soler et al.,
2013; Villodas et al., 2021; Zhang et al., 2022). The current study expands upon this previous
work to suggest that other subtypes of caregiver childhood emotional abuse (e.g., negativity,
hostility, rejection, isolation) may also initiate intergenerational risk for their children’s
polyvictimization and subsequent emotional and behavioral problems, and their effects should
not be overlooked in future research.
Our finding regarding the intergenerational pathway extending from chronic emotional
abuse with higher severity and early childhood onset (Profile 3) fits well with the prior literature.
Emotional abuse, as well as severity and chronicity of childhood maltreatment of any type, have
each individually been implicated in the development of elevated adulthood mental health and
substance use problems, known mechanisms of risk for intergenerational maltreatment
(Appleyard et al., 2011; Berlin et al., 2011; Conrad-Hiebner & Byram, 2020; Dixon et al., 2005;
Guastaferro & Bray, 2020; Horan & Widom, 2015; Humphreys et al., 2020; Jackson et al., 2014;
Jonson-Reid et al., 2012; Kaplow & Widom, 2007; Madigan et al., 2019; Nelson et al., 2017;
Shin et al., 2016; Thornberry et al., 2010). Furthermore, early childhood maltreatment, especially
relational types like emotional abuse, may disrupt secure caregiver-child attachment, increasing
risk for subsequent adulthood consequences across the child-rearing period including
dysfunctional parenting practices, poor mental health, and intergenerational child maltreatment
continuity (Bruce et al., 2009; Bugental et al., 2003; Cicchetti, 2016; Egeland et al., 1983;
Hodgdon et al., 2018; Hodgdon & Landers, 2022; Pears & Capaldi, 2001; Russotti et al., 2021;
Sroufe et al., 2005). The current study extends the previous literature by demonstrating that the
specific combination of chronic, early childhood onset, higher severity emotional abuse among
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caregivers may have a significant detrimental effect on their child’s likelihood of experiencing
maltreatment polyvictimization across childhood and greater emotional and behavioral problems
in adolescence.
Notably, the caregiver profile characterized by less severe emotional abuse with later
onset that was limited to adolescence was also associated with the same intergenerational effects
on childhood polyvictimization and adolescent internalizing and externalizing symptoms among
their children. This was somewhat unexpected given prior findings indicating that chronic and
severe, but not moderately severe, caregiver childhood maltreatment is associated with
intergenerational maltreatment continuity (Pears & Capaldi, 2001). It appears that this caregiver
profile in our sample was primarily defined by emotional abuse onset in adolescence. This
suggests that experiencing the disruptive influence of emotional abuse during adolescent
development, in particular, might incur risk for adverse intergenerational outcomes that may be
on par with the risk associated with earlier onset, chronic, and more severe emotional abuse.
Adolescence is a critical period for identity formation that sets the stage for adulthood
psychopathology, substance use, social support, romantic relationships, and educational and
vocational attainment (Hodgdon & Landers, 2022). Our findings align well with prior literature
demonstrating that emotional abuse during the vulnerable adolescent period may lead to
difficulties in these critical domains, which have been shown to individually and collectively
predict increased risk for intergenerational maltreatment continuity (Arslan, 2016; Berlin et al.,
2011; Choi et al., 2019; Conrad-Hiebner & Byram, 2020; Currie & Spatz Widom, 2010; Dixon et
al., 2005; Egeland et al., 1988; Gabalda et al., 2009; Hodgdon & Landers, 2022; Horan &
Widom, 2015; Madigan et al., 2019; Schofield et al., 2013; Shaffer et al., 2009; St-Laurent et al.,
2019; Thompson, 2006; Thornberry et al., 2013; Tracy et al., 2018). The current study expanded
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on this previous literature by demonstrating that a caregiver’s history of emotional abuse during
adolescence, even when less severe and time-limited, may still exert direct and indirect
detrimental effects on their child’s well-being.
Clinical Implications
Childhood emotional abuse has received less research attention in the intergenerational
maltreatment literature in comparison to sexual and physical abuse. However, our findings
suggest that emotional abuse may be a critical contributor to intergenerational processes and
should be included in routine maltreatment risk screening protocols. Additionally, this study
demonstrated that limited, less severe emotional abuse with adolescent onset among caregivers
may be just as detrimental for their children’s outcomes as chronic, lower severity, early
childhood onset emotional abuse. Timing and severity characteristics should be incorporated into
screening tools, and providers should pay close attention to the presence of caregivers’
experiences of adolescent onset emotional abuse even when seemingly less severe.
Limitations
There are some limitations in the present study that warrant consideration. First, the
maltreatment data for this study were collected through self-report measures, rather than official
report, which may be subject to recall bias and social desirability bias. Although our sample
included a maltreatment group with DCFS documented maltreatment prior to enrollment in the
study, the self-report measure was chosen for two critical research design reasons: (1) childhood
maltreatment measured at T4 (Mage = 18.25 years) allowed for self-report across the full
childhood period while DCFS records were only available for incidents that occurred prior to
enrollment, and (2) caregiver maltreatment was assessed only at T3 with the self-report measure,
thus child self-report of maltreatment was used in order to maintain consistency between
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caregiver and child measures. Despite concern about the effects of recall bias in subjective
measurements of childhood maltreatment, previous literature has indicated that retrospective
self-report is valid in terms of predicting longitudinal and intergenerational outcomes and may be
a better predictor of adverse adolescent and adulthood outcomes than official records (Danese &
Widom, 2021; Khoury et al., 2022; Negriff et al., 2017; Newbury et al., 2018).
There are a few methodological limitations to note as well. There is some concern that
the classify-analyze approach for predicting distal outcomes from latent profiles may introduce
classification error, as individuals are assigned to profiles based on the highest posterior
probability of membership, and there is marginal possibility with this method that individuals
may be misclassified. Despite this concern, the classify-analyze approach is recommended for a
study of this design (Nylund-Gibson et al., 2019). Finally, our sample was drawn from a specific
geographic region, which may limit the generalizability of the findings to other populations with
different sociodemographic characteristics. While we controlled for various demographic factors
in our analyses, there may have been unmeasured confounding variables that influenced the
observed associations. Although this is a noteworthy limitation of latent profile analysis, its
ability to identify patterns in the clustering of maltreatment experiences significantly contributes
to the field’s understanding of the diverse lived experiences of individuals affected by these
intergenerational processes. Additionally, the indicators we selected to enter in the latent profile
analysis were theory-driven and based on a large body of literature establishing the influence of
caregiver maltreatment characteristics and type on intergenerational maltreatment continuity. As
with any study using latent profile analysis, the generalizability of the current study’s findings
would be strengthened by future studies replicating the design with different sample populations.
Nevertheless, this study contributes to the growing literature on the intergenerational
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
90
consequences of childhood emotional abuse and highlights the importance of addressing
emotional maltreatment within families to prevent adverse outcomes in future generations.
Conclusion
The current study bolsters the extant evidence suggesting that caregiver childhood
experiences of emotional abuse may be just as detrimental in terms of intergenerational outcomes
as other types of maltreatment that involve overt physical harm. Our findings demonstrated that
caregiver’s experiences of emotional abuse that were chronic, higher severity, and with early
childhood onset were associated with polyvictimization among their children, which, in turn, was
associated with greater adolescent internalizing and externalizing symptoms. Critically, the
findings also showed that caregiver emotional abuse with later onset in adolescence that was
limited and lower severity was also associated with these same intergenerational outcomes.
Therefore, it may be that emotional abuse experienced during adolescence, even when limited
and less severe, may have similar negative effects on intergenerational outcomes as emotional
abuse that is chronic, more severe, and begins earlier in childhood. This finding underscores the
importance of considering the developmental timing of caregiver childhood emotional abuse in
future research.
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
91
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Table 1
Sample Characteristics for Caregivers (G1, T3) and Adolescents (G2, T4)
Note. G1 = caregiver, G2 = child/adolescent; nG1 = 183, nG2 = 259; The discrepancy between the sample size for
caregivers and youth is due to the presence of 35 sibling pairs and 2 sibling trios (nsiblings= 76) with the same primary
caregiver. G1 participants were, on average, 41.5 years old (SD = 10.0) at T3, G2 participants were, on average, 18.1
years old (SD = 1.4) at T4.
109
Table 2
Descriptive Statistics for Study Variables
Note. G1 = caregiver, G2 = child/adolescent; nG1 = 183, nG2 = 259; chronicity = the number of
developmental periods (range 0-3) during which the participant experienced emotional abuse, age of
onset = the developmental period during which the participant’s emotional abuse began (0 = no
emotional abuse, 1 = early childhood onset, 2 = middle childhood onset, 3 = adolescent onset).
110
Table 3
Correlations between Study Variables
Note. G1 = caregiver, G2 = child/adolescent; nG1 = 183, nG2 = 259.
*p < .05, **p < .01, ***p < .001.
111
Table 4
Model Fit Indices for Latent Profile Analysis of Caregiver (G1) Emotional Abuse Characteristics
Note. AIC = Akaike Information Criteria; BIC = Bayesian Information Criteria; aBIC = sample size adjusted Bayesian
Information Criteria; VLMR = Vuong-Lo-Mendell-Rubin likelihood ration test; LMR = Lo-Mendell-Rubin test; BLRT =
Bootstrapped log-likelihood ration test.
112
Figure 1
Caregiver (G1) Emotional Abuse Characteristics for the 3-Profile LPA Solution
Note. LPA = latent profile analysis; No emotional abuse (Profile 1), n = 150; Limited, lower severity, adolescent onset
(Profile 2), n = 43; Chronic, higher severity, early childhood onset (Profile 3), n = 66; possible ranges and interpretations
of emotional abuse characteristic variables: chronicity (0 – 3), 0 = no abuse, 1 = limited, 2+ = chronic; severity (0 – 5), 0
= no abuse, 1 = low severity, 2 = moderate severity, 3 = moderately high severity, 4 = severe, 5 = very severe; age of onset
(0 = 3), 0 = no abuse, 1 = early childhood, 2 = middle childhood, 3 = adolescence.
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Figure 2
Mediation Path Model
Note: G1 = caregiver, G2 = child/adolescent; G1 emotional abuse profiles were determined with an unconditional
latent profile analysis, G1 participants were assigned to emotional abuse profiles for use in path analysis; G2 age at
T4, G2 sex, and caregiver type were included as covariates on G2 internalizing and externalizing symptoms at T4;
Only significant effects are drawn in the figure. See Table 5 for significant direct and indirect effects.
*p < .05, **p < .01.
Table 5
Significant Direct and Indirect Effects from Mediation Model
Note. G1 = caregiver; G2 = child/adolescent; G2 age at T4, G2 sex, and caregiver type included
as covariates on G2 internalizing and G2 externalizing symptoms.
*
p < .05, **p < .01.
115
Paper 3
Interrupting the Cycle of Violence: Evidence-Based Dyadic Interventions to Mitigate Risk for
Intergenerational Childhood Maltreatment Continuity
Hannah Leigh Fritz, M.A.
University of Southern California
116
Interrupting the Cycle of Violence: Evidence-Based Dyadic Interventions to Mitigate Risk for
Intergenerational Childhood Maltreatment Continuity
Children of caregivers with childhood maltreatment histories are approximately three
times more likely to experience maltreatment themselves compared to peers with nonmaltreated
caregivers, making caregiver maltreatment one of the strongest predictors of intergenerational
abuse and neglect.1–5 This pattern in which both caregiver and child experience abuse or neglect
is referred to as intergenerational maltreatment continuity, encompassing incidents in which the
child’s maltreatment is perpetrated by a maltreated biological parent (i.e., intergenerational
transmission) as well as those committed by another adult in a position of trust and/or caretaking
responsibility.
2 The purpose of this narrative review is to provide background on the public
health crisis of childhood maltreatment, discuss theoretical models of intergenerational
maltreatment continuity, outline the psychosocial risk factors that should be addressed with
intervention, and present the literature on psychotherapeutic dyadic interventions with robust
empirical evidence demonstrating their effectiveness in mitigating risk for intergenerational
continuity of childhood maltreatment.
What is Childhood Maltreatment and Intergenerational Maltreatment Continuity?
Childhood maltreatment is defined as physical and/or emotional maltreatment resulting in
actual or potential harm that threatens the health, survival, or development of a child, perpetrated
by an adult in a position of trust, responsibility, or power.
6,7 This may involve physical abuse,
sexual abuse, emotional abuse, and/or neglect. Childhood maltreatment is associated with an
array of adverse behavioral health, economic, and social outcomes that may emerge during
childhood and adulthood, and persist across the lifespan.8–15 Worldwide, nearly 300 million
children experience maltreatment by the age of four and, in the United States, approximately one
117
in seven children under the age of 18 is maltreated annually.
7,16–19 These estimates may still
underestimate prevalence as many cases go undetected, unreported, and unaddressed. As of
2022, the lifetime economic burden of childhood maltreatment is an estimated $592 billion
dollars, making it one of the largest and most costly public health concerns that is modifiable by
appropriate prevention and intervention.
16
Critically, the sequelae of maltreatment have been shown to extend intergenerationally,
with significantly elevated risk of childhood maltreatment among the children of caregivers with
maltreatment histories.1–5 Three theoretical models are most often proposed to explain
intergenerational maltreatment continuity: attachment theory, social learning theory, and
ecological systems theory. From an attachment theory perspective, childhood maltreatment is
likely to compromise secure attachment with a caregiving figure, leading to increased risk for
disorganized attachment and a subsequent cascade of relational challenges and psychopathology
across childhood and into adulthood.20 Intergenerational consequences may include difficulty
bonding with their own child, serving as a safe base for secure attachment, and interpreting their
child’s physical and emotional needs, which may increase emotional and behavioral challenges
among their children and risk for abusive or neglectful parenting practices.20–24 Second, social
learning theory suggests that individuals learn social behavior through modeling and observation
in the childhood environment and are likely to replicate those behaviors and environments as
they grow older, including with their own families in adulthood.25 Therefore, caregivers whose
childhood context included maltreatment may be more likely to engage in abusive or neglectful
parenting practices themselves and may have difficulty creating safe child-rearing
environments.25 Lastly, ecological systems theory conceptualizes childhood maltreatment as a
product of the interactions between risk and protective factors in the proximal and distal social
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ecological systems surrounding a child that may increase risk for their maltreatment.26–28
Proximal influences include family-level risk factors such as caregiver mental health, social
support, stressful life events, and disciplinary practices, while distal factors include influences
such as neighborhood safety, community violence, systematic and structural racism, and public
health policies.26–29 Though these three theories look at the same intergenerational pattern from
different angles, they share common features in the conceptualization of intergenerational
maltreatment. Among all, it is theorized that maltreatment is the result of a cascade of negative
risk factors stemming from the caregiver’s childhood maltreatment that impacts developmental,
social, and emotional processes, leading to difficulty in parenthood with building a secure,
attuned, and responsive caregiver-child relationship and maintaining a safe child-rearing
environment.30–35 In sum, childhood maltreatment has a wide array of deleterious sequelae for
those directly affected and their children, and is a critical public health concern that warrants
sustained attention from research, policy, and intervention.
Psychosocial Risk Factors: Targets for Intervention
Psychotherapeutic interventions that aim to mitigate risk for intergenerational
maltreatment continuity typically target the risk factors in the family environment most proximal
to the child, including individual-level risk factors among caregivers and interpersonal-level risk
factors in the caregiver-child relationship.36 Caregiver risk factors primarily include adulthood
psychopathology (i.e., depression, posttraumatic stress, dissociation), substance use, lack of
social support, socioeconomic insecurity, harmful parenting practices or skill deficits, parenting
stress, negative attitudes about parenting, perceived child problems, poor reflective functioning,
and adult intimate partner violence.
2,3,31,33–35,37–61 Prominent interpersonal factors that increase
risk for child maltreatment include ruptured or disorganized caregiver-child attachment
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relationships and caregiver disciplinary practices in response to child externalizing behaviors
such as aggression, emotional outbursts, defiance, and non-compliance.
29,62–69 Maltreated
caregivers may have difficulty differentiating between frustrating but developmentally
appropriate behaviors (e.g., dawdling, requiring help with dressing or feeding) and defiant or
noncompliant behaviors. This may lead to caregiver emotion dysregulation, reinforced negative
attitudes toward the child, and subsequent use of abusive parenting practices to enforce child
compliance.67,70–72 Fortunately, considerable research and clinical experience suggests that
amelioration of these risk factors significantly reduces the burden of childhood maltreatment and
the potential for intergenerational continuity.45,46,48,54,56,73–76
Benefits of Dyadic Intervention
Family response to childhood maltreatment is one of the most important predictors of
psychopathology, behavioral disturbance, and later intergenerational maltreatment outcomes.
77
When response is supportive, reassuring, and preventative of further maltreatment, risk for
deleterious longitudinal outcomes is reduced, while the opposite response can have an
exacerbating effect.
77–80 Given the relational nature of childhood maltreatment and its disruptive
impacts on attachment formation and parenting practices, dyadic intervention offers an important
environment for recovery and repair.
81 Prevention and intervention strategies that aim to mitigate
the risk of intergenerational maltreatment continuity are best suited to a dyadic setting including
trauma and behavioral health adult components and attachment- and/or trauma-focused dyadic
components.82 Interventions that address the individual and relational consequences of
maltreatment within the familial and societal contexts, and are sensitive to the developmental and
material needs of the family system, are more likely to have positive outcomes than individual
interventions that are separated from the contextual environment, especially for individuals with
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chronic maltreatment and polyvictimization experiences.
83–85 As such, involving caregivers and
children together in dyadic psychotherapeutic intervention allows providers to directly observe
and intervene in caregiver-child relational dynamics, thereby building familial support,
increasing the sense of safety in the caregiving relationship, and improving longitudinal
outcomes for both child and caregiver.25,67,70,78
With the exception of severe maltreatment cases in which the child is in imminent or
ongoing danger by remaining in the family home or engaging with maltreating caregivers,
children who are relocated to out-of-home placement (e.g., foster care) tend to have poorer
outcomes across psychological, social, and developmental domains than those remaining in the
family of origin and receiving appropriate intervention to prevent further maltreatment.
80 To the
degree that it is psychologically and physically safe for the child, maintaining home placement in
conjunction with conjoint therapy following family-perpetrated maltreatment tends to be
associated with more beneficial outcomes than siloed individual interventions.
86,87 Dyadic
intervention with perpetrating caregivers can be complex and certainly comes with its own set of
clinical, ethical, and legal considerations. In this context, interventionists must contend with
challenges related to duty to protect a child’s physical and emotional safety, discovery of
additional or ongoing maltreatment, mandated reporting, family and criminal court involvement,
provider-patient privilege, dual relationships, professional ethical codes of conduct, and
maintaining rapport amidst these interconnected and frequently compounding factors.88
However, the caregiver-child relationship has critical behavioral and relational health
implications across the lifespan, and failure to resolve trauma between a child and an abusing or
neglectful caregiver may result in long-term detrimental psychological and interpersonal
outcomes into adulthood.
81 Addressing these conflicts in trauma-informed and evidence-based
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therapeutic settings in which providers use strengths-based principles of behavior and relational
change may have positive influences on long-term trajectories for maltreated children and their
future families.81,89
Method and Description of Review
The following section presents five dyadic interventions with robust empirical evidence
supporting their effectiveness in mitigating risk for intergenerational childhood maltreatment. In
this review, interventions that mitigate risk are conceptualized in two ways: 1) those that have
been directly tested for reducing the incidence of intergenerational maltreatment continuity, that
is, both caregiver and child childhood maltreatment were measured (retrospective self-report or
official case record review) and evidence supports reduced incidence of intergenerational
continuity among families receiving the intervention as compared to controls not receiving the
intervention, and 2) interventions that have been tested with caregivers who have childhood
maltreatment histories and have been shown to improve outcomes of caregiver behavioral health
and caregiver-child dyadic functioning that are known risk factors for childhood maltreatment
among their children (See Psychosocial Risk Factors: Targets for Intervention). The interventions
included in this narrative review were selected from literature searches in PsychINFO and
PubMed based on four criteria: 1) have randomized controlled trial (RCT) evidence with families
at risk of their children experiencing maltreatment‡‡ demonstrating a) effectiveness in reducing
incidence of maltreatment among the children involved in the intervention and/or b) improved
outcomes on known risk factors for intergenerational maltreatment continuity, 2) been adapted
and tested specifically with maltreated caregivers and have been shown to mitigate risk for
‡‡ While a caregiver’s history of maltreatment is a risk factor for maltreatment among their children, these groups of
caregivers – those maltreated during childhood and those at high risk of having maltreated children – are distinct,
but may have some overlap.
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intergenerational maltreatment continuity, 3) contain dyadic, relational components that involve
both caregiver and child in treatment simultaneously, and 4) are based in a developmental
theoretical framework, providing caregivers with developmentally-appropriate psychoeducation
on the potential intergenerational consequences of childhood maltreatment. It should be noted
that none of the interventions included were originally designed to address intergenerational
childhood maltreatment continuity, specifically. To-date no dyadic intervention has been
developed and tested with a randomized controlled trial design that explicitly aims to address
intergenerational maltreatment.
For each intervention, the original design and RCT outcomes are reviewed first. Second,
analyses specific to the subsample of maltreated caregivers from the RCT(s) are presented,
including adaptations to original study design (if applicable) and outcomes specific to this
population. Table 1 presents the intervention design, treatment targets, outcome results from
randomized controlled trials (RCTs), and potential challenges to implementation. Special
considerations for childhood maltreatment intervention and recommendations for integrating
emerging scientific literature into clinical practice are also discussed. This review is intended to
provide a roadmap of evidence-based dyadic interventions for health and social service providers
interacting with many different family constellations. While there has been extensive work on
individual child and adult interventions, this report focuses specifically on interventions that
target dyadic psychosocial determinants of childhood maltreatment and intergenerational
continuity.82,90–97
Note: It is important to acknowledge the widespread detrimental intergenerational
impacts of historical, racial, and indigenous trauma, as well as structural and systemic racism, on
mental health, poverty, childhood maltreatment incidence and reporting, and disproportionate
123
involvement in the child welfare system among non-white families.98 Considerable work has
contributed to an emerging literature providing empirically-supported models and adaptations of
intervention for identity- and discrimination-based traumas.43,99–102 Though this review does not
directly address these interventions, intersectional multicultural identities are a critical aspect of
family functioning, communication, beliefs, and response to psychotherapeutic intervention. As
such, relevant sociocultural and historical experiences should always be considered and
incorporated into treatment to meet unique individual and family needs (See Integrating
Emerging Evidence in Clinical Practice).
Evidence-Based Dyadic Interventions for Intergenerational Childhood Maltreatment
Minding the Baby
Home visitation programs, in which intervention is delivered by providers in the home
environment, have gathered considerable empirical support as effective approaches for families
at risk of child maltreatment.45,103–111 Minding the Baby (MTB) is a home-visitation program that
aims to identify caregivers during the prenatal period who are at high risk of having children who
are maltreated, including caregivers with their own childhood maltreatment histories, offering
interdisciplinary in-home medical and mental health care.112,113 MTB is delivered by a pediatric
nurse practitioner and social worker through 45-90 minute in-home sessions, weekly through the
first year of the child’s life and bi-weekly through 24 months.112 Cost of multiple providers with
weekly or bi-weekly sessions may be a barrier to implementation for some providers and
agencies. The program focuses on improving caregiver-child attachment, caregiver posttraumatic
stress, and providing individualized infant and perinatal health care and social services.113,114 In
addition, MTB has a strong emphasis on increasing caregiver reflective functioning; a
caregiver’s capacity to reflect on and understand their child’s mental states in a developmentally
124
appropriate manner.30,113,115 Difficulty with reflective functioning, particularly in combination
with poor parenting outcomes, has been linked to increased risk for subsequent child abuse and
neglect.30,116,117
RCT evidence suggests that caregiver-child dyads who received MTB were less likely to
be referred to child protective services for child maltreatment, and showed improvements in
caregiver-child secure attachment and communication, caregiver reflective functioning, fewer
and more spaced apart subsequent pregnancies, and child receipt of on-time medical care than
those in the control group receiving prenatal and postnatal care as usual.113,118 Follow-up studies
showed support for the lasting effects of MTB one to eight years postintervention.119,120 As
compared to controls, dyads that participated in MTB reported lower levels of child externalizing
behaviors at both preschool- and school-age follow-up, as well as lower levels of harsh
punishment, coercive parenting, and impaired caregiver reflective functioning at school-age
follow-up.119,120
Studies exploring the outcomes associated with MTB participation among maltreated
caregivers, specifically, rather than in a mixed sample as in the above studies, are limited.
However, a secondary follow-up study measured the impact of caregiver childhood maltreatment
type on supportive/engaged parenting and parental reflective functioning at child age 6 years,
testing participation in the MTB intervention as a moderator.30 This study demonstrated that
participation in MTB mitigated the harmful effects of emotional abuse, in particular, on caregiver
reflective functioning.30 This study did not measure incidence of childhood maltreatment among
the children in the sample as an outcome, therefore conclusions about MTB as an intervention
for intergenerational continuity remain uncertain. However, given the previous RCTs
demonstrated lower rates of child protective services involvement among caregivers with
125
improved reflective functioning as a product of MTB participation,113,118 there is some initial
evidence that MTB may be a valuable intervention for reducing the incidence of maltreatment
continuity among families in which caregivers have experienced childhood emotional abuse.
Promoting First Relationships
Children and toddlers involved in foster care have often experienced multiple care
placements, each transition thwarting the child’s ability to build secure attachment relationships
with a caregiver.
121 Significant disruption to early primary attachment relationships, such as
removal from home and the task of establishing new attachment relationships with each
placement transition, can have serious consequences on relational and emotional development,
including disorganized attachment, internalizing, and externalizing problems across childhood
and into adulthood.
122,123 However, caregivers’ ability to understand child emotional cues and
respond sensitively may buffer these detrimental effects, supporting secure attachment
formation.
121 Promoting First Relationships (PFR) is a manualized attachment- and strengthsbased home visitation intervention consisting of 10 weekly 60- to 75-minute sessions with
caregiver-child dyads ages birth to five years.124,125 Providers complete comprehensive training
and are required to complete annual fidelity monitoring to maintain certification. While this rigor
of training may be appropriate given that there is no degree requirement for providers, these
requirements may deter some providers from pursuing the intervention.
Originally designed for caregivers and young children with disabilities, PFR has been
adapted, implemented, and tested extensively with families involved in the child welfare system.
The primary targets for intervention in PFR are caregiver-child relational and attachment
functioning, reflective and responsive parenting, and developmental guidance and
psychoeducation.124,125 A unique aspect of this intervention is the use of reflective video
126
feedback. Caregivers view observational videos of themselves interacting with the child, and
providers give supportive in-the-moment feedback guiding caregiver reflection, parenting insight
regarding the child’s cues for social and emotional needs, and perspective-taking.
Community-based RCTs of PFR with caregivers (biological parents, kin carers, and nonkin foster parents) and children in child welfare and out-of-home placement, suggest that
caregivers receiving PFR, as compared to controls receiving a psychoeducational parenting
program, showed improvements in understanding their child’s needs and cues and increased
response sensitivity.
125 PFR participation also attenuated the relationship between multiple outof-home placements and child insecure attachment at 6-month follow-up.126 Furthermore, two
years post-intervention, kin and foster caregivers in the PFR group were more likely to have
provided stable, uninterrupted care and to adopt or take legal guardianship of the child than
foster and kin caregivers in the control group.127 Another study with child welfare-involved but
intact families (i.e., receiving welfare services with child remaining in the home of origin)
demonstrated that caregivers receiving PFR showed improvements in sensitive parenting
postintervention that subsequently predicted more secure attachment six months later.125,128,129
PFR has also been successfully adapted and tested for use in the perinatal period with Spanishand English-speaking women with a perinatal psychiatric diagnosis, indigenous populations, and
with recently reunified birth parents and children in child welfare.
128,130–133
Among maltreated caregivers, Pasalich and colleagues tested the effect of caregivers’
childhood maltreatment type (i.e., physical, sexual, and emotional abuse) on response to
intervention among child welfare-involved but intact families.
129 This study showed that
caregivers with childhood physical abuse, but not sexual or emotional abuse, demonstrated
improvements in parental sensitivity related to PFR, which subsequently influenced secure child
127
attachment six months later.129 This finding suggests that attachment-based interventions that aim
to improve caregiver competence in reflective functioning and understanding of their child’s
socioemotional needs, such as PFR, may be most effective for caregivers who experienced
physical abuse during their childhood.129
Child-Parent Psychotherapy
Child-Parent Psychotherapy (CPP) is a manualized attachment-based relational
intervention for caregiver-child dyads ages birth to five years who have experienced family
violence.
134 The intervention is intended for use with dyads in which the child has experienced
family violence, however, the original model also incorporates intervention components to
address the caregiver’s maltreatment history, if applicable. The intervention is primarily
grounded in attachment theory, incorporating elements of psychoanalytic, social learning, and
cognitive behavioral theories in case conceptualization and intervention design.
134 Treatment is
typically delivered through weekly sessions in a clinic setting, though it has also been adapted
for home visitation, with a recommended treatment duration of approximately one year.
135,136 It
should be noted that this length of treatment may be difficult for some dyads to complete,
particularly among those with co-occurring life stressors and/or child welfare involvement. The
primary mechanisms of change are enhancing the attachment relationship and parent-child
interactions, developing dyadic behavioral and affective co-regulation skills, addressing negative
self-concept among caregivers and children, and identifying and managing trauma reminders and
posttraumatic stress symptoms. Intergenerational maltreatment is addressed through a strong
focus on repairing disorganized caregiver-child attachment, collaborative trauma narrative
processing (of child’s maltreatment), and addressing contextual factors that may increase risk for
128
intergenerational maltreatment continuity such as socioeconomic and cultural stressors (e.g.,
racial discrimination, immigration status, etc.).
Evidence from RCTs with caregivers and preschool-aged children with childhood
exposure to domestic violence and possible co-occurrence of other childhood maltreatment,
showed significant decreases in child behavioral problems and posttraumatic stress symptoms (a
reduction from 50% to 6% meeting diagnostic criteria for PTSD at pre- and post-intervention
assessment), and caregiver posttraumatic stress among dyads who received CPP.74,137 These
effects were maintained at 6-month follow-up, and showed particularly promising improvements
among children with four or more traumatic experiences.
138,139 Several RCTs have also supported
the effectiveness of CPP in improving attachment security, child cognitive functioning, and
caregiver relationship satisfaction among dyads with caregiver depression, one of the most
prominent risk factors of subsequent childhood maltreatment.
137,140 Promising results have also
been demonstrated with foster care youth and children with developmental disabilities who have
experienced trauma.
141–144
CPP has also been successfully adapted and tested for pregnant people (Perinatal ChildParent Psychotherapy; P-CPP) and caregiver-infant dyads (Infant-Parent Psychotherapy; IPP;
Cicchetti et al., 2006; Lavi et al., 2015; Lieberman et al., 2009, 2015). During the prenatal
period, P-CPP aims to support parental-fetal attachment, address perinatal depression and other
mental health concerns, decrease anticipatory parenting stress, facilitate reflection on caregivers’
own experiences of parenting during childhood, and discuss how they would like to parent their
child.
147,148 P-CPP also incorporates psychoeducation on the consequences of childhood
maltreatment for both caregiver and fetus/infant during the perinatal period, provides support to
ameliorate ongoing domestic violence, and promotes physical and emotional safety.
147,148
129
Following birth, the primary targets for intervention of IPP include preventing or addressing
disorganized attachment, enhancing caregiver-infant interactions, treating caregiver mental
health and posttraumatic stress symptoms, and providing developmental guidance.
145,149
Considerable evidence supports IPP’s effectiveness in repairing ruptured and disorganized
attachment, decreasing caregiver child-related parenting stress, and reducing risk for child
neglect.145,149,150 P-CPP and IPP have been tested with caregivers with histories of childhood
polyvictimization (i.e., exposure to multiple maltreatment types) and with dyads with current and
ongoing family trauma, and have been shown to significantly reduce caregiver mental health
concerns, improve child-rearing attitudes, and empower caregivers with relational, behavioral,
and affective parenting skills.
146,147
Parent-Child Interaction Therapy
Parent-Child Interaction Therapy (PCIT) is an evidence-based manualized dyadic
intervention that is primarily based in social learning theory.
151 Originally developed for young
children ages 2-7 years with severe disruptive behaviors, PCIT has been expanded to include
empirically supported adaptations for toddlers (PCIT-Toddlers) and older children up to age 12
years (PCIT-OC).
151–155 In a treatment course of approximately 14 - 20 weekly sessions, PCIT
aims to enhance the caregiver-child relationship through guided, structured play to increase
warmth and positive interactions, decrease unwanted child behaviors, improve behavior
management with specific parenting skills, and increase child compliance.
151 Caregivers are
coached via remote headset during in-vivo caregiver-child interactions, allowing the provider to
give instructions and guide caregiver responses to the child’s behaviors and verbalizations while
observing through a one-way mirror or observation camera system. Significant empirical support
demonstrates PCIT to be effective with young children with severe oppositional and defiant
130
behavior problems, improving behaviors in home and school settings, with positive impacts
lasting across childhood.
156
PCIT has been explored extensively as a treatment for families with physical abuse
experiences, including those where both the child and caregiver experienced childhood physical
abuse, child welfare-involved children and their caregivers who have perpetrated physical abuse
(i.e., to prevent out-of-home placement or work toward reunification), and physically abused
foster youth and non-relative foster caregivers.67,72,157–164 Across several studies, PCIT
participation has been linked with lower rates of child maltreatment revictimization and
caregiver perpetration of maltreatment, reduced parenting stress, and significantly improved
outcomes in child externalizing symptoms, posttraumatic stress, posttraumatic stress-related
sexual concerns.
72,153,158,159,161,163–174 Via coaching, PCIT offers caregiver-child dyads a
behavioral framework and developmentally appropriate hands-on guidance to develop positive
interactions through structured behavioral play, emotion self- and co-regulation, nonviolent
discipline skills, and to establish the predictability and consistency in limit-setting that is often
faltering in maltreating families.
25,67,70 Appropriate adaptation of PCIT for maltreating parents
with chronic and severe child welfare histories may also facilitate earlier reunification and better
outcomes among children previously placed in out-of-home care.167 Research also supports
adaptations for maltreating families including implementation with children up to 12 years of
age, addition of attachment-based parenting and self-motivation skills, delivery in community
centers and domestic violence shelters, and incorporating in-home coaching for families at high
risk of maltreatment recidivism, finding increased caregiver retention and improved outcomes
with these adapted models.
153,157,162,167,169,170,173,175–177 Some challenges of implementing this
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model include extensive training under the direct supervision of a certified PCIT trainer and the
need for clinic spaces with specialized equipment.
Multisystemic Therapy
Multisystemic Therapy (MST) is a manualized family-based intervention for adolescents
ages 12-17 years that is offered via intensive in-home visitation with multiple sessions per week
over a 3-5 month period.
178,179 Based in ecological systems theory, MST incorporates individual,
family, community, and sociocultural factors in case conceptualization and treatment
planning.
179–181 Considerable evidence suggests significant reduction in violence and criminal
behavior, out-of-home placement, mental health symptomatology, and substance use among
adolescents, as well as improved caregiver mental health, social support, positive parenting
practices, family cohesion, and communication among dyads receiving MST as compared to
those receiving typical child welfare services.178,181–189
MST has been adapted and tested for use with child welfare-involved children ages 6-17
years and their caregivers to mitigate risk of child abuse and neglect (MST-CAN).190 The
intervention is designed for families involved in the child welfare system due to the child’s
maltreatment experiences, however, many of these families also have considerable caregiver
maltreatment experiences as well. A team of three providers – a crisis caseworker, a part-time
psychiatrist, and a full-time supervisor – tailor the intervention to address multiple risk factors
for child maltreatment in the familial and social environments, rather than pointedly addressing
individual family members or incidents.
180,181,191,192 By providing comprehensive in-home mental
health and social services with a team of providers, MST-CAN aims to remove barriers to care
that many child welfare-involved families face, including caregiver mental health, transportation
challenges, fear or mistrust in medical settings, and management of a complex schedule of court-
132
mandated appointments.
191 Evidence from RCTs supports MST-CAN’s effectiveness in reducing
out-of-home placement, maltreatment revictimization, subsequent child protective services
reports, and caregiver behaviors associated with maltreatment, and improved child and caregiver
mental health symptoms and social support.
193 As with other multi-provider interventions, the
costs associated with operating in provider teams rather than an individual provider may be
prohibitive for some clinics and agencies.
Considerations for Intergenerational Maltreatment Intervention
Because the impacts of childhood maltreatment affect individuals across childhood into
adulthood, as well as their children and family systems, there are multiple points across
development when intervention may be necessary and effective in mitigating risk for
intergenerational maltreatment continuity. Considerable evidence suggests that the most effective
approach to breaking the cycle of maltreatment is prevention.82,194,195 Providers, agencies,
researchers, and public policies should emphasize compassionate and responsive early
identification of families with caregivers who have experienced childhood maltreatment,
providing necessary supports and services as early as possible to sustain healthy family
functioning and keep these families from entering an intergenerational cycle of maltreatment.82
In order to effectively address childhood maltreatment in the context of multiple interconnected
past and present traumatic experiences and major stressors (e.g., child welfare involvement, need
for social services or medical care, housing instability, lack of transportation, and economic
hardship), interventions must be flexibly implemented, tailored, and paced to the needs of each
family.90,196–198 In many cases, a phase-based approach to care may be most effective in which
efforts are directed first toward preventing (further) child maltreatment in the current context,
establishing physical and emotional safety, and addressing present stressors. Moving on to
133
address the impacts of past maltreatment experiences should take place only when current family
functioning is stabilized.196 Furthermore, caregivers with unaddressed maltreatment histories
themselves may be less equipped to support their child in such treatment due to difficulties with
attunement and emotion regulation.
199 Given that family response is such a critical factor in
longitudinal outcomes following maltreatment, critical caregiver mental health, substance use
concerns, prior traumatic experiences, and lack of motivation for treatment involvement may
need to be addressed before preparing to engage in dyadic intervention with the child.
84,167,199–201
Risk for intergenerational childhood maltreatment is a complex web of interconnected
factors, requiring a multi-pronged, multi-systemic intervention approach. On the direct service
level, this may involve interdisciplinary and cross-agency collaboration to provide
comprehensive care across medical and social service domains.202 Training mental health
providers, physicians, and social workers to communicate effectively and to comprehensively
address family needs is critical.203–206 At the policy level, this involves developing public health
policies that coalesce multi-sector partnerships to enhance collaborative maltreatment prevention
and compassionate family-centered response.207
Integrating Emerging Evidence in Clinical Practice
New literature relevant to childhood maltreatment identification and intervention emerges
on an ongoing basis. This research provides critical understanding of the complex and
interconnecting factors that contribute to maltreatment and its developmental and
intergenerational sequalae. However, it presents a challenge for providers aiming to provide upto-date evidence-based care while also striving to maintain high fidelity to an established
treatment model. Novel information may emerge regarding factors that influence variations in
treatment response such as differences in client characteristics, cultural values, language,
134
experiences of specific maltreatment types (e.g., sexual, physical, and emotional abuse, and
neglect), psychiatric or medical comorbidities, and treatment settings.
208 Providers aiming to
deliver evidence-based interventions for maltreated individuals and families are faced with the
responsibility of reviewing these new findings and integrating them into clinical practice,
frequently making decisions about content modifications (e.g., removing or adding components)
or cultural adaptations to existing interventions before research evidence to support those
modifications is available.208–213 Furthermore, even in the absence of new research evidence,
providers are faced with real-world clinical situations and diverse family presentations,
inevitably leading to planned, and often unplanned, modifications to intervention protocols to
meet the specific needs of their families.214,215 Fortunately, prior meta-analytic research on the
impacts of such modifications suggests that these adjustments generally are not detrimental to
intervention outcomes.215 In fact, some evidence indicates that adding components from other
evidence-based models to tailor interventions to a specific family or target population may yield
enhanced outcomes and greater client satisfaction and treatment engagement.215 Best practices
for clinicians modifying evidence-based interventions include making pre-planned modifications
(when possible) that are minimal, well-defined, grounded in the treatment’s original theoretical
conceptualization, and based in an understanding of the target population and cultural
background.214,215
Conclusion
Childhood maltreatment is a significant public health problem with critical psychological,
social, and behavioral implications for individuals directly exposed as well as their children.
Fortunately, considerable efforts have been made in developmental psychopathology and clinical
science to identify mechanisms of risk and protective factors and to develop prevention and
135
intervention strategies to meet the needs of individuals and families at-risk of intergenerational
maltreatment continuity. Providers interacting with these families are tasked with selecting
interventions for individual families or agency-wide implementation, decision-making processes
that should be grounded in empirically-supported theoretical models and intervention protocols
with robust evidence. This narrative review presents providers with a synthesis of the research
literature on dyadic interventions that have randomized controlled evidence supporting their
effectiveness in mitigating risk for intergenerational childhood maltreatment continuity. While
there is considerable support for each of the reviewed interventions to address intergenerational
maltreatment, it is important to reiterate that no intervention for this specific target has yet been
developed and supported with the gold standard of evidence from randomized controlled trials.
Given the significance of this public health crisis, there is great need for future clinical science
innovation to development intervention approaches that are tailored to the specific needs of
families with childhood maltreatment.
Table 1
Evidence Based Intervention Design, Intervention Targets, Outcomes, and Implementation
Challenges
137
Table 1 Continued
Note. RCT = randomized controlled trial; CPS = child protective services; Design, intervention targets, and
outcomes listed are based on the RCT-tested intervention protocol(s). Adaptations for other populations and/or
presenting problems may be available, slight differences in design between multiple RCT studies of the same
intervention are possible.
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
138
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General Discussion
This dissertation sought to better understand intergenerational continuity of childhood
maltreatment, specifically aiming to identify the attributes of caregiver childhood maltreatment
(i.e., type, timing, severity) and the psychosocial risk mechanisms in the proximal child-rearing
environment that confer greatest risk. The first study tested trajectories of caregiver adulthood
depressive symptoms, social support, and economic insecurity as competing mediators in the
relationship between caregiver and child maltreatment types (i.e., sexual abuse, physical abuse,
emotional abuse, and physical neglect). This study found two mediation pathways: 1) an
association between caregiver childhood emotional abuse and child physical neglect via elevated
initial report of caregiver adulthood depressive symptoms, and 2) a type-to-type association
between caregiver and child childhood physical abuse that was mediated by lower caregiver
social support, also at initial self-report. In Study 2, we investigated co-occurrence between
chronicity, severity, and age of onset in caregivers’ childhood experiences of emotional abuse
and tested the influence of different clusters of these characteristics on outcomes among their
children. The latent profile analysis in this study found that, in addition to a group with no
emotional abuse, there were two distinct profiles of caregivers with childhood emotional abuse
experiences. One was characterized by chronic, early childhood onset, and higher severity
emotional abuse, and the other group was defined by adolescent onset emotional abuse that was
limited (i.e., not chronic, occurring during a single developmental period) and lower severity.
Interestingly, we found similar intergenerational associations for each of these two emotional
abuse groups on their children’s experiences of polyvictimization across childhood and
subsequent internalizing and externalizing symptoms in late adolescence. The third paper
provided a narrative review of the extant research literature regarding interventions that aim to
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disrupt the intergenerational cycle of maltreatment by addressing the detrimental effects of
prominent psychological, behavioral, and relational risk factors for maltreatment continuity. The
review summarizes the literature on the state of this public health issue in the United States
today, primary targets for intervention, the benefits of dyadic caregiver-child interventions to
prevent maltreatment onset and reduce the detrimental intergenerational impacts of previous
abuse, and best practices for clinicians tasked with evaluating, adapting, and implementing
evidence-based interventions.
Contributions to the Literature
This dissertation advances the scientific literature by providing several new insights into
the complex mechanisms underlying the continuity of maltreatment across generations. Our use
of latent growth curve modeling in Study 1 was unique in that most prior studies do not explore
the possibility of change over time in maltreatment risk factors, but typically measure mediating
variables at a single timepoint. Interestingly, our latent growth curve models found significant
intercepts, but did not find significant slopes, suggesting that these risk factors may be relatively
stable across parenthood. This finding indicates that caregiver challenges with depressive
symptoms, social support, and economic insecurity may not resolve over time without
appropriate intervention and have the potential to steadily exert adverse consequences on their
children’s outcomes across development. Our results support previous literature suggesting that
caregiver mental health and social support are critical foci for intervention aiming to break the
cycle of maltreatment. The findings of Study 1 suggest that clinicians should pay particular
attention to identifying and supporting caregivers with histories of childhood emotional abuse
who exhibit elevated depressive symptoms - these families may be at greater risk of their child
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experiencing neglect - and those who may lack sufficient social support and may be at risk of
intergenerational continuity of physical abuse.
The findings from Study 2 reveal important insights into the intergenerational pathways
of risk from various constellations of caregiver childhood emotional abuse characteristics to their
children’s maltreatment polyvictimization and later adolescent internalizing and externalizing
symptoms. The identification of three subgroups of caregivers, each characterized by distinct
combinations of emotional abuse experiences, provides novel evidence regarding the
heterogeneity of childhood emotional abuse experiences based on multiple timing and severity
characteristics. The mediation analysis demonstrated that caregiver membership in both
emotional abuse groups was associated with greater childhood polyvictimization among their
children, which subsequently predicted elevated adolescent internalizing and externalizing
symptoms. These findings extend previous literature by highlighting the significant detrimental
effects of emotional abuse on intergenerational outcomes and emphasize the importance of
addressing emotional maltreatment within families to prevent adverse outcomes in future
generations. Additionally, the unexpected finding that limited, less severe emotional abuse with
adolescent onset among caregivers was associated with similar intergenerational effects on their
children’s polyvictimization and later emotional and behavioral problems highlights the critical
role of developmental timing in shaping intergenerational outcomes. This study demonstrates the
need for future research that examines the reasons why experiencing emotional abuse during
adolescence, specifically and exclusively, portends intergenerational outcomes that appear to be
as damaging as those observed among caregivers with more severe and more chronic emotional
abuse.
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Study 3 provides an up-to-date overview of the current literature on dyadic prevention
and intervention protocols with randomized controlled evidence supporting their effectiveness in
reducing the incidence of maltreatment continuity and addressing associated risk factors. By
integrating theoretical frameworks from attachment, social learning, and cognitive behavioral
theories, the review underscores the importance of addressing the multifaceted impacts of
childhood maltreatment within a dyadic relational context. With an intended target audience of
current clinicians, the paper provides evidence-based recommendations for tailoring intervention
to meet the needs of the diverse populations they serve. Overall, Study 3 consolidates a vast
intervention literature, presenting the key information concerning the effectiveness and
adaptability of dyadic interventions for addressing intergenerational childhood maltreatment
continuity.
Limitations and Future Directions
There are a few limitations that should be acknowledged. The first is that the quantitative
analyses relied on a predominantly female caregiver sample (94.1%) which may limit the
generalizability of findings to male caregivers. The limited sample size of male caregivers meant
that we were unable to test for gender differences in trajectories of caregiver risk across the
child-rearing period (Study 1) or profiles of caregiver childhood emotional abuse characteristics
(Study 2), and the potential for different intergenerational influences on child outcomes in both
studies. It is certainly not uncommon for studies exploring caregiver-child relationship factors to
lack a robust male caregiver sample size, with many studies examining only mother- or female
caregiver-child relationships and discounting the role of father figures all together. However,
there is considerable evidence that fathers and male caregivers have important influences on the
family system. For example, coregulation with partners and children of stress response and mood
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states, household parenting and disciplinary practices, and caregiver-child attachment
relationships, that may be quite different from female caregivers and may have critical
implications for intergenerational maltreatment continuity (e.g., Fox et al., 1991; Jewell et al.,
2008; Saxbe et al., 2015; Saxbe & Repetti, 2010). There are rich opportunities for further
research on the role of male caregivers in intergenerational maltreatment continuity, and this
would be an exciting future direction for this program of research to take.
Secondly, research on biomarkers underlying childhood maltreatment have shown
promising avenues for understanding the biological mechanisms involved, including alterations
in the stress response system such as the hypothalamic-pituitary-adrenal (HPA) axis and
epigenetic changes including DNA methylation (e.g., Carpenter et al., 2011; Dunn et al., 2019;
Essex et al., 2013; Heim et al., 2002). These biomarkers may be transmitted across generations
(e.g., Yehuda et al., 2014; Yehuda & Bierer, 2008) and may potentially influence the
intergenerational maltreatment patterns studied herein. This dissertation was specifically
designed to explore psychosocial factors that incur risk for intergenerational maltreatment
continuity, therefore, accounting for biological mechanisms was outside of the scope of the
project. However, it should be acknowledged that these factors may have introduced some
confounds to our findings. The Young Adolescent Project research group has an established and
growing interest in biomarkers of maltreatment, with ongoing research collaborations,
publications, and data collection related to the biological pathways through which maltreatment
may increase vulnerability for mental and physical health problems. Another potential future
direction for this program of research is to examine the biological correlates of maltreatment
across multiple generations to elucidate the ways in which these biomarkers may influence
intergenerational maltreatment continuity.
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Extending intergenerational research to include three or more generations is another
exciting avenue for potential future investigation. By including third-generation individuals,
researchers can gain deeper insight into how the impacts of childhood maltreatment may
proliferate or resolve across family lineages, through both psychosocial and biological pathways.
A multigenerational approach would allow for the exploration of the lasting impacts of
maltreatment as families navigate multiple life cycles of gestation, caregiver-child relationship
formation, child and adolescent development and mental health, intimate partnership dynamics,
changing family and social constellations, neighborhood or economic transitions, and broader
sociocultural shifts. This type of perspective also has the potential to provide a more nuanced
understanding of intervention effectiveness, shedding light on which strategies have the most
enduring impact across familial lineages. In sum, expanding into intergenerational patterns
across three or more generations holds considerable promise for contributing novel
advancements to our understanding of the complex influences of childhood maltreatment and
facilitating long-term reflection that may lead to more effective intervention.
Conclusion
This dissertation explored the attributes of caregiver childhood maltreatment and
adulthood risk factors in the child-rearing environment that confer greatest risk for
intergenerational childhood maltreatment continuity. Studies 1 and 2 employed methodology that
considers how maltreatment experiences arise in the lived experiences of those affected and their
children, more firmly establishing how these person-centered approaches may be incorporated
into the study of intergenerational familial processes. Additionally, throughout the dissertation,
attention has been paid to the clinical implications and potential applications of the findings. The
final paper provides a scoping review of evidence-based protocols for working with caregiver-
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child dyads who have histories of a diverse variety of childhood maltreatment experiences and
may be at heightened risk of intergenerational continuity. In conclusion, this dissertation
advances the literature with both substantive and methodological contributions, provides
clinicians with recommendations for science-based clinical practice, and highlights exciting
future research directions in the study of intergenerational childhood maltreatment.
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
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Appendix A
Figure A1
Mediation Path Model with Caregiver (G1) Any Childhood Maltreatment Not Specific to Type
Note: Standardized effects; Model fit statistics: G1 = caregiver, G2 = child; nG1 = 208, nG2 = 247; G1 any
maltreatment = caregiver maltreatment reported at T3 regardless of type, 0 = no maltreatment, 1 = maltreatment;
household income = household income per capita; G1 depressive symptoms and G1 household income slopes and
intercepts for each participant were extracted from separate latent growth curve models, G1 social support intercept
= T2 social support (i.e., the number of individuals from whom the participant receives tangible, emotional, and
informational support), G1 social support intercept = T2-T3 social support change score; covariates were G2 age at
T2, G2 sex, and caregiver type; Only significant effects are drawn in the figure, significant indirect effects are
bolded. Table A1 presents the significant direct and indirect effects from the model, nonsignificant effects are
presented in Table A2. Model fit was good (χ2 = 18.61 (19), p = 0.48; RMSEA = 0.00 [90% CI 0.00-0.06]; CFI =
1.000; TLI = 1.000; SRMR = 0.15).
*p < .05, **p < .01.
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Table A1
Significant Effects from the Mediation Path Model with Caregiver (G1) Any Childhood
Maltreatment
Note. Standardized effects; G1 = caregiver; G2 = child; nG1 = 208, nG2 = 247; CI = confidence interval.
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
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Table A2
Nonsignificant Effects from the Mediation Path Model with Caregiver (G1) Any Childhood
Maltreatment
Standardized Estimate (95% CI)
Nonsignificant Direct Effects
G1 Any Maltreatment ® G1 Depressive Symptom Slope .05 (-.09, .18)
G1 Any Maltreatment ® G1 Household Income Intercept -.13 (-.25, -.02)
G1 Any Maltreatment ® G1 Household Income Slope -.08 (-.20, .06)
G1 Any Maltreatment ® G1 Social Support Slope .05 (-.08, .18)
G1 Depressive Symptom Intercept ® G2 Sexual Abuse .19 (-.03, .40)
G1 Depressive Symptom Intercept ® G2 Physical Abuse .10 (-.15, .31)
G1 Depressive Symptom Intercept ® G2 Emotional Abuse .02 (-.17, .22)
G1 Depressive Symptom Slope ® G2 Sexual Abuse .10 (-.11, .35)
G1 Depressive Symptom Slope ® G2 Physical Abuse .19 (-.02, .44)
G1 Depressive Symptom Slope ® G2 Emotional Abuse -.04 (-.21, .17)
G1 Depressive Symptom Slope ® G2 Physical Neglect .11 (-.10, .43)
G1 Household Income Intercept ® G2 Sexual Abuse -.15 (-.56, .30)
G1 Household Income Intercept ® G2 Physical Abuse .16 (-.17, .51)
G1 Household Income Intercept ® G2 Emotional Abuse -.16 (-.48, .19)
G1 Household Income Intercept ® G2 Physical Neglect -.21 (-.58, .17)
G1 Household Income Slope ® G2 Sexual Abuse .13 (-.34, .53)
G1 Household Income Slope ® G2 Physical Abuse -.08 (-.45, .28)
G1 Household Income Slope ® G2 Emotional Abuse .28 (-.07, .61)
G1 Household Income Slope ® G2 Physical Neglect .20 (-.20, .56)
G1 Social Support Intercept ® G2 Sexual Abuse -.16 (-.50, .10)
G1 Social Support Intercept ® G2 Emotional Abuse -.03 (-.26, .24)
G1 Social Support Intercept ® G2 Physical Neglect -.10 (-.41, .19)
G1 Social Support Slope ® G2 Emotional Abuse -.08 (-.28, .16)
G1 Social Support Slope ® G2 Physical Neglect -.13 (-.40, .13)
G1 Any Maltreatment ® G2 Sexual Abuse .18 (-.01, .38)
G1 Any Maltreatment ® G2 Physical Abuse .15 (-.03, .32)
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Table A2 Continued
Standardized Estimate (95% CI)
G1 Any Maltreatment ® G2 Emotional Abuse .17 (-.01, .34)
Nonsignificant Indirect Effects
G1 Any Maltreatment ® G1 Depressive Symptoms Intercept ® G2 Sexual Abuse .03 (-.01, .10)
G1 Any Maltreatment ® G1 Depressive Symptoms Intercept ® G2 Physical Abuse .02 (-.02, .07)
G1 Any Maltreatment ® G1 Depressive Symptoms Intercept ® G2 Emotional Abuse .00 (-.03, .05)
G1 Any Maltreatment ® G1 Depressive Symptoms Slope ® G2 Sexual Abuse .00 (-.01, .05)
G1 Any Maltreatment ® G1 Depressive Symptoms Slope ® G2 Physical Abuse .01 (-.01, .06)
G1 Any Maltreatment ® G1 Depressive Symptoms Slope ® G2 Emotional Abuse .00 (-.03, .01)
G1 Any Maltreatment ® G1 Depressive Symptoms Slope ® G2 Physical Neglect .01 (-.01, .04)
G1 Any Maltreatment ® G1 Household Income Intercept ® G2 Sexual Abuse .02 (-.03, .11)
G1 Any Maltreatment ® G1 Household Income Intercept ® G2 Physical Abuse -.02 (-.10, .02)
G1 Any Maltreatment ® G1 Household Income Intercept ® G2 Emotional Abuse .02 (-.02, .09)
G1 Any Maltreatment ® G1 Household Income Intercept ® G2 Physical Neglect .03 (-.01, .12)
G1 Any Maltreatment ® G1 Household Income Slope ® G2 Sexual Abuse -.01 (-.07, .02)
G1 Any Maltreatment ® G1 Household Income Slope ® G2 Physical Abuse .01 (-.02, .07)
G1 Any Maltreatment ® G1 Household Income Slope ® G2 Emotional Abuse -.02 (-.10, .01)
G1 Any Maltreatment ® G1 Household Income Slope ® G2 Physical Neglect -.02 (-.10, .01)
G1 Any Maltreatment ® G1 Social Support Intercept ® G2 Sexual Abuse .02 (-.01, .10)
G1 Any Maltreatment ® G1 Social Support Intercept ® G2 Emotional Abuse .00 (-.04, .05)
G1 Any Maltreatment ® G1 Social Support Intercept ® G2 Physical Neglect .01 (-.02, .09)
G1 Any Maltreatment ® G1 Social Support Slope ® G2 Sexual Abuse -.02 (-.09, .03)
G1 Any Maltreatment ® G1 Social Support Slope ® G2 Physical Abuse -.02 (-.10, .04)
G1 Any Maltreatment ® G1 Social Support Slope ® G2 Emotional Abuse .00 (-.05, .01)
G1 Any Maltreatment ® G1 Social Support Slope ® G2 Physical Neglect -.01 (-.06, .01)
Note. Standardized effects; G1 = caregiver; G2 = child; nG1 = 208, nG2 = 247; CI = confidence interval.
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Appendix B
Table B1
Nonsignificant Direct and Indirect Effects from Mediation Model
Standardized Estimate (95% CI)
Nonsignificant Direct Effects
G1 Sexual Abuse ® G1 Depressive Symptom Intercept .06 (-.15, .26)
G1 Sexual Abuse ® G1 Depressive Symptom Slope -.01 (-.19, .15)
G1 Sexual Abuse ® G1 Household Income Intercept .01 (-.16, .19)
G1 Sexual Abuse ® G1 Household Income Slope -.05 (-.22, .13)
G1 Sexual Abuse ® G1 Social Support Intercept .04 (-.13, .20)
G1 Sexual Abuse ® G1 Social Support Slope .02 (-.14, .21)
G1 Physical Abuse ® G1 Depressive Symptom Intercept .07 (-.15, .26)
G1 Physical Abuse ® G1 Depressive Symptom Slope .19 (-.02, .36)
G1 Physical Abuse ® G1 Social Support Slope .06 (-.10, .20)
G1 Emotional Abuse ® G1 Depressive Symptom Slope -.07 (-.22, .09)
G1 Emotional Abuse ® G1 Household Income Intercept -.11 (-.24, .04)
G1 Emotional Abuse ® G1 Household Income Slope -.05 (-.18, .09)
G1 Emotional Abuse ® G1 Social Support Intercept -.05 (-.21, .09)
G1 Emotional Abuse ® G1 Social Support Slope .02 (-.14, .17)
G1 Physical Neglect ® G1 Depressive Symptom Intercept .01 (-.17, .16)
G1 Physical Neglect ® G1 Depressive Symptom Slope -.04 (-.20, .11)
G1 Physical Neglect ® G1 Household Income Intercept .11 (-.04, .26)
G1 Physical Neglect ® G1 Household Income Slope .12 (-.04, .27)
G1 Physical Neglect ® G1 Social Support Intercept -.09 (-.22, .05)
G1 Physical Neglect ® G1 Social Support Slope -.12 (-.31, .06)
G1 Depressive Symptom Intercept ® G2 Sexual Abuse .14 (-.10, .37)
G1 Depressive Symptom Intercept ® G2 Physical Abuse .09 (-.19, .30)
G1 Depressive Symptom Intercept ® G2 Emotional Abuse -.02 (-.21, .19)
G1 Depressive Symptom Slope ® G2 Sexual Abuse .08 (-.13, .37)
G1 Depressive Symptom Slope ® G2 Physical Abuse .17 (-.08, .30)
G1 Depressive Symptom Slope ® G2 Emotional Abuse -.05 (-.21, .19)
G1 Depressive Symptom Slope ® G2 Physical Neglect .15 (-.09, .34)
G1 Household Income Intercept ® G2 Sexual Abuse -.14 (-.54, .28)
G1 Household Income Intercept ® G2 Physical Abuse .19 (-.17, .55)
G1 Household Income Intercept ® G2 Emotional Abuse -.17 (-.47, .19)
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Table B1 Continued
Standardized Estimate (95% CI)
G1 Household Income Intercept ® G2 Physical Neglect -.22 (-.59, .18)
G1 Household Income Slope ® G2 Sexual Abuse .11 (-.40, .49)
G1 Household Income Slope ® G2 Physical Abuse -.11 (-.50, .23)
G1 Household Income Slope ® G2 Emotional Abuse .28 (-.05, .59)
G1 Household Income Slope ® G2 Physical Neglect .17 (-.26, .54)
G1 Social Support Intercept ® G2 Sexual Abuse -.10 (-.41, .16)
G1 Social Support Intercept ® G2 Emotional Abuse .01 (-.21, .28)
G1 Social Support Intercept ® G2 Physical Neglect -.06 (-.37, .20)
G1 Social Support Slope ® G2 Emotional Abuse -.05 (-.25, .19)
G1 Social Support Slope ® G2 Physical Neglect -.08 (-.34, .18)
G1 Sexual Abuse ® G2 Sexual Abuse .02 (-.22, .22)
G1 Sexual Abuse ® G2 Physical Abuse .11 (-.34, .11)
G1 Sexual Abuse ® G2 Emotional Abuse .08 (-.12, .30)
G1 Sexual Abuse ® G2 Physical Neglect .02 (-.20, .21)
G1 Physical Abuse ® G2 Sexual Abuse .10 (-.12, .30)
G1 Physical Abuse ® G2 Physical Abuse .13 (-.09, .30)
G1 Physical Abuse ® G2 Emotional Abuse -.01 (.20, .23)
G1 Physical Abuse ® G2 Physical Neglect -.08 (-.33, .12)
G1 Emotional Abuse ® G2 Sexual Abuse .12 (-.09, .31)
G1 Emotional Abuse ® G2 Physical Abuse .09 (-.10, .26)
G1 Emotional Abuse ® G2 Emotional Abuse .14 (-.05, .34)
G1 Emotional Abuse ® G2 Physical Neglect .15 (-.06, .34)
G1 Physical Neglect ® G2 Sexual Abuse .08 (-.15, .28)
G1 Physical Neglect ® G2 Physical Abuse .05 (-.17, .25)
G1 Physical Neglect ® G2 Emotional Abuse .15 (-.06, .35)
G1 Physical Neglect ® G2 Physical Neglect .17 (-.03, .35)
Nonsignificant Indirect Effects
G1 Sexual Abuse ® G1 Depressive Symptoms Intercept ® G2 Sexual Abuse .01 (-.01, .08)
G1 Sexual Abuse ® G1 Depressive Symptoms Intercept ® G2 Physical Abuse .01 (-.01, .07)
G1 Sexual Abuse ® G1 Depressive Symptoms Intercept ® G2 Emotional Abuse .00 (-.04, .02)
G1 Sexual Abuse ® G1 Depressive Symptoms Intercept ® G2 Physical Neglect .01 (-.03, .08)
G1 Physical Abuse ® G1 Depressive Symptoms Intercept ® G2 Sexual Abuse .01 (-.01, .07)
G1 Physical Abuse ® G1 Depressive Symptoms Intercept ® G2 Physical Abuse .01 (-.01, .06)
G1 Physical Abuse ® G1 Depressive Symptoms Intercept ® G2 Emotional Abuse .00 (-.04, .02)
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Table B1 Continued
Standardized Estimate (95% CI)
G1 Physical Abuse ® G1 Depressive Symptoms Intercept ® G2 Physical Neglect .02 (-.01, .08)
G1 Emotional Abuse ® G1 Depressive Symptoms Intercept ® G2 Sexual Abuse .03 (-.01, .11)
G1 Emotional Abuse ® G1 Depressive Symptoms Intercept ® G2 Physical Abuse .02 (-.04, .08)
G1 Emotional Abuse ® G1 Depressive Symptoms Intercept ® G2 Emotional Abuse -.01 (-05, 05)
G1 Physical Neglect ® G1 Depressive Symptoms Intercept ® G2 Sexual Abuse .00 (-.03, .03)
G1 Physical Neglect ® G1 Depressive Symptoms Intercept ® G2 Physical Abuse .00 (-.03, .03)
G1 Physical Neglect ® G1 Depressive Symptoms Intercept ® G2 Emotional Abuse .00 (-.02, .02)
G1 Physical Neglect ® G1 Depressive Symptoms Intercept ® G2 Physical Neglect .00 (-.04, .05)
G1 Sexual Abuse ® G1 Depressive Symptoms Slope ® G2 Sexual Abuse -.01 (-.34, .02)
G1 Sexual Abuse ® G1 Depressive Symptoms Slope ® G2 Physical Abuse -.01 (-.06, .03)
G1 Sexual Abuse ® G1 Depressive Symptoms Slope ® G2 Emotional Abuse .00 (-.02, .02)
G1 Sexual Abuse ® G1 Depressive Symptoms Slope ® G2 Physical Neglect .00 (-.05, .03)
G1 Physical Abuse ® G1 Depressive Symptoms Slope ® G2 Sexual Abuse .02 (-.01, .10)
G1 Physical Abuse ® G1 Depressive Symptoms Slope ® G2 Physical Abuse .03 (-.01, .06)
G1 Physical Abuse ® G1 Depressive Symptoms Slope ® G2 Emotional Abuse -.01 (-07, 02)
G1 Physical Abuse ® G1 Depressive Symptoms Slope ® G2 Physical Neglect .03 (-.01, .12)
G1 Emotional Abuse ® G1 Depressive Symptoms Slope ® G2 Sexual Abuse -.01 (-.06, .01)
G1 Emotional Abuse ® G1 Depressive Symptoms Slope ® G2 Physical Abuse -.01 (-.08, .01)
G1 Emotional Abuse ® G1 Depressive Symptoms Slope ® G2 Emotional Abuse .00 (-.01, .05)
G1 Emotional Abuse ® G1 Depressive Symptoms Slope ® G2 Physical Neglect -.01 (-.07, .01)
G1 Physical Neglect ® G1 Depressive Symptoms Slope ® G2 Sexual Abuse -.01 (-.05, .01)
G1 Physical Neglect ® G1 Depressive Symptoms Slope ® G2 Physical Abuse -.01 (-.06, .02)
G1 Physical Neglect ® G1 Depressive Symptoms Slope ® G2 Emotional Abuse .00 (-.01, .03)
G1 Physical Neglect ® G1 Depressive Symptoms Slope ® G2 Physical Neglect -.01 (-.08, .01)
G1 Sexual Abuse ® G1 Household Income Intercept ® G2 Sexual Abuse -.01 (-.06, .04)
G1 Sexual Abuse ® G1 Household Income Intercept ® G2 Physical Abuse .01 (-.04, .06)
G1 Sexual Abuse ® G1 Household Income Intercept ® G2 Emotional Abuse .00 (-.07, .04)
G1 Sexual Abuse ® G1 Household Income Intercept ® G2 Physical Neglect .00 (-.07, .04)
G1 Physical Abuse ® G1 Household Income Intercept ® G2 Sexual Abuse .03 (-.05, .13)
G1 Physical Abuse ® G1 Household Income Intercept ® G2 Physical Abuse -.04 (-.14, .02)
G1 Physical Abuse ® G1 Household Income Intercept ® G2 Emotional Abuse .03 (-.02, .11)
G1 Physical Abuse ® G1 Household Income Intercept ® G2 Physical Neglect .04 (-.02, .15)
G1 Emotional Abuse ® G1 Household Income Intercept ® G2 Sexual Abuse .02 (-.02, .11)
G1 Emotional Abuse ® G1 Household Income Intercept ® G2 Physical Abuse -.02 (-.11, .01)
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Table B1 Continued
Standardized Estimate (95% CI)
G1 Emotional Abuse ® G1 Household Income Intercept ® G2 Emotional Abuse .02 (-.01, .10)
G1 Emotional Abuse ® G1 Household Income Intercept ® G2 Physical Neglect .03 (-.01, .12)
G1 Physical Neglect ® G1 Household Income Intercept ® G2 Sexual Abuse -.02 (-.11, .02)
G1 Physical Neglect ® G1 Household Income Intercept ® G2 Physical Abuse .02 (-.01, .13)
G1 Physical Neglect ® G1 Household Income Intercept ® G2 Emotional Abuse -.02 (-.11, .01)
G1 Physical Neglect ® G1 Household Income Intercept ® G2 Physical Neglect -.02 (-.14, .01)
G1 Sexual Abuse ® G1 Household Income Slope ® G2 Sexual Abuse -.01 (-.08, .03)
G1 Sexual Abuse ® G1 Household Income Slope ® G2 Physical Abuse .01 (-.02, .08)
G1 Sexual Abuse ® G1 Household Income Slope ® G2 Emotional Abuse -.01 (-.11, .03)
G1 Sexual Abuse ® G1 Household Income Slope ® G2 Physical Neglect -.01 (-.12, .02)
G1 Physical Abuse ® G1 Household Income Slope ® G2 Sexual Abuse -.02 (-.12, .06)
G1 Physical Abuse ® G1 Household Income Slope ® G2 Physical Abuse .02 (-.04, .11)
G1 Physical Abuse ® G1 Household Income Slope ® G2 Emotional Abuse -.05 (-.16, .00)
G1 Physical Abuse ® G1 Household Income Slope ® G2 Physical Neglect -.03 (-.14, .04)
G1 Emotional Abuse ® G1 Household Income Slope ® G2 Sexual Abuse -.01 (-.07, .02)
G1 Emotional Abuse ® G1 Household Income Slope ® G2 Physical Abuse .01 (-.01, .06)
G1 Emotional Abuse ® G1 Household Income Slope ® G2 Emotional Abuse -.01 (-.08, .02)
G1 Emotional Abuse ® G1 Household Income Slope ® G2 Physical Neglect -.01 (-.08, .02)
G1 Physical Neglect ® G1 Household Income Slope ® G2 Sexual Abuse .01 (-.03, .11)
G1 Physical Neglect ® G1 Household Income Slope ® G2 Physical Abuse -.01 (-.12, .02)
G1 Physical Neglect ® G1 Household Income Slope ® G2 Emotional Abuse .03 (-.01, .16)
G1 Physical Neglect ® G1 Household Income Slope ® G2 Physical Neglect .02 (-.02, .13)
G1 Sexual Abuse ® G1 Social Support Intercept ® G2 Sexual Abuse -.01 (-.08, .01)
G1 Sexual Abuse ® G1 Social Support Intercept ® G2 Physical Abuse -.02 (-.11, .04)
G1 Sexual Abuse ® G1 Social Support Intercept ® G2 Emotional Abuse .00 (-.02, .03)
G1 Sexual Abuse ® G1 Social Support Intercept ® G2 Physical Neglect .00 (-.07, .01)
G1 Physical Abuse ® G1 Social Support Intercept ® G2 Sexual Abuse .01 (-.02 (.09)
G1 Physical Abuse ® G1 Social Support Intercept ® G2 Emotional Abuse .00 (-.05, .03)
G1 Physical Abuse ® G1 Social Support Intercept ® G2 Physical Neglect .01 (-.02, .08)
G1 Emotional Abuse ® G1 Social Support Intercept ® G2 Sexual Abuse .01 (-.01, .08)
G1 Emotional Abuse ® G1 Social Support Intercept ® G2 Physical Abuse .02 (-.03, .09)
G1 Emotional Abuse ® G1 Social Support Intercept ® G2 Emotional Abuse .00 (-.03, .02)
G1 Emotional Abuse ® G1 Social Support Intercept ® G2 Physical Neglect .00 (-.01, .07)
G1 Physical Neglect ® G1 Social Support Intercept ® G2 Sexual Abuse .01 (-.01, .07)
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Table B1 Continued
Standardized Estimate (95% CI)
G1 Physical Neglect ® G1 Social Support Intercept ® G2 Physical Abuse .04 (-.01, .13)
G1 Physical Neglect ® G1 Social Support Intercept ® G2 Emotional Abuse .00 (-.04, .16)
G1 Physical Neglect ® G1 Social Support Intercept ® G2 Physical Neglect .01 (-.01, .06)
G1 Sexual Abuse ® G1 Social Support Slope ® G2 Sexual Abuse -.01 (-.09, .05)
G1 Sexual Abuse ® G1 Social Support Slope ® G2 Physical Abuse -.01 (-.10, .06)
G1 Sexual Abuse ® G1 Social Support Slope ® G2 Emotional Abuse .00 (-.04, .02)
G1 Sexual Abuse ® G1 Social Support Slope ® G2 Physical Neglect .00 (-.07, .01)
G1 Physical Abuse ® G1 Social Support Slope ® G2 Sexual Abuse -.02 (-.10, .02)
G1 Physical Abuse ® G1 Social Support Slope ® G2 Physical Abuse -.03 (-.11, .03)
G1 Physical Abuse ® G1 Social Support Slope ® G2 Emotional Abuse .00 (-.04, .01)
G1 Physical Abuse ® G1 Social Support Slope ® G2 Physical Neglect -.01 (-.07, .01)
G1 Emotional Abuse ® G1 Social Support Slope ® G2 Sexual Abuse -.01 (-.07, .05)
G1 Emotional Abuse ® G1 Social Support Slope ® G2 Physical Abuse -.01 (-.08, 05)
G1 Emotional Abuse ® G1 Social Support Slope ® G2 Emotional Abuse .00 (-.03, .01)
G1 Emotional Abuse ® G1 Social Support Slope ® G2 Physical Neglect .00 (-.04, .01)
G1 Physical Neglect ® G1 Social Support Slope ® G2 Sexual Abuse .04 (-.01, .17)
G1 Physical Neglect ® G1 Social Support Slope ® G2 Physical Abuse .05 (-.01, .18)
G1 Physical Neglect ® G1 Social Support Slope ® G2 Emotional Abuse .01 (-.02, .06)
G1 Physical Neglect ® G1 Social Support Slope ® G2 Physical Neglect .01 (-.02, .08)
Note. Standardized effects; G1 = caregiver; G2 = child; nG1 = 208, nG2 = 247; CI = confidence interval.
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Appendix C: Measures
Childhood Trauma Interview (CTI): Screen
Many people have upsetting or disturbing experiences as they grow up. We would like to get a
picture of some of these experiences that you may have had. This information will be very
important to us as we try to understand your growth and development. What you tell us may
allow us to help someone else. Please try and answer the questions the best you can.
Please read the following statements and circle either “YES” or “NO”.
Each year, millions of families separate because a parent moves
away or the adolescent needs to go live with a different family
Did anyone close to you ever move away from you
(i.e. a brother, sister, or parent)? YES NO
Was there ever a time when someone close to you was very sick or
died? YES NO
Have YOU ever been very sick (e.g. needing hospitalization)? YES NO
Have you ever gone through any painful or scary medical
procedures? YES NO
Did you ever run away from home? YES NO
Have you ever had a social worker come and talk with you about
the things that were happening in your family? YES NO
Have you ever had to go live with someone else because of what
was happening in your family? YES NO
Over 400,000 kids each year don’t get the care they need from
their parents.
Have there been times when you did not have enough to eat, did
not have clothes, medicine or medical attention, or didn’t have a
place to sleep? YES NO
Have there been times when the person(s) who was supposed to be
taking care of you couldn’t do it very well because of the problems
they were having? YES NO
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Have there been times when the place you were living has been
without running water or electricity or other things that made it
hard to live there? YES NO
Were there times when you didn’t have a place to live and had to
stay in a car or in a shelter? YES NO
Have there been times when grown-ups have given you drugs or
alcohol? YES NO
Were you ever left with someone who scared you? YES NO
Last year, hundreds of thousands of kids had the experience of
their parent or caretaker treating them in mean ways.
Have there been times in your life when the adults that take care of
you said mean or insulting things to you, put you down, or told you
that you were no good? YES NO
Have there been times when you have seen or heard adults that
take care of you say mean, insulting or threatening things to each
other, hit each other or hurt each other physically? YES NO
Have there been times when you felt rejected by your family? YES NO
Have the people who take/took care of you had problems with
drugs or alcohol? YES NO
Were there times when you were locked in a room, closet, or
somewhere else for a long time as a punishment? YES NO
Last year, millions of kids were hit by a parent or adult that was
taking care of them.
Have you ever been hit or beaten, or physically mistreated by any
adults? YES NO
Have you ever been beaten up, mugged, held up, or threatened
physically? YES NO
Have you ever cut yourself on purpose or tried to hurt yourself in
any way? YES NO
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Each year, more than a million people witness violence in their
community and homes.
Have you ever witnessed or known someone who was physically
hurt, attacked, or killed? YES NO
Have you witnessed or been involved in a serious accident, like a
car accident? YES NO
Each year 1 in 4 kids have something done to them sexually that
they didn’t want.
Has anyone ever done something, or tried to do something sexual
to you that you didn’t want? YES NO
Has anyone ever done something [anything else] to you that made
you uncomfortable sexually? YES NO
Has anyone in your family ever been sexually assaulted? YES NO
Has anyone else you know ever had an unwanted sexual
experience? YES NO
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Childhood Trauma Interview (CTI): Sexual Abuse
STEM QUESTIONS:
Has anyone ever done something, or tried to do something sexual to you that you didn’t want?
1 YES 0 NO
Has anyone ever done something to you sexually that made you uncomfortable?
1 YES 0 NO
IF “NO” SKIP TO NEXT SECTION
FOLLOW-UP for each endorsed stem question:
How many people did this to you? _______
How old were you the first time this happened? _____
How old were you when it stopped? _____
How many times/ how often did this happen? ____________
Who was the person who did this to you? _______________
Did this person also hurt you physically [become violent] or threaten to do so?
1 YES 0 NO
How close were you to this person before this started?
1 Not at all close
2 A little close
3 Moderately close
4 Very close
5 Extremely close
How close are you to this person now?
1 Not at all close
2 A little close
3 Moderately close
4 Very close
5 Extremely close
Can you tell me some of the details about what happened?
How upsetting was this for you?
1 Not at upsetting
2 A little upsetting
3 Moderately upsetting
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4 Very upsetting
5 Extremely upsetting
Did this person kiss you? 1 YES 0 NO
Did this person touch your private parts? 1 YES 0 NO
Did this person touch your breasts? 1 YES 0 NO 8 N/A
Did this person play with his/her private parts in front of you?
1 YES 0 NO
Did this person have you play with his/her private parts? 1 YES 0 NO
Did this person put his/her mouth on your private parts? 1 YES 0 NO
Did this person have you put your mouth on his/her private parts?
1 YES 0 NO
Did this person put something inside your private parts or bottom?
1 YES 0 NO
What did he/she put in? 1Penis 2 Finger Other (specify)
What part of your body did he/she put it in? 1 Vagina 2 Bottom
Did this person show you sexual pictures or movies?
Did this person do something else? YES (specify) NO
Was there another person? 1 YES 0 NO
IF “NO” SKIP TO NEXT SECTION. IF “YES” REPEAT ALL QUESTIONS FOR EACH
INCIDENT/PERSON
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Childhood Trauma Interview (CTI): Physical Abuse
Have you ever been hit or beaten, or physically mistreated by any adults?
1 YES 0 NO
IF “NO” SKIP TO NEXT SECTION
How many people have done this to you?
Who was this person? ___________________
How close were you to this person before this started?
1 Not at all close
2 A little close
3 Moderately close
4 Very close
5 Extremely close
How old were you the first time this happened [this started]? _____
How old were you when it stopped? _____
How often did this happen?__________
How many times did this happen in your entire life?_______
Did this person ever leave marks on your body? 1 Yes 0 No
Did you ever see a doctor for the injuries you received? 1 Yes 0 No
What happened?
How upsetting was this for you?
1 Not at upsetting
2 A little upsetting
3 Moderately upsetting
4 Very upsetting
5 Extremely upsetting
Was there another person? 1 YES 0 NO
IF “NO” SKIP TO NEXT SECTION. IF “YES” REPEAT ALL QUESTIONS FOR EACH
PERSON
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Childhood Trauma Interview (CTI): Emotional Abuse
STEM QUESTIONS:
Have there been times in your life when the adults that take care of you said mean or insulting
things to you, put you down, or told you that you were no good?
1 YES 0 NO
Have there been times when you have seen or heard adults that take care of you say mean,
insulting or threatening things to each other, hit each other or hurt each other physically?
1 YES 0 NO
Have there been times when you felt rejected by your family?
1 YES 0 NO
Have the people who take/took care of you had problems with drugs or alcohol?
1 YES 0 NO
Were there times when you were locked in a room, closet, or somewhere else for a long time as a
punishment?
1 YES 0 NO
FOLLOW-UP for each endorsed stem question:
How many people? _____ ______
Who was this person? _____ ______
How close were you to this person before this started?
1 Not at all close
2 A little close
3 Moderately close
4 Very close
5 Extremely close
How old were you the first time this happened? _____
How old were you when it stopped? _____
How often did this happen? (i.e. daily, weekly)__________
What happened?
How upsetting was this for you?
1 Not at upsetting
2 A little upsetting
3 Moderately upsetting
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4 Very upsetting
5 Extremely upsetting
Was there another person? 1 YES 0 NO
IF “NO” SKIP TO NEXT SECTION. IF “YES” REPEAT ALL QUESTIONS FOR EACH
INCIDENT
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Childhood Trauma Interview (CTI): Physical Neglect
STEM QUESTIONS:
Have there been times when you did not have enough to eat, did not have clothes, medicine or
medical attention, or didn’t have a place to sleep?
1 YES 0 NO
Have there been times when the person(s) who was supposed to be taking care of you couldn’t
do it very well because of the problems they were having?
1 YES 0 NO
Have there been times when the place you were living has been without running water or
electricity or other things that made it hard to live there?
1 YES 0 NO
Were there times when you didn’t have a place to live and had to stay in a car or in a shelter?
1 YES 0 NO
Have there been times when grown ups have given you drugs or alcohol?
1 YES 0 NO
Were you ever left with someone who scared you?
1 YES 0 NO
FOLLOW-UP for each endorsed stem question:
How many times did this happen?
How old were you? ____
How long did it go on for? _________________
What happened?
How upsetting was this for you?
1 Not at upsetting
2 A little upsetting
3 Moderately upsetting
4 Very upsetting
5 Extremely upsetting
Was there another person/time? 1 YES 0 NO
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IF “NO” SKIP TO NEXT SECTION. IF “YES” REPEAT ALL QUESTIONS FOR EACH
INCIDENT
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Beck Depression Inventory
On this questionnaire are groups of statements. Please read each group of statements carefully. Then
pick out the one statement in each group which best describes the way you have been feeling during
the PAST WEEK, INCLUDING TODAY! Circle the number beside the statement you picked. Be
sure to read all the statements in each group before making your choice.
1. 0 I do not feel sad.
1 I feel sad.
2 I am sad all the time and I can't snap out of it.
2. 0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel that the future is hopeless and that things cannot improve.
3. 0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.
4. 0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
5. 0 I don't feel particularly guilty.
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
6. 0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
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3 I feel I am being punished.
7. 0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
1 of 3
8. 0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
9. 0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10. 0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even though I want to.
11. 0 I am no more irritated now than I ever was.
1 I get annoyed or irritated more easily than I used to.
2 I feel irritated all the time now.
3 I don't get irritated at all by the things that used to irritate me.
12. 0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.
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13. 0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions than before.
3 I can't make decisions at all anymore.
14. 0 I don't feel I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel that there are permanent changes in my appearance that make me look
unattractive.
3 I believe that I look ugly.
15. 0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.
16. 0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.
17. 0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
18. 0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
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3 I have no appetite at all any more.
19. 0 I haven't lost much weight, if any, lately.
1 I have lost more than 5 pounds.
2 I have lost more than 10 pounds.
3 I have lost more than 15 pounds.
19a. I am purposely trying to lose weight by eating less. (check one) 1 Yes 2 No
20. 0 I am no more worried about my health than usual.
1 I am worried about physical problems such as aches and pains; or upset
stomach; or
constipation.
2 I am very worried about physical problems and it's hard to think of much else.
3 I am so worried about my physical problems that I cannot think about anything
else.
21. 0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I am much less interested in sex now.
3 I have lost interest in sex completely.
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Social Support Questionnaire
List all of the people in your social support network.
FOLLOW-UP questions for each person listed:
1. Gender
0 Male
1 Female
2. Age
3. Relationship
1 Other/spouse
2 Parent
3 Sibling
4 Friend
5 Other family member
6 Professional (Dr., therapist)
7 Other
8 Step-parent
9 Child
10 Non-biological child
11 Co-worker/boss
4. How long have you known them?
5. How often do you have contact with them?
6. How important is this person to you?
1 Not too important
2 Mildly important
3 In between
4 Fairly important
5 Very important
7. I can go to this person for advice
0 No
1 Yes
8. This person can come to me for advice
0 No
1 Yes
9. I can talk to this person about personal concerns
0 No
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1 Yes
10. This person talks to me about personal concerns
0 No
1 Yes
11. I borrow money or material goods from this person
0 No
1 Yes
12. This person borrows money or goods from me
0 No
1 Yes
13. I can count on help from this person in an emergency
0 No
1 Yes
14. This person can count on help from me in an emergency
0 No
1 Yes
15. This person and I get together to have fun or go out
0 No
1 Yes
16. I ask this person for advice about childrearing
0 No
1 Yes
17. This person asks me for advice about childrearing
0 No
1 Yes
18. I talk to this person about problems with my children
0 No
1 Yes
19. This person talks to me about problems with their children
0 No
1 Yes
20. I tell this person happy news about my children
0 No
1 Yes
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21. This person tells me happy news about their children
0 No
1 Yes
22. I get help from this person such as babysitting
0 No
1 Yes
23. This persons gets help from me such as babysitting
0 No
1 Yes
24. I talk to this person when I am upset and just need to talk
0 No
1 Yes
25. This person comes to me when they are upset and need to talk
0 No
1 Yes
26. I talk to this person when I am upset with my kids and need to let off steam
0 No
1 Yes
27. This person comes to me when they are upset with their kids and need to let off steam
0 No
1 Yes
28. When I go to this person for help or support I usually find it
0 No
1 Yes
29. When this person comes to me for help or support they usually find it
0 No
1 Yes
30. How satisfied are you with the relationship you have with this person
1 Not too satisfied
2 Mildly satisfied
3 In between
4 Fairly satisfied
5 Very satisfied
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
192
Youth Self-Report - Part 2
0= Not True (as far as you know) 1= Somewhat of Sometimes True 2= Very True or Often True
Missing = 9
0 1 2 1. I act too young for my age 0 1 2 30. I am afraid of going to school
0 1 2 2. I have an allergy (describe): 0 1 2 31. I am afraid I might think or do something
bad
0 1 2 3. I argue a lot 0 1 2 32. I feel that I have to be perfect
0 1 2 4. I have asthma 0 1 2 33. I feel that no one loves me
0 1 2 5.I act like the opposite sex 0 1 2 34. I feel that others are out to get me
0 1 2 6. I like animals 0 1 2 35. I feel worthless or inferior
0 1 2 7. I brag 0 1 2 36. I accidentally get hurt a lot
0 1 2 8. I have trouble concentrating of paying
attention
0 1 2 37.I get in many fights
0 1 2 9. I can’t get my mind off certain thoughts
(describe):
0 1 2 38. I get teased a lot
0 1 2 10. I have trouble sitting still 0 1 2 39. I hang around with others who get in
trouble
0 1 2 11. I’m too dependent on adults 0 1 2 40. I hear sounds or voices that other people
think aren’t there (describe):
0 1 2 12. I feel lonely 0 1 2 41. I act without stopping to think
0 1 2 13. I feel confused or in a fog 0 1 2 42. I would rather be alone than with others
0 1 2 14. I cry a lot 0 1 2 43. I lie or cheat
0 1 2 15. I am pretty honest 0 1 2 44. I bit my fingernails
0 1 2 16. I am mean to others 0 1 2 45. I am nervous or tense
0 1 2 17. I daydream a lot 0 1 2 46. Parts of my body twitch or make nervous
movements (describe):
0 1 2 18.I deliberately try to hurt of kill myself 0 1 2 47. I have nightmares
0 1 2 19. I try to get a lot of attention 0 1 2 48. I am not liked by other people
0 1 2 20.I destroy my own things 0 1 2 49. I can do certain things better than most
people
0 1 2 21. I destroy things belonging to others 0 1 2 50. I am too fearful or anxious
0 1 2 22. I disobey my parents 0 1 2 51. I feel dizzy
0 1 2 23. I disobey at school 0 1 2 52. I feel too guilty
0 1 2 24. I don’t eat as well as I should 0 1 2 53. I eat too much
0 1 2 25. I don’t get along with other people 0 1 2 54. I feel overtired
0 1 2 26. I don’t feel guilty after doing something I
shouldn’t
0 1 2 55. I am overweight
0 1 2 27. I am jealous of others 56. Physical problems without known medical
cause:
0 1 2 28. I am willing to help other when they need
help
0 1 2 a. Aches or pains (not headaches)
0 1 2 29. I am afraid of certain animals, situations,
or places, other than school (describe):
0 1 2 b. Headaches
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
193
0= Not True (as far as you know) 1= Somewhat or Sometimes true 2= Very true or Often true
0 1 2 c. Nausea, feel sick 0 1 2 86. I am stubborn
0 1 2 d. Problems with eyes (not if corrected by
glasses) (describe):
0 1 2 87. My moods or feelings change suddenly
0 1 2 e. Rashes or other skin problems 0 1 2 88. I enjoy being with other people
0 1 2 f. Stomachaches or cramps 0 1 2 89. I am suspicious
0 1 2 g. Vomiting, throwing up 0 1 2 90. I swear or use dirty language
0 1 2 h. Other (describe): 0 1 2 91. I think about killing myself
0 1 2 57. I physically attack people 0 1 2 92. I like to make others laugh
0 1 2 58. I pick my nose, skin, or other parts of my
body (describe):
0 1 2 93. I talk too much
0 1 2 59. I can be pretty friendly 0 1 2 94. I tease others a lot
0 1 2 60. I like to try new things 0 1 2 95. I have a hot temper
0 1 2 61. My schoolwork is poor 0 1 2 96. I think about sex too much
0 1 2 62.I am poorly coordinated or clumsy 0 1 2 97. I threaten to hurt people
0 1 2 63. I would rather be with older people than
people my own age
0 1 2 98. I like to help others
0 1 2 64. I would rather be with younger people
than people my own age
0 1 2 99. I am too concerned about being neat or
clean
0 1 2 65. I refuse to talk 0 1 2 100. I have trouble sleeping (describe):
0 1 2 66. I repeats certain acts over and over
(describe):
0 1 2 101. I cut classes or skip school
0 1 2 67. I run away from home 0 1 2 102. I don’t have much energy
0 1 2 68. I scream a lot 0 1 2 103. I am unhappy, sad, or depressed
0 1 2 69. I am secretive or keep things to myself 0 1 2 104. I am louder than other people
0 1 2 70. I see things that other people think aren’t
there (describe):
0 1 2 105. I use alcohol or drugs for nonmedical
purposes (describe):
0 1 2 71. I am self-conscious or easily embarrassed 0 1 2 106. I try to be fair to others
0 1 2 72. I set fires 0 1 2 107. I enjoy a good joke
0 1 2 73. I can work well with my hands 0 1 2 108. I like to take life easy
0 1 2 74. I show off or clown around 0 1 2 109. I try to help other when I can
0 1 2 75. I am shy 0 1 2 110.I wish I were of the opposite sex
0 1 2 76. I sleep less than most people 0 1 2 111. I keep from getting involved with others
0 1 2 77. I sleeps more than most people during
day and/or night (describe):
0 1 2 112. I worry a lot
0 1 2 78. I have a good imagination
0 1 2 79. I have a speech problem (describe):
0 1 2 80. I stand up for my rights
0 1 2 81. I steal at home
0 1 2 82. I steal from places other than home
0 1 2 83. I store up things I don’t need (describe):
0 1 2 84. I do things other people think are strange
(describe):
INTERGENERATIONAL CHILD MALTREATMENT CONTINUITY
194
0 1 2 85. I have thoughts that other people would
think are strange (describe):
Subscales:
Anxious/Depressed: (13 Items: 14, 29, 30, 31, 32, 33, 35, 45, 50, 52, 71, 91, 112)
Withdrawn/Depressed: (7 Items: 42, 65, 69, 75, 102, 103, 111)
Somatic Complaints: (10 Items: 47, 51, 54, 56a, 56b, 56c, 56d, 56e, 56f, 56g)
Rule-Breaking Behavior: (12 Items: 26, 39, 43, 63, 67, 72, 81, 82, 90, 96, 101, 105)
Aggressive Behavior: (17 Items: 3, 16, 19, 20, 21, 22, 23, 37, 57, 68, 86, 87, 89, 94, 95, 97, 104)
Internalizing: Anxious/Depressed + Withdrawn/Depressed + Somatic Complaints
Externalizing: Rule-Breaking Behavior + Aggressive Behavior
Abstract (if available)
Abstract
Childhood maltreatment (i.e., childhood abuse and neglect) impacts approximately 1 in 7 children in the United States, with more than 3.5 million children referred to Child Protective Services annually. Critically, the negative impacts of childhood maltreatment are not limited to those directly exposed but are also present among the children of those affected. Children of caregivers with maltreatment histories are at increased risk of emotional and behavioral problems and are significantly more likely to be maltreated themselves. In order to develop and implement effective interventions, more research is needed to understand two critical aspects of intergenerational maltreatment: (1) the attributes of caregiver childhood maltreatment experiences that may confer greatest risk for intergenerational maltreatment, including type (i.e., sexual abuse, physical abuse, emotional abuse, and physical neglect), chronicity, severity, and age of onset, and (2) the potentially modifiable psychosocial risk factors in the child-rearing environment that may serve as mechanisms of intergenerational maltreatment continuity. The purpose of this dissertation is to expand and deepen our understanding of these two pivotal areas of intergenerational continuity - caregiver maltreatment attributes and risk mechanisms - using methodology that accounts for the ways that these complex experiences arise in the lives of those affected.
The first study in this dissertation addresses some of the most critical psychosocial risk mechanisms of intergenerational continuity: caregiver depression, lack of social support, and economic insecurity. This study uses latent growth curve modeling to explore trajectories of these risk mechanisms among caregivers across their child’s development (i.e., the child-rearing period). Trajectories of caregiver depression, lack of social support, and economic insecurity are then tested as simultaneous mediators in the intergenerational continuity of specific childhood maltreatment types between caregivers and their children. The purpose of this study is to identify the unique and relative contributions of each caregiver childhood maltreatment type on caregiver adulthood risk trajectories that may impact parenting and the child-rearing environment and incur risk for specific child maltreatment experiences. The second study explores the intergenerational implications of childhood emotional abuse, a relatively understudied maltreatment type with critical and often underestimated individual and intergenerational implications. First, latent profile analysis is used to identify subgroups of caregivers based on the chronicity, severity, and age of onset of their self-reported experiences of emotional abuse during childhood. Profiles of caregiver emotional abuse are then tested as predictors of their children’s polyvictimization (i.e., multi-type maltreatment) and subsequent behavioral and emotional problems among those same children in adolescence. This study is intended to contribute a more comprehensive understanding of the overlap between timing and severity characteristics of childhood emotional abuse experiences, and to determine how certain patterns of co-occurrence in these characteristics may precipitate a cascade of intergenerational maltreatment and detrimental behavioral health outcomes.
An overarching goal of this dissertation is to inform intervention and improve quality of life and health outcomes among individuals and family systems experiencing the adverse impacts of maltreatment. As such, the third study is a narrative review of the literature that synthesizes the extant scientific evidence regarding family-centered approaches and clinical best practices for disrupting the intergenerational cycle of maltreatment. This paper is written for clinicians tasked with evaluating, selecting, and implementing interventions from the variety of available protocols. It provides a detailed review of several dyadic caregiver-child interventions with substantial empirical support demonstrating their effectiveness in mitigating risk for intergenerational maltreatment.
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Asset Metadata
Creator
Fritz, Hannah Leigh
(author)
Core Title
Intergenerational childhood maltreatment continuity: examining caregiver psychosocial mechanisms, timing and severity characteristics, and dyadic clinical intervention
School
College of Letters, Arts and Sciences
Degree
Doctor of Philosophy
Degree Program
Psychology
Degree Conferral Date
2024-12
Publication Date
12/13/2024
Defense Date
06/04/2024
Publisher
Los Angeles, California
(original),
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
Child abuse,child neglect,childhood maltreatment,intergenerational maltreatment,intergenerational trauma,maltreatment intervention,maltreatment timing,maltreatment type,OAI-PMH Harvest,risk mechanisms
Format
theses
(aat)
Language
English
Contributor
Electronically uploaded by the author
(provenance)
Advisor
Margolin, Gayla (
committee chair
), Negriff, Sonya (
committee chair
), Hackman, Daniel (
committee member
), Morales, Santiago (
committee member
), Saxbe, Darby (
committee member
)
Creator Email
hannah.l.fritz@gmail.com,hfritz@usc.edu
Unique identifier
UC11399EVIV
Identifier
etd-FritzHanna-13693.pdf (filename)
Legacy Identifier
etd-FritzHanna-13693
Document Type
Dissertation
Format
theses (aat)
Rights
Fritz, Hannah Leigh
Internet Media Type
application/pdf
Type
texts
Source
20241217-usctheses-batch-1229
(batch),
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
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Repository Name
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Repository Location
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Repository Email
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Tags
child neglect
childhood maltreatment
intergenerational maltreatment
intergenerational trauma
maltreatment intervention
maltreatment timing
maltreatment type
risk mechanisms