Breaking the cycle of child maltreatment:
A systematic review on the protective factors in the
intergenerational transmission of child maltreatment
Bachelor thesis
Author: Renske Verhage 10198377
Assessor: Ernst Mulder Bachelor thesis
Words: 6507 5 February 2016
Table of contents Abstract……….……….…………3 Introduction ………..………….…4 Method………...………7 Analysis……….8 Child factors……….………….…8 Parental factors..……….………...10 Family factors……….…………..22 Discussion………24 References………26
Abstract
With numerous negative consequences of childhood maltreatment, intergenerational transmission of child maltreatment (ITCM) is one of them. Although a review about the risk factors for this mechanism is known, a systemic review on the protective factors was missing. Regarding protective factors in ITCM, relevant studies were found in electronic databases and the results were systematically analyzed. Many different child-, parental, and family protective factors were found. Results show that the most important protective factors are as followed: older age at parenting, social support and healthy coping with maltreatment. However, besides these findings, little consensus is found regarding other protective factors. Yet, parenting programs could focus on social support groups and prevention of teenage pregnancy.
Keywords: intergenerational transmission of child maltreatment, child abuse, neglect, protective factor.
Introduction
Child maltreatment is a broad concept that includes several forms of physical abuse, sexual abuse, psychological maltreatment, and neglect (Dong, Anda, Dube, Giles, & Felitti, 2003). There are many pathways to childhood abuse and intergenerational transmission of child maltreatment (ITCM) is one of them (Egeland et al., 2002). ITCM is the phenomenon in which maltreated children are likely to become parents who maltreat their own children (Widom, Czaja, DuMont, 2015). In the 1970s, clinicians had already noticed that “The most constant fact [concerning child abusers] is that parents themselves were nearly always abused or battered or neglected as children” (Fontana, 1973, p. 74). And in 1987 Kaufman and Zigler wrote: “being maltreated puts one at risk for becoming abusive [but] the path between these points is far from direct or inevitable” (p. 190). Many studies since have provided empirical evidence for the mechanism of ITCM (Berlin, Appleyard & Dodge, 2011; Dixon, Brown & Hamilton-Giachritsis, 2005; Egeland, Bosquet, & Chung, 2002; Smith, Cross, Winkler, Jovanovic, & Bradley, 2014). Parents who were physically abused in their childhood were found to be 1.4 times more likely to neglect their children and 5 times more likely to abuse their own children than parents who where not abused. Parents who were neglected in their childhood were 2.6 times more likely to neglect their children and 2 times more likely to physically abuse their children than parents who did not experience childhood abuse (Kim, 2009).
ITCM does not imply that every child experiencing maltreatment will maltreat his/her own children. Findings indicate that around 30 per cent of childhood
maltreatment persists to the next generation (Ertem, Leventhal, & Dobbs, 2000; Thornberry, Knight, & Lovegrove, 2012). Vice versa, not being maltreated in childhood does not mean that the person will not maltreat its own children. These
mechanisms are influenced by risk factors and protective factors. Hindley,
Ramchandani and Jones (2006) conducted a systematic review on the risk factors of ITCM. They found many risk factors of which the most consistent were the number of previous episodes of maltreatment in the child or family, neglect, parental conflict, and parental mental health problems. As there are many risk factors, there is no single solution to the problem of ITCM. Supposedly, protective factors can break the
intergenerational cycle of child maltreatment. Therefore, this review will examine protective factors of ITCM as found in empirical literature.
To recall, child maltreatment is the physical abuse, sexual abuse,
psychological abuse or neglect of a child. Neglect is the continuing failure to meet the child’s basic needs and is also considered abuse (United States Department of Health & Human Services, 2013). Infant neglect is the most common form of maltreatment, followed by physical abuse and then sexual abuse and psychological maltreatment. Different forms of maltreatment often occur simultaneously (Dong et al., 2003). Therefore, all types of abuse and neglect will be considered as maltreatment. The negative consequences of all types of child maltreatment are numerous, ranging from cognitive deficits to insecure attachment and different types of psychopathology, such as depression and posttraumatic stress disorder (Norman, Byambaa, Butchart, Scott & de Vos, 2012). Sexually abused children are even more prone to long-lasting
consequences of adult psychopathology (Putnam, 2003).
Even though much is known about the risk factors of ITCM, the exact
mechanisms of intergenerational transmission of child abuse are unknown (Robboy & Anderson, 2011). However, many theoretical structures give plausible explanations. Two theories offering a framework for ITCM are the attachment theory and social learning theory. Attachment theory notes that a child can acquire an attachment with
others (Bowlby, 1973). This attachment-relationship is based on the degree of sensitive and responsive parenting and can vary from a secure attachment to an insecure attachment (Van Ijzendoorn, 2005). A concept derived from attachment theory is the internal working model. An internal working model is a cognitive-affective scheme, based on experiences with previous attachment-relationships (Bowlby, 1980). This model contains the information that gives a basis to the expectations about responsiveness and sensitivity of others. It also provides
perspective about what the child thinks he or she is worth and capable of. In the case of ITCM, a maltreated child forms a set of expectations of their parents as being unresponsive and insensitive and his/her self as being unworthy of love. Maltreated children will not learn from their parents how to attain a healthy relationship and will show difficulties in developing secure attachment with their own children because of the lack of responsiveness and sensitivity they are able to give (Bartholomew,
Henderson & Dutton, 2001).
Social learning theory also provides a theoretical framework for ITCM. This theory holds that behavior is learned from the environment through the process of observational learning (Bandura, 1977). Children observe direct behavior from others and the consequences of this behavior. Based on this feedback on behavior – so-called reinforcement – the child forms expectations about which types of behavior are most likely to succeed. In other words, the expectations guide future behavior. Several transmission processes can be derived from this theory. Such as, the child never learns proper behavior from a parent because he or she is not an acceptable role model and this creates difficulties in the child of adopting an acceptable parenting role (Pears & Capaldi, 2001). Or, abused children learn that aggression or neglect is appropriate,
which increases the likelihood of neglect or using aggression with their own children (Bert, Guner, & Lanzi, 2009).
The theoretical groundwork of ITCM come down to insecure attachment, dysfunctional internal working models, and learned dysfunctional behavior.
Understanding the dysfunctional side of ITCM is only half of the picture, however. Understanding the protective factors – so-called cycle-breakers – offers a
complementary perspective, useful for intervention and prevention of recurrent child abuse. Since around one million children are victims of ITCM per year (U.S
Department of Health and Human Services, 2007) and the negative consequences of maltreatment are seriously worrying, a better understanding of ITCM is needed for the sake of breaking the cycle of child maltreatment. Until nowadays, there is no systematic review on the cycle-breakers, yet there is substantial literature available. Therefore, this systematic review will answer the following main question: “What are the protective factors in the intergenerational transmission of child abuse?” Protective factors will be distinguished as child factors, parental factors, and family factors as in the systematic review to risk factors in ITCM (Hindley et al., 2006). After all, ITCM is an intergenerational mechanism, which means it is influenced by the family, the parent and the child.
Method
The database Web of Science was used to search peer-reviewed literature for this systematic review. Searches were limited to literature published from the year 1995. The following keywords were used: intergenerational transmission of child abuse, itca, itcm, generational transmission, generational continuity,
resilienc*. The search generated 62 articles. Based on abstracts, 32 met the following criteria: 1) English-language; 2) empirical research; 3) to some extent quantified findings; 4) considering parental history of any kind of maltreatment; 5) considering effects on parental behavior; and 6) description of risk- or protective factor(s) in any domain. Not all articles were fully available on Web of Science. Therefore, articles were retrieved on www.lib.uva.nl. While looking up the articles, other relevant studies emerged that were not found in the Web of Science-search. Relevant studies found on every first webpage when looking up articles on www.lib.uva.nl are included in this review. After thorough examination of the articles, few were deleted from the review when they turned out not to be empirical or not examining childhood maltreatment. Subsequently, protective factors are presented in categories: child-, parental-, or family factors. In the parental category, articles were divided into one-, two- or three-generational studies, given the large number of investigations examining parental factors. Quality of methodology was not reviewed in advance but will be discussed in the analysis. The total number of participants in the 20 studies included is N=12,138 and the total number of citations is 1,497. Based on critical analysis of design, measurement, samples and outcomes, this review will give an overview of literature on the aforementioned research question.
Analysis Child factors
This section describes the child factors that play a role in breaking the generational cycle of child maltreatment. Protective child factors are factors that prevent the abused children from abusing their own children later in life. These factors occur during childhood. Two comparable studies assessing child factors were found (Leifer,
Kilbane & Kalick, 2004; Robboy & Anderson, 2011). Both studies assessed and compared a cohort of families with at least one child who is sexually abused.
Whereas Robboy and Anderson (2011) recruited sexually abused girls from a child abuse assessment center, Leifer et al. (2004) recruited their participants from referrals made to Child Protective Services (cps) at a hospital. The latter study examined 196 girls and their mothers. Mothers were examined with the Adult Abuse History interview. Based on history of abuse for child and mother, four groups were compared: 1) abused mothers of children who were not abused (discontinuity); 2) abused mothers who had at least one abused child (continuity); 3) non-abused mothers whose children were not abused; and 4) non-abused mothers with at least one abused child (initiators). The discontinuity group reported small differences compared to the continuity group, such as less disruption in their childhood attachment relationships and more years lived with their biological mothers. This suggests that the
discontinuity families were more likely to experience secure attachment. Furthermore, the mothers in the discontinuity group reported fewer episodes of abuse victimization during their childhood, which suggests that discontinuity mothers simply experienced less severe abuse.
Robboy and Anderson (2011) compared 139 sexually abused girls and their mothers to a demographically similar non-abused group. Mothers were assessed on a present/absent scale for maternal history of childhood abuse, and for coping
mechanisms such as substance abuse, eating disorders, and self-mutilation. In contrast to the study of Leifer et al. (2004), no differences were found between discontinuity mothers and other groups regarding substance abuse. No other statistically significant protective factors were found, which suggests that coping mechanisms do not play a role in breaking the cycle of intergenerational child abuse.
To conclude, both studies yield diverse results due to different outcome measures. Because the latter study used a present/absent scale, differentiations to severity of abuse could not be made. Therefore, the finding of Leifer et al. (2004) cannot be confirmed by Robboy and Anderson (2011). No differences occurred regarding demographic characteristics such as the age or race of the child since no protective factors were found in this domain. Accordingly, child factors found in this section are mainly related to attachment and experience of abuse during childhood.
Parental factors
Next to child factors, parental factors can play a protective role in breaking the cycle of ITCM. Parental protective factors are influences that prevent the abused parent from abusing their own children. These factors occur in adult- or parenthood. Since a considerably large number of studies assessing parental protective factors were found, this section will be divided into sub-sections. First, four studies assessing three
generations of abused participants will be examined since these longitudinal studies appear to give the most robust results. Then, six two-generation studies will be examined. Lastly, five studies that give a better understanding of certain mechanisms in ITCM will be discussed. Next to measured outcomes, important points of focus are measurement of maltreatment, specific characteristics of the samples, and samples that are at-risk for ITCM.
Three-generation studies.
Four longitudinal studies concerning the intergenerational transmission of child maltreatment have been found (Widom, Czaja, & DuMont, 2015; Wang, Zing, & Zhao, 2014; Trickett, Noll, & Putnam, 2011; Noll, Trickett, Harris, & Putnam,
2009). All three studies assessed children (G2) for child abuse, and their parents (G1) for history of childhood abuse. After 15 to 23 years, the children of G2 (G3) were assessed for child abuse as well. The studies differ in their measured outcomes, as will be shown in this analysis.
The research of Widom et al. (2015) is a robust study since they used different sources to assess childhood abuse. A goal of this research was to overcome
methodological issues due to measurement of child abuse. Using a questionnaire to assess child abuse could lead to underreporting due to shame, social stigma or fear of repercussions (Ullman, 2010). Interviews may carry out the same effects, but the interviewer can reassure the mother and create a safe environment in which the mother will be more honest. Then, cps reports may seem a reliable source, but not all cases of child maltreatment are reported to official institutions such as cps. Widom and colleagues overcame these issues by using reports for abused children, self-reports for abusive parents, self-reports of cps about concern for possible child
maltreatment, and confirmed cps-reports of child maltreatment. They recruited 908 children (G2) with documented cases of child abuse or neglect and matched these cases to 667 comparison participants. G1 and G3 (N=697) were assessed for
childhood abuse with the aforementioned techniques. Few protective or risk factors were assessed, but when continuity and discontinuity groups were compared, little evidence was found for an intergenerational transmission of physical abuse (OR=0.75 compared to the significant effects of sexual abuse OR=3.03 and neglect OR=1.58). This suggests that the specific type of maltreatment plays a role in whether the abuse is intergenerationally transmitted. In this sense, although counter intuitive, being physically abuse may be a protective factor for the transmission of maltreatment. The
authors suggest that, due to recent public education for physical abuse awareness, the use of physical abuse may have declined in the last generation.
The results of the study of Wang et al. (2014), however, show a rather high rate of intergenerational transmission of physical abuse (r=.34 – r=.55). The Chinese study assessed 635 pre-school aged children, their parents, and future children for corporal punishment with the Parent-Child Conflict Tactics Scale. This form of punishment is the use of physical force with the intention of causing the child to experience pain (Straus, 2001). Since the operationalization of corporal punishment is similar to the concept of physical abuse, this study is included in the current review. Wang and colleagues focused on gender. They found a large difference in variance for the prediction of transmission of corporal punishment between boys (3%) and girls (44%) if they were punished by their mother. Vice versa, for boys, 48% of variance explained fathers’ use of corporal punishment compared to 10% for girls. This suggests a moderating role of gender and a decreased chance of ITCM if the child is of opposite gender of the parent. Since almost half of the marriages end in divorce nowadays, this result could be of great importance for single parent households (Copen, Daniels, Vespa, & Mosher, 2012). It would suggest that, for the sake of prevention of ITCM, the child is better off with a parent of the opposite gender. However, the results of this Chinese study cannot easily be generalized to Westerner families. Cultural differences may be of great importance when it comes down to punishment in the upbringing in the child and the role of the father in the family (Kim et al., 2013). For example, punitive parenting may be more accepted in Chinese cultures than in American cultures, which could explain the differences in ITCM of physical abuse.
As similar to the study of Wang et al. (2014), the longitudinal study of Noll, Trickett, Harris and Putnam (2009) shows a rather high rate of ITCM. They recruited 84 sexually abused girls (G2) based on cps reports and a comparison group of 82 demographically matched girls. Using the Comprehensive Trauma Interview and cps reports of their mothers and future children (N=135), they found that 45% of the abused girls had a mother with a history of childhood abuse (continuity group) compared to 16% of the non-abused girls that had a mother who reported childhood abuse (discontinuity group). Comparing the continuity group to the discontinuity group, teenage pregnancy occurred significantly less in the mothers who discontinued the cycle of child maltreatment. Even more, 57% of the G3 children who were abused had a mother who got pregnant under the age of 20. These results suggest that being of older age when pregnant of the first child is a protective factor for ITCM. This is not a surprising result, since teenage mothers often live in poverty and have more behavioral difficulties compared to adult mothers, which are risk factors for child maltreatment (Dixon et al., 2005).
The study of Noll, Trickett, Harris & Putnam (2009) is expanded by Trickett, Noll, & Putnam (2011). The design, sample and measurements are similar to Tricket et al. (N=166). Yet, other measurements were added such as, social support and parenting practices. Few protective factors were found, except for the following: The results report a negative relationship between G2 history of childhood sexual abuse and punitive punishment (c.q. physical and emotional abuse; Kim, Trickett, & Putnam, 2010), when G2 mothers report high levels of social support. This suggests that social support is a protective factor in the intergenerational transmission of child maltreatment.
To conclude, a longitudinal American study found evidence for a decline in ITCM for physical abuse. In contrast, in China this effect appears to not be the same. This difference may be due to U.S. campaigns for raising awareness for physical abuse. However, two other American studies did not find variation between rates of ITCM for different types of maltreatment. Note that these two studies had a rather small sample size, which may make differentiations between types of maltreatment less perceptible for detecting differences. Furthermore, social support and older age when parenting were shown to be protective factors. This is not surprising since more mature mothers are considered to be more adequate caregivers (Dixon et al., 2005), and social support is believed to assist in coping with all sorts of mental health
problems (Turner, 2010). Important to note is that no large effect sizes were found for protective effects.
Two-generation studies.
Six studies examining two generations for child abuse and parental factors were found, of which three were similar retrospective studies (Bartlett & Easterbrooks, 2015; Leifer, et al., 2004; Sidebotham & Heron, 2006). All three studies examined a cohort of at-risk participants and analyzed their cps reports, but different outcomes were measured. The study of Leifer and colleagues - as discussed in the child factor section - also revealed important parental protective factors. To recall, 96 sexually abused and 100 non-abused children and their mothers were assessed for maternal history of childhood abuse, trauma, and attachment outcomes. The results of the Adult Attachment Interview showed a considerable difference in the rate of secure
attachment when comparing the mothers of discontinuity families (25%) to continuity families (7%). Discontinuity mothers also reported a substantial lower number of
negative outcomes in romantic relationships compared to continuity mothers. This suggests that it is possible to have a secure attachment relationship after being maltreated. It confirms the theory of the internal working model in the sense that a secure attachment helps the child to create healthy future relationships with their children and romantic partners. Lastly, the results of the study revealed fewer trauma-related symptoms and less substance abuse in the discontinuity group compared to the continuity group. This suggests that discontinuity mothers might have better coping mechanisms and are therefore less susceptible for transmitting childhood
maltreatment.
The study of Sidebotham and Heron (2006) focused mainly on different outcomes. They assessed a large cohort of families (N=14.256) in the United Kingdom, of which 293 of the children were investigated by and/or reported at cps. Parents were assessed with a life events inventory for history of childhood
maltreatment. They found a modest effect of ITCM (OR=1.86-2.61). Regarding protective factors, maternal employment slightly reduced the risk of transmitting child maltreatment. However, when other demographic variables came into play, it no longer appeared a significant protective factor. Other results showed that the
relationship between maternal childhood abuse and cps registration of the child was no longer significant when the parents had a higher age at the time they became parents, had no psychiatric history, and had higher educational achievement and higher income. This suggests that higher educated parents that do not suffer from poverty, as studies point this out as a risk factor (Dixon et al., 2005), are less likely to transmit childhood maltreatment. These results are also in line with previous studies regarding healthy coping and adverse outcomes considering that parents without psychiatric problems are more likely to not maltreat their own children.
Bartlett and Easterbrooks (2015) did not focus on demographic outcomes or attachment styles as the previous two studies, but mainly focused on supportive relationships of the mother. Similar to the previous two studies, the authors analyzed cps reports to assess for childhood abuse. They recruited 447 young mothers that participated in a young parent program. Nearly half of the participants were reported to be maltreated, of which 25% had children who had a cps record for maltreatment. This is in line with the previously found modest effects of ITCM. The results reveal a somewhat strong effect of age of the mother: the older the mother, the lesser
likelihood of ITCM (OR= .57). However, this did not account for the transmission of neglect. This suggests that maternal age probably does not play a role in teenage mothers when it comes down to infant neglect. Yet, social support appeared to be a slightly effective protective factor for the transmission of neglect (OR= .94).
The previous three researches used retrospective designs. Contrary to these studies, the investigation of Dixon et al. (2005) used a prospective design. However, the results are in line with previous research, as will be shown. A number of 4351 parents of newborn children were recruited and were observed for 13 months for abusive parenting behavior. Based on cps reports, they found that 135 of the parents had a history of childhood maltreatment. Because risk factors were the main focus, no protective factors were found. A significant risk factor in this study was the age of the mother or partner: being under age 21 significantly increased the risk for ITCM. When parents were above 21, the relationship between having experienced abuse and being abusive was rather weak. This suggests that being above age 21 has a protective effect on ITCM.
Another prospective study was the longitudinal investigation of Valentino, Nutall, Comas, Borkowski and Akai (2012). Contrary to previous research, this study
did not use cps records. Instead, they recruited 70 teenage mothers and their children from a parenting program and assessed them with the Childhood Trauma
Questionnaire. The use of measurement may have been influential to the results, since this study found no effect of maternal age in contrast to the study of Bartlett and Easterbrooks (2015), despite both studies assessing teenage mothers. Adolescent mothers may be too ashamed to report abuse in a questionnaire, because the abuse is relatively recent compared to adult mothers. This may lead to underreporting, which decreases effects of possible influential variables. Yet, this study is valuable for its focus on parenting styles. Results show that an authoritarian parenting style was a protective factor for African American families. However, this effect did not apply to Caucasian American families. An explanation for this result would be that African American children benefit from more control in their upbringing that leads to less maladaptive behavior, compared to Caucasian children (Lansford et al., 2004).
Continuing in the trend of parenting styles, Pears and Capaldi (2001)
conducted a longitudinal research to 206 children and their parents about childhood abuse and parenting styles, such as consistency and adequate punishment. Children and parents were assessed with the Assessing Environment-III Questionnaire for childhood abuse and a ITCM rate of 23% was found, which is similar to previously found rates of transmission. The relationship between G1 abuse and G2 abuse was found to be negatively influenced by consistent discipline of the parent. This suggests that when parents consistently and adequately discipline their children, the risk of transmitting abusive parenting decreases. Since race was an unknown variable in this research, comparisons with the study of Valentino et al. (2012) cannot be made. However, since an authoritarian parenting style includes consistent discipline, the
results of Pears and Capaldi may generalize Valentino et al.’s results to other ethnical groups than just African Americans.
To conclude, some factors that imply healthy coping were found, such as less trauma-related symptoms and absence of substance abuse and psychopathology. The small effects of social support may strengthen these factors, since social support is believed to assist healthy coping with negative life experiences as presented in the previous section (Turner, 2010). Furthermore, evidence for adequate internal working models in discontinuity mothers was found since these mothers reported more secure attachment and better outcomes in romantic relationships. So far, no consensus is found on parenting practices, and whether authoritarian parenting is effective for only African American families, or other ethnic groups as well. Education and income appeared as protective factors, which is in line with research to risk factors stating that poverty positively influences the mechanism of ITCM. Lastly, based on previous studies and the three-generation studies, older age at parenting appears as a fairly strong protective factor for ITCM. However, this effect only appeared when the research used cps reports. Two reasons may account for this remarkable finding: 1) A questionnaire is deterrent because the abuse is relatively recent and this leads to underreporting compared to cps reports; and/or 2) when the mothers are still young, the chance that they have moved to another state is smaller. The researchers now only have to search for cps records in one state instead of several states which takes less time and effort.
Processes in at-risk families.
Contrary to previous studies, the following studies assess only one generation for history of childhood maltreatment. The samples consist of at-risk individuals that
were assessed for the risk of maltreating their own children. At-risk samples are considered to be at higher risk for maltreating their own children. More concrete, the participants must meet at least one of the following risk factors: being under 21 when becoming a parent; living with a violent adult; suffering from depression; suffering from a substance abuse problem; and/or having poor parenting skills (Dixon et al., 2005). These studies give more detailed information about the behavioral processes in maltreated parents and about the protective factor to prevent them maltreating their own children. Four studies were found using the Childhood Trauma Questionnaire (CTQ) for identifying parents with a history of childhood abuse. However, all four studies focused on different variables.
The first study examined 175 teenage mothers in poverty and assessed them with the CTQ and Trier Social Stress Test (Cook et al., 2012). The investigators found no directly protective factors, but found that a negative relationship between
maltreatment and adaptive functioning (e.g. healthy coping) which was mediated by stress reactivity. They suggested that heightened arousal is normally associated with positive functioning. However, in a high stress environment, high stress reactivity makes the maltreated parent even more vulnerable for maladaptive functioning and heightens the risk for child maltreatment. This suggests that, for an at-risk maltreated parent, low stress response is a protective factor.
The second study examined a small sample of 76 mothers living in poverty (Caldwell, Shaver, Li, & Minzenberg, 2011). Based on attachment theory, it was found that maltreated mothers with an anxious attachment style were slightly more likely do develop depression compared to non-maltreated mothers. This suggests that maltreated, insecurely attached mothers are at higher risk for maltreating their own children since suffering from depression was identified as a risk factor for child
maltreatment (Dixon et al., 2005). Then, in order to break the cycle of maltreatment, one should focus on changing the attachment style from an anxious to a secure attachment. However, this evidence is not very robust because it implies a lot of assumptions and therefore this result is not seriously taken into account for ITCM.
Third, the study of Min et al. (2013) also used the CTQ to examine 231
mothers living in poverty. Nearly half appeared to be maltreated in childhood. After 9 years, the mothers were assessed for social support and the children for behavioral problems. No direct protective factors were found, but the results pointed out a negative relationship between maternal social support and child problem behavior. This problem behavior may persist into parenthood, which increases the risk for child maltreatment (Dixon et al., 2005). The authors therefore suggested that children are protected from the negative impact of maternal childhood maltreatment, when these mothers receive social support. Although this argumentation is built on many
assumptions, social support appeared as a protective factor in many previous studies. The results of this study will therefore be considered as a confirmation of previous findings.
The last study using CTQ to assess at-risk mothers is the study of Smith et al. (2014). They focused on emotional dysregulation and negative affect as two
behavioral consequences of childhood maltreatment. A sample of 83 low-income mothers was assessed with the CTQ and Child Abuse Potential Inventory. The results show a somewhat weak relationship between maternal history of childhood
maltreatment and child abuse potential (r= .31 - .35). Amongst many risk factors, a protective factor was found: results show that the relationship between childhood abuse and abuse potential no longer was effective when emotional dysregulation and negative affect came into play. This suggests that emotional stability and absence of
negative affect are protective factors in the risk for ITCM. Placing this in attachment theory, it may be that maltreated mothers are insecurely attached and as a
consequence they are displaying emotional dysregulation and negative affect. Then, maltreated mothers who do not display those adverse behaviors, might be securely attached, which decreases the likelihood of maltreating their children.
To finish the parental protective factors section, one last study should be given consideration. The qualitative study of McWey, Pazdera, Vennum and Wojciak (2013) gives a more detailed insight in behavioral patterns of parents and the exact mechanism of ITCM. The researchers interviewed 24 parents that were maltreated in childhood and were at-risk for foster care. Sixty-three per cent of the interviewed parents recognized intergenerational patterns in the upbringing of their own children and seventy-five per cent of the parents noted that they want to raise their children differently than the way their parents raised them. Surprisingly, all parents stated that they took action to improve their parent-child relationship. However, 71 per cent took actions that were observed as destructive, for example punishment. This study shows that being aware of intergenerational patterns is related to specific beliefs and
behaviors to change the upbringing of their children in a different way from how they were raised by their parents. The authors suggest that raising awareness and
understanding of the intergenerational patterns can lead to a behavioral change in maltreated parents.
To conclude, the studies in this section have rather small samples sizes and they do not strictly examine the relationship between having been maltreated and maltreating your own children. However, it does support previously found research in the sense that social support and coping mechanisms were found among children that were at less risk to transmit maltreatment to the next generation. Especially the
qualitative study gave useful insight in the behavioral patterns and thought patterns of maltreated parents.
Family factors
An important influence on parents and children is the family and community. Protective family factors are influences from family or community members, or family/community factors that prevent the abused parent from abusing their own children.
Several studies worked from a social-support theoretical framework, which states that living in a supportive environment reduces physical and mental health problems (Turner, 2010). One of those studies is the longitudinal research of Conger, Schofield, Neppl and Merrick (2013). They observed 558 adolescents (G2) and their parents (G1) for harsh parenting practices. Those practices consist of angry hostility, angry coercion, physical attacks and antisocial behavior. Each of those behaviors can be assigned to either physical or emotional abuse, if not neglect. For 22 years G1, G2 and future children (G3) were observed for harsh parenting, partner relationships and communication patterns. A relationship was found between G1 harsh parenting and G2 harsh parenting (r= .30). The romantic partner in the family appeared to be of importance in this association. Warmth and positive communication was both a slightly negatively mediating and moderating influence in the relationship, meaning that the more warmth and positive communication the partner gives, the less harsh parenting is transmitted to the next generation.
Consistent with the previous study, the research of Wang et al. (2014) shows the importance of romantic relationships. Recall that this study, as discussed earlier in the parental factors-section, found mostly same-gender intergenerational transmission
of maltreatment. In that trend, the results show that marital satisfaction plays a moderating role in specific kinds of relationships. For example, low marital satisfaction of mothers positively moderated the relationship between corporal
punishment of grandmothers and punishment of mothers. The same moderating effect - of low marital satisfaction of fathers - applies to the relationship between father and sons. The authors therefore suggest that marital satisfaction is a protective factor for the same-sex transmission of child maltreatment. Although this is Chinese study, the results are in line with the social support theory in the sense that a good marriage has a protective influence on negative life experiences such as maltreatment. Since Asians have been found to call less upon their social relations than Americans in stressful situations (Taylor et al., 2004), this effect might be even stronger in American families.
The study of Dixon, Hamilton-Giachritsis and Browne (2009) extended their research – as discussed earlier in this section (Dixon et al., 2005) – by adding variables such as social support and income. To recall, they observed 4351 newly parents for 13 months for abusive parenting practices. It was found that continuity mothers were slightly more likely to feel socially isolated and suffer from poverty, compared to discontinuity mothers. The authors therefore suggested that social support and sufficient financial sources could be seen as protective factors. Because being consistent with previous research reporting social support and higher income as protective factors, these factors are now considered protective.
In line with the previous findings, the research of Schofield, Lee and Merrick (2013) consider social relations equally important. They conducted a meta-analysis of 5 studies with a total number of participants of 2652, and found that safe, stable and nurturing relationships moderated the relationship between being maltreated in
childhood and future abusive parenting styles. All studies reported small but significant effects.
To conclude, both the meta-analysis and the studies of Conger et al. (2013), Wang et al. (2014), and Dixon et al. (2009) confirm the social support theory. This reinforces the evidence of social support as a protective factor in ITCM. Social support may be derived from the partner or other close relationships.
Discussion
The goal of this research was to analyze empirical literature about protective factors in ITCM and to create a comprehensive, systematic overview of the findings. Protective factors were divided in child, parental and family factors. Since there are many factors possibly playing a role in breaking or maintaining the generational cycle of child abuse, the outcomes of the studies vary extensively. First of all, the majority of studies reported a modest effect size of ITCM. If effect sizes were not known, chi-square tests or Fisher’s exact tests proved the significant differences between
continuity groups and discontinuity groups. Where researchers agree that transmission is not the most common outcome of maltreatment (Kaufman & Zigler, 1987; Ertem et al., 2000; Thornberry et al., 2012), the studies in this review show an average
transmission rate between 20 and 30 per cent. Overall, small effects of protective factors were found.
The most consistent protective factors found were: being of older age when parenting and social support and to a lesser extent the results of healthy coping, such as absence of psychopathology and drug abuse. Results that confirm attachment theory are also found. To recall, a secure attachment gives an individual an adequate working model in which he or she has realistic expectations of others and about the
self. Responsiveness and sensitivity of others, especially parents, foster a secure attachment and so, maltreated children often are insecurely attached (Riggs & Kaminski, 2010). However, next to parents, the child can form an attachment relationship with other significant people. Results from this review show that maltreated children can have a secure attachment and healthy, adequate internal working models. Even more, this has proven to be of protective influence in ITCM. Regarding theories for ITCM, little evidence is found that is in line with social learning theory. However, social support-theory emerged as a suitable model for breaking the cycle of ITCM.
This review has some limitations. First, as earlier discussed, many researches experience methodological issues. Maltreatment is not always reported at protective agencies, so cps records do not reflect the whole maltreated population. Self-reports and parental reports have a high risk of dishonest completion. Widom et al. (2015) plead for more sources of information regarding to maltreatment, since only one source of information may lead to incorrect conclusions. Therefore, triangulation is essential, especially to a subject that is sensitive as maltreatment. However, only three studies included two or more resources of information about childhood abuse. For this reason, it is suggested for future research that studies should include information from at least two separate sources. Another limitation of this review is the generalizability of different types of maltreatment. Physical abuse, sexual abuse, psychological maltreatment, and neglect are often combined (Dong et al., 2003). For example, physical abuse and sexual abuse often imply neglect too, and sexual abuse frequently goes together with physical abuse. Furthermore, psychological abuse is partly
maltreatment cannot be generalized to others types and sometimes not to all types of maltreatment.
Still, this review serves some important keynotes for breaking the cycle of ITCM. For example, the present results suggest that prevention programs for ITCM consider the impact of social support and age of parenting. Social support groups for maltreated young parents may enable them to find social support. Or parenting programs may encourage parents to maintain healthy relationships with their partners and to seek social support from their close relations. Furthermore, public policy could focus maltreated children and precocious sexual behavior that prevents the children from becoming pregnant at an early age.
Although many protective factors are found, little consensus is established. For example, there are still uncertainties about the effects of authoritative parenting styles in different cultural settings and the transmission of physical abuse. This shows us that the intergenerational transmission of maltreatment is complex and influenced many different factors and many different environments. By given this subject more attention, we can identify important factors so that we are better equipped to bread the cycle of child maltreatment.
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