Young Adults Females who Transitioned out of Residential Care: The Relationship between Self-Reported and Substantiated Child Maltreatment and Insecure Attachment
and Impaired Self Reference.
Corine Tiest 10347828 First supervisor: Eveline van Vugt Second supervisor: Nadine Lanctot Masterthesis Forensische Orthopedagogiek 02-12-2015
Abstract
Aim: The aim of the current study was to assess which form of child maltreatment had a unique association with insecure attachment and impaired self- reference, after controlling for the intercorrelation between the two dependent variables. Specifically among females in residential care child maltreatment rates are much higher than for the general population. Research over the last few decades has revealed general associations between a history of child maltreatment and insecure attachment and impaired self- reference (both often found among girls who engage in problem behaviors).
Methode: The sample was composed of 131 young female adults who transitioned out of residential care (Mean age = 19.4; SD = 1.48). Insecure attachment and impaired self- reference were assessed with the Trauma Symptom Inventory -2 (Briere, 2011), and child maltreatment was assessed retrospectively with the Childhood Trauma Questionaire (Bernstein & Fink, 1998).
Results: Young female adults with child maltreatment experiences have a higher risk for the development of an insecure attachment or impaired self-reference. Especially self- reported emotional abuse was strongly associated with both constructs, even after controlling for their intercorrelation. Additionally, age and self- reported sexual abuse were uniquely associated with impaired self- reference. Self-reported data on child maltreatment explained a larger part of the variances on both insecure attachment and impaired self- reference than official
(substantiated) reports of child maltreatment.
Conclusion: The strong association between child maltreatment and respectively insecure attachment and impaired self- reference indicates the need for trauma informed and gender sensitive treatment to support these young females to establish healthy relationships with others, understanding their own and other’s needs and help them overcome problems related to the self and their identity.
Keywords: insecure attachment, impaired self- reference, females, residential care, self reported child maltreatment, substantiated child maltreatment.
Young Adults Females who Transitioned out of Residential Care: The Relationship between Self-Reported and Substantiated Child Maltreatment and Insecure Attachment
and Impaired Self Reference.
Research over the last few decades has revealed a significant association between parenting behavior and the emotional, cognitive and social development of children (Anda et al., 2006; Edwards, Holden, Felitti, & Anda, 2003; Lee & Hoaken, 2007). Over time
parenting behaviors have been grouped together and studied on two dimensions, respectively responsiveness and demandingness (Moore & Larkin, 2005). Responsiveness, on the one hand, refers to the extent to which parents foster individuality and support; it includes warmth, autonomy, support, and reasoned communication. Demandingness, on the other hand, refers to the claims parents make on children to become integrated into society by behavior regulation, direct confrontation, and supervision of children`s activities (Baumrind, 2005).
In case of child maltreatment, parents are often not able to provide a good balance between these two dimensions. For instance, a neglecting parenting style is characterized by both low levels of responsiveness and demandingness, while an abusive parenting style is often characterized by low levels of sensitivity but high levels of demandingness (Baumrind, 2005). In general, child maltreatment is considered a series of acts by the parent or caregiver that result in harm, potential harm, or treat of harm to a child. Based on operational criteria, successively three types of abuse, emotional, physical, and sexual abuse, and the two types of neglect are distinguished, emotional and physical neglect (Leeb, Paulozzi, Melanson, Simon, & Arias, 2008).
The literature suggests that parents, by their interactions with the child, play an important role in the development of a child’s internal working model. Internal working models are shaped through the interactions with significant others (e.g., parents), and are
based on memories, experiences, and expectations. The internal working model provides the individual with a framework for understanding the world, the self, and others, and it defines and influences thoughts, feelings and behaviors troughout the life span (Bowlby, 1979; Briere & Runtz, 2002; Dimaggio, Vanheule, Laysaker, Carcione, & Nicolo, 2009; Fullerton & Ursano, 1994; Pearlman & Courtois, 2005). A dysfunctional internal working model, often found among children with negative parenting experiences, has been linked to a range of internalizing problems, including withdrawn behaviour and passivity, social rejection, and feelings of personal incompetence (Finzi, Ram, Har-Even, Shnit, & Weizman, 2001; Fonagy & Target, 1997; Pietromonaco & Barrett, 2000).
A dysfunctional internal working model has been found to be an important risk factor for the development of insecure attachment and impaired self- reference (Bowlby, 1982; Bretherton, 1991). Attachment is formed during early childhood and is defined as an aspect of the relationship between a child and caregiver in which a safe and secure environment is provided to the child (Bowlby, 1982). The purpose of attachment is for the primary caregiver to be available for the child as a secure base. From this secure base the child can explore, develop and, when necessary, find a source of comfort (Waters & Cummings, 2000). Later in life, attachment provides the framework on which individuals can start to build an image of who they are as unique human being. This process is also referred to as self- reference. More precisely, self- reference is the ability to monitor one’s feelings, thoughts, needs, goals, and behaviors, and to provide a filter through which an individual reacts to others’ behaviour (Klein & Gangi, 2010; Samsonovich & Nadel, 2005). Previous studies have shown that the level of self-reference depends on a person`s age: self-reference is often more noticeable and more expected from the environment when individuals become older (Kensinger & Leclerc, 2009; Young & Gudjonsson, 2005). Despite the different manifestations of attachment and self- reference over time, both constructs are strongly associated (Procaccia Versonese, &
Catiglioni, 2014). For instance, insecurely attached children tend to report less reflective abilities and show less interaction with others, which may lead to impaired self- reference (Field & Sundin, 2001).
Research exploring the development of insecure attachment and impaired self- reference shows that together with a dysfunctional internal working model, child
maltreatment is an often found risk factor for developing insecure attachment and impaired self- reference (Cicchetti & Valentino, 2007; Finzi et al., 2001; Klein, 2001). A large body of research has demonstrated that maltreated children have higher rates of insecure attachment than do non maltreated children (Cicchetti & Barnett, 1991; Cicchetti, Rogosch, & Toth, 2006; Cicchetti, Toth, & Lynch, 1995; Crittenden, 1988; Lyons-Ruth, Connell, Zoll, & Stahl, 1987; Schneider-Rosen, Braunwald, Carlson, & Cicchetti, 1985; van IJzendoorn, Schuengel, & Bakermans- Kranenburg, 1999), even when compared to other high at risk children (Cyr, Euser, Bakermans-Kranenburg, & van IJzendoorn, 2010). Similarly, research in the field of self-reference finds strong links between child maltreatment experiences and high levels of impaired self-reference (Bakermans-Kranenburg, van IJzendoorn, & Juffer, 2005; Bretherton & Munholland, 2008; Procaccia et al, 2014; Schunk & Meece, 2006; Smeekens, Riksen- Walraven, & Van Bakel, 2009; Weinfeld, Sroufe, & Egeland, 2000). The impact of child maltreatment on attachment is established in the childhood (Stronach, Toth, Rogosch, Oshri, Manly, & Cicchetti, 2011), with remaining effects throughout the life span. The conceptual internal working model from Bowlby (1979) is useful in understanding the strong association between child maltreatment and both insecure attachment and self-relevance. As mentioned self- reference is based on a framework that develops early in life e.g., the internal working model. This internal working model is formed in interaction with the environment and based on attachment experiences. The impact of child maltreatment is established in the childhood and affects the attachment experiences and through that the internal working model are
affected (Fonagy, Gergely, Jurist, & Target, 2002). Due to these effects child maltreatment has remaining effects throughout the life span (e.g., impaired self- reference), because the framework on which an individual develops one’s self- reference is negatively influenced by the child maltreatment experiences.
Gender appears to significantly influence the development of attachment and self- reference (Procaccia et al., 2014). Literature across multiple disciplines underscores that girls develop their internal working models through a different path than boys, because of the strong relational orientation of girls (Tolin & Foa, 2006). Parents have higher expectations for their daughters regarding interpersonal skills and pro social behavior than for boys (Keenan & Shaw, 1997; Smetana, 2010). In addition, parents encourage their daughters more often to participate in relational activities (e.g., playing house) compared to their sons who are often more encouraged towards physical and motor activities. These differences in parenting foster that girls are socialized to be more interpersonally aware and sensitive, while boys are
generally more focussed on achieving goals. Furthermore girls are more orientated on
emotions and less on the actual dimension of the action, which in contrast plays a central part in boys (Gore, Aseltine, & Colten, 1993; Maccoby 1998; McClure, 2000; Zahn – Waxler, Crick, & Shirtcliff, 2005).
Research of Cullerton-Sen and colleagues (2008) shows that also the outcomes of child maltreatment differ for girls and boys. A reason for this difference is that boys and girls make meaning of experiences in a different way (Rose & Rudolf, 2006). Girls are more likely than boys to focus on the social aspects of the maltreatment, such as the lack of trust and love and closeness with significant others (Coyne, Archer, & Eslea, 2006; Crick, Grotpeter, & Bigbee, 2002; Rose & Rudolf, 2006; Zahn- Waxler et al., 2006). Boys on the other hand focus more on non-social aspects of the maltreatment, such as (not) getting food and the physical harm of the maltreatment (Rose & Rudolf, 2006). More precisely, relative to boys, girls
experience more emotional and physiological distress in response to relational conflicts. Whereas boys are more likely than girls to view the physical maltreatment as wrong (Coyne et al., 2006; Galen & Underwood, 1997; Giles & Heyman, 2005; Goldstein, Tisak, & Boxer, 2002; Murray-Close, Crick, & Galotti, 2006).
Another explanation for the gender difference in the consequences of child maltreatment, is the difference in type of child maltreatment to which girls and boys are exposed to. For instance, research shows that boys compared to girls are more likely to experience physical maltreatment (Sedlack & Broadhurst, 1996). In contrast, girls are three times more likely than boys to be sexually abused (Feiring, Taska, & Lewis, 1999).
Furthermore, girls are more likely than boys to be either sexually- and emotionally abused or neglected. These types of maltreatment may result in a negative self-view, feelings of guilt and shame. Girls tend to be more prone to these effects after maltreatment, than boys are (Topitzes, Mersky, & Reynolds, 2011). A possible explanation is given by the meta-analysis of Gore and colleagues (1993). Girls seem to value their feelings and self-esteem more on the evaluations and opinions of others, whereas boys’ development proceeds through their clear distinctions between themselves and others.
In residential care, high rates of trauma and child maltreatment experiences are commonly reported among youth (Bettmann, Lundahl, Wright, Jasperson, & McRoberts, 2011). Research of Collin-Vézina and colleagues (2011) shows that for females in residential care specifically, the child maltreatment rates are much higher than for the general population. More precisely, 62 % of girls self-report a history of sexual abuse and exposure to on-going physical abuse and verbal abuse. However, rates vary depending the source used to identify child maltreatment (Hambrick, Tunno, Gabrielli, Jackson, & Belz, 2014). In addition, prevalence rates differ depending the type of child maltreatment examined. Unlike physical and sexual abuse, emotional abuse and neglect are more often reported in self-report than
official child maltreatment data (Finkelhor, Ormrod, Turner, & Hamby, 2005). One of the explanations for this is that neglect and emotional abuse are harder to register because of their intangible characteristics. Emotional abuse and neglect do not come with visible injuries, and thus identification of emotional abused or neglected children relies largely on the skills of trained personnel (Hamarman & Ludwig, 2000). Nonetheless, it is important to have a better understanding of the different information that substantiated data and self-report provide, and the value that this information has for clinical practice, knowing that treatment decisions in clinical practice are often based on substantiated data (Ministère de la Santé et des Services sociaux, 2007).
Understanding the problem of child maltreatment requires valid methods to document the prevalence and effects of child maltreatment. Many studies have examined the
relationship between child maltreatment and insecure attachment (Briere, Godbout, & Runtz, 2012; Stronach, Toth, Rogosch, Oshri, Manlu, & Cicchetti, 2012). To our knowledge, no research has yet examined the role of child maltreatment on both attachment and self- reference in one model, while controlling for the interrelation between these constructs. Findings indicate that child maltreatment harms the process of developing a healthy internal working model, which is needed for the development of secure attachment and the ability to self-reference (Klein, 2001). Furthermore, the informative nature of self-report and
substantiated data regarding the effects of child maltreatment for female adolescents is not yet studied.
Current study
The purpose of the current study was two sided. First, the informative nature of self-reported data on child maltreatment over and above the substantiated data will be explored in relation to insecure attachment and impaired self-reference. In practice Child Protection Services tend to build a case only on substantiated data. We expect that the informative nature
of substantiated data is lower compared to self- reported data, because only a smaller percentage of cases is substantiated due to lack of evidence. Secondly, the interrelation of impaired self-reference and insecure attachment will be examined with a path analyses. Because insecure attachment and impaired self- reference develop through the same path and are based on the same mechanisms, we expect that child maltreatment is similarly associated with both constructs. In sum, after controlling of the intercorrelation of impaired
self-reference and insecure attachment the unique associations of each form of child maltreatment will be examined. We expect that in the current sample of female adolescents in residential care, emotional abuse and neglect will be strongly associated to both outcomes, because of the fact that girls are more sensitive to emotions and have a relational orientation (Feingold, 1988; Nolen-Hoeksema, & Jackson, 2001).
Method Participants
The current study is part of a larger longitudinal study on the effectiveness of a Cognitive Behavioural Treatment program implemented in nine girl only units in Montreal, Quebec. Currently six data collection waves have been collected (T1-T6), covering the period from mid-adolescence to emerging adulthood. The present study was based on data from the sixth wave only.
In the present study N= 131 Canadian young adult females participated. All females were placed in residential care in Montreal, Canada, in the year 2007-2008. At time of the sixth measurement wave, all participants were out of care, and the age of the females ranged from 15.5 to 23.1 years (Mean age = 19.4; SD = 1.48). The main reason for placement of the participating females in the youth centre was for serious behavior problems. These problems threatened the security and/or development of the participants. Placement in the youth centre was for a minimum of three months and for an average duration of six months. Care during
this placement was supervised by qualified practitioners (e.g., Psycho educators,
psychologists, social workers, or criminologists). All care was based on psychosocial re-adaption principles and provided to both the adolescent as well as their families (ACJQ, 2012).
Procedure
Before data collection started, the institutional review board of the University of Sherbrooke, Canada, approved the data collection procedures. All participants formally agreed to participate at each wave of the data collection, and parental permission was asked for all participants under the age of 14. Once the female adolescents agreed to participate, an interviewer met individually to administer the questionnaires. The team of interviewers was a group of university students with training in research ethics and interviewing techniques. These interviewers assisted the participants to complete their questionnaire, which took about 90 min to complete. At the end of the interviews, participants were asked to provide contact details for follow up assessments.
Measurements
Demographics. Demographic characteristics used for the purpose of this study were age at time of assessment (T6) and whether the females were assigned to either the treatment or control group.
Substantiated maltreatment. A history of child maltreatment was based on
substantiated reports of child maltreatment by Child Protection Services, Quebec, Canada. The reports were collected retrospectively and cover four forms of substantiated child maltreatment up to the girls’ admission in the residential care; physical abuse, emotional abuse, sexual abuse and neglect. In the current sample 51.1% of the females had a
of the females had reports of physical abuse. Lastly, 16% of the females had a substantiated report of sexual abuse.
Child maltreatment. Child maltreatment was assessed retrospectively at Time 6 with the Childhood Trauma Questionnaire (CTQ, Bernstein & Fink, 1998). This questionnaire was a 28 item self-report inventory and consisting of five scales of maltreatment: emotional, physical, and sexual abuse and emotional and physical neglect. It provides a brief, reliable, and valid screening for histories of abuse and neglect experienced in childhood. Respondents rated the extent to which each item was true for them on a scale from 1 (never true) to 5 (very often true). Items were preceded with the following stem: “while you were growing up…”. An item on the emotional abuse scale was e.g. “Felt hated by family”. The Cronbach’s alpha of the subscale emotional abuse was .89. An item on the subscale physical abuse was e.g. “Hit hard enough to see a doctor”. The Cronbach’s alpha for this scale was .86. An item on the subscale of sexual abuse was e.g. “Made to do sexual things”. The Cronbach’s alpha for this subscale was .95. An item on the subscale emotional neglect was e.g. “Was looked out for” (reversed). The Cronbach’s alpha on this subscale ranged was .89. At last, an item on the subscale physical neglect was e.g. “Not enough to eat”. The Cronbach’s alpha for this subscale ranged was .78 (Bernstein & Fink, 1998).
Trauma – related symptoms. The Trauma Symptom Inventory -2 (TSI-2, Briere, 1995) was used to assess trauma-related symptoms (e.g. posttraumatic stress and other
psychological cons of traumatic events), and consists of 10 scales of 10 items. Each item was rated according to its frequency of occurrence over the previous six months using a 4-point Likert scale from 0 (never) to 3 (often). For purpose of the present study two scales were retained for analysis: Impaired self-reference and insecure attachment. The impaired self- reference subscale assesses difficulties related to the sense of self and personal identity. Items reflect an on-going confusion about life goals and identity, an inability to understand one`s
own behavior, and problems to identify own needs and those of others. An item on the subscale impaired self- reference was e.g. “I have the feeling that I don’t know who I am.” The Cronbach’s alpha for this subscale was .82. An item on the subscale insecure attachment was e.g. “I have felt like others left or rejected me.” The Cronbach`s alpha for our sample was .89 (Miller & Resick, 2007).
Analyses
In the present study there were only three missing data points due to participants skipping questions or unknown substantiated data. These data points were excluded from the data collection. Because the missing data points are less than 10% of the whole data
collection, there is no need to impute the missings, because the statistic power will not significantly change (Rippe, den Heijer, & le Cessie, 2013).
Secondly, a point-biserial correlation coefficient was computed to assess the
relationship between child maltreatment reported by the CTQ and the substantiated data on the one hand, and insecure attachment and impaired self-reference on the other hand. Furthermore, we conducted a hierarchical multiple regression analysis to examine the association between both official and self-reported child maltreatment insecure attachment and impaired self-reference, controlling for age at T6 and treatment group.
After examining basic correlations between our variables of interest, we computed a hierarchical regression to determine whether the variance changed with different information sources on child maltreatment. We proceeded to test our multilevel path model using Mplus 6 software, employing full information maximum likelihood estimation to address a limited amount of missing data (Muthén & Muthén, 2010). Hence, our primary analysis could best be described as a multilevel path analysis testing direct effects of child maltreatment on both insecure attachment and self-reference. Given low to moderate correlations among the child maltreatment predictors (correlations ranged from .02 to .55), a small number of child
maltreatment factors in our model, and a fairly large sample, we felt comfortable including all of the child maltreatment variables in our model as predictors. Correlations among predictor variables in the low to moderate range are not likely to bias coefficient estimates and
researchers suggest that correlations among predictor variables under .5 typically pose minimal threats to the accuracy of statistical tests (Grewal, Cote, & Baumgartner, 2004). In line with recommendations of Hu and Bentler (1999) the standardized root mean square residual (SRMR) and the comparative fit index (CFI) were used to evaluate goodness of model fit. A cut-off score of .08 or lower for SRMR and a value of .95 or larger for the CFI is viewed as a good fit. The SRMR and CFI have been found to provide an appropriate balance between Type I and II error rates. In line with standard reporting practices, the root mean square error of approximation (RMSEA) was reported of which values under .06 are considered acceptable (Hu & Bentler, 1999). We also evaluated our models based on the significance of the path coefficients with a primary focus on path coefficients corresponding to between-group effects of insecure attachment and impaired self- reference.
Results Descriptive analyses
Prevalence of maltreatment. Table 1 and 2 present descriptive information on all the variables of interest. For descriptives purposes only, we categorized the various forms of child maltreatment based on the cutpoint provided by the CTQ (Bernstein & Fink, 1998) ranging from “none to minimal”, “low to moderate”, “moderate to severe”, or “severe to extreme”. Table 1 shows that child maltreatment is commonly seen among a large part of females in residential care. Of the 131 participants, approximately one fourth reported severe to extreme child maltreatment experiences, with rates between 21.8% for physical abuse and 30.8% for emotional abuse. Results on the substantiated data of child maltreatment reveal a different image (table 2). Based on the substantiated data, high rates of neglect were reported among
the females with a rate of 51.1 %. The prevalence rates of the other types of self reported child maltreatment were much lower, e.g., 24.4% for physical abuse, 16.0% for sexual abuse and 10.7% for emotional abuse.
Table 1 Prevalence of maltreatment measured using the CTQ in terms of severity
None to Minimal Low to Moderate Moderate to Severe Severe to Extreme
Sexual Abuse 63.2 7.5 8.3 21.0
Emotional Abuse 45.1 18.0 6.1 30.8
Physical Abuse 64.7 9.8 3.7 21.8
Emotional Neglect 28.6 33.8 11.3 26.3
Physical Neglect 45.1 12.0 18.8 24.1
As demonstrated in Table 3, there was a positive correlation between insecure attachment and impaired self-reference. This indicates that individuals with higher levels of insecure attachment also show more impaired self-reference. Self-reported child
maltreatment, was positively correlated with both insecure attachment and impaired self-reference. For the substantiated data on child maltreatment, only a correlation with age and impaired self-reference was found.
Table 3. Intercorrelations between Self- and Official-reported Child maltreatment and Trauma related symptoms insecure attachment and Impaired self-reference (N = 131)
Official Reported Child Maltreatment
Self-reported Child Matreatment
Em o tio n al abus e P h y si cal abus e S ex u al abus e N eg lect Em o tio n al abus e P h y si cal abus e S ex u al abus e Em o tio n al n eg lect P h y si cal n eg lect Age -.01 .12 -.00 .11 -.11 -.07 -.08 .06 -.03 Treatment group .11 -.15 -.05 .22* .06 -.06 .07 -.04 .05 Insecure attachment .02 .04 .03 -.09 .51** .36** .33** .27** .24*** Impaired Self-reference .08 .01 -.02 -.08 .41** .30** .30** .24** .22* * p < .05, **p < .01, ***p < .001.
Table 2 Prevalence of maltreatment measured using substantiated data (Child Protection Services)
No Yes
Emotional Abuse 89.3 10.7
Physical Abuse 75.6 24.4
Sexual Abuse 84.0 16.0
Hierarchical multiple regression.
A hierarchical multiple regression analysis was performed to examine the extent to which self-reported data on child maltreatment predicted insecure attachment and impaired self-reference. Preliminary analyses were conducted to ensure no violation of the assumptions of normality, linearity, and homoscedasticity. Additionally, tests for multicollinearity
indicated that a low level of multicollinearity was present; the VIFs ranged from 1.11 to 2.93. This indicates that multicollinearity was unlikely to be a problem (Tabachnick & Fidell, 2007). All predictor variables were statistically associated with insecure attachment and impaired self-reference. This indicates that the data was suitably correlated with the dependent variable for examination through multiple linear regression to be reliably
undertaken. The correlations were all moderate to strong, ranging from r = .27 to r = .55. For the substantiated data these correlations were not significantly correlated with insecure attachment and impaired self-reference.
Insecure attachment. In the first step of the hierarchical multiple regression for insecure attachment, two descriptive constructs were entered: age and treatment group. This model explained 3.4 % of variance in insecure attachment (Table 4). Age and treatment group were not significantly related to insecure attachment. At step 2 the substantiated data on child maltreatment was entered, the total variance explained by the model as a whole was 5.2%. Age, treatment group, and substantiated data were not significantly related insecure
attachment. More precisely, the introduction of the substantiated data explained an additional 1.9 % variance in insecure attachment, after controlling for age and treatment group (R2 Change = .019). In step 3 the self- reported child maltreatment data was entered in the model. Emotional abuse was significant associated with insecure attachment (β = .49, p < .001). Results show that the total variance explained by the model as a whole was 34.2% (F (5, 118)
= 10.39; p < .001). The introduction of the self- reported data of child maltreatment explained 29.0% variance in insecure attachment, after controlling for age, treatment group and the information of the substantiated data (R2 Change = .29; p <.001).
* p < .05, **p < .01, ***p < .001.
Impaired self-relevance. Results of the hierarchical multiple regression analysis for impaired reference show that age was significantly associated with impaired
self-reference (β = .23, p < .05). This model explained 7.7% of variance in impaired self-reference (Table 5), F (2, 127) = 5.31; p <.01. The introduction of the substantiated data explained 1.9% of the variance in model 2 after controlling for age and treatment group. Step two explained 9.6% of the variance in the whole model, which indicates that the explained variance does not change significantly by entering substantiated data. In step 3 the self-reported child
maltreatment data was entered in the model. Self-reported emotional abuse was again significantly associated with impaired self- reference (β = .20, p < .05), as is self-reported emotional abuse (β = .26, p < .01). Results show that the total variance explained by the
Table 4: Hierarchical regression of the insecure attachment based on official and self-reported data
Step1 Step 2 Step 3
Variables B SE (B) Β B SE(B) β B SE(B) Β
Age -.69 .46 -.14 -.35 .40 -.07 -.19 .413 -.04 Treatment group 1.23 1.37 .08 1.00 1.19 .07 1.57 1.24 .11 Official reported Sexual abuse .71 1.74 .04 -1.17 1.17 -.12 Official reported Emotional abuse .90 2.11 .04 -2.09 1.86 -.09 Official reported Physical abuse 1.36 1.52 .08 -.38 1.40 -.02 Official reported Neglect -1.77 1.35 -.12 -.78 1.58 -.04 Self reported Sexual
abuse .12 .11 .10 Self reported Emotional abuse .57 .14 .51*** Self reported Physical abuse .03 .14 .03 Self reported Emotional neglect .02 .15 .02 Self reported Physical neglect -.08 .17 -.05 ∆R2 .03 .02 .29***
model as a whole was 28.0%. The introduction of the self-reported child maltreatment data explained 18.3% variance in impaired self-reference after controlling for age, treatment group and the substantiated data on child maltreatment (R2 Change = .183; p < .001).
* p < .05, **p < .01, ***p < .001. Path analysis.
To examine the informative value of the data on child maltreatment after controlling for the interrelatedness between insecure attachment and impaired self- reference (r =.702, p <.001), a path analysis model was conducted (see Figure 1). Age and treatment group were again entered as a covariate. All indices showed an acceptable fit of the data to the model, ᵡ2
(1) = .088, p = .77; RMSEA = .000, SRMR =.004, CFI = 1.00.
In this full model (Figure 1), insecure attachment was not significantly related to either age or treatment group. Impaired self-reference was positively associated with age (r = -.716, p <.05) but not with treatment group. Self-reported emotional abuse was significantly related to insecure attachment (r = .569, p <.001) and to impaired self-reference (r =.245, p <.05). Last, self-reported sexual abuse was significantly related to impaired self-reference (r = .206, Table 5: Hierarchical regression of the impaired self-reference based on self-report and official data
Step1 Step 2 Step 3
Variables B SE (B) Β B SE(B) β B SE(B) Β
Age -.97 .38 -.23 -.79 .36 -.18 -.72 .37 -.17 Treatment group 1.34 1.15 .10 1.19 1.07 .09 1.48 1.12 .12 Official reported sexual abuse .06 1.46 -1.00 -1.70 1.42 -.10 Official reported emotional abuse 1.68 1.78 .08 -.27 1.67 -.01 Official reported physical abuse 1.24 1.28 .09 .15 1.26 .01 Official reported neglect -1.31 1.14 -.11 -1.24 1.05 -.10 Self-reported Sexual abuse .21 .10 .20** Self-reported emotional abuse .25 .13 .26* Self-reported physical abuse .01 .13 .01 Self-reported emotional neglect .12 .13 .11 Self-reported physical neglect -.03 .16 -.03 ∆R2 .08** .02 .18***
p <.05). These results indicate that the correlation found in the hierarchal regression between impaired self- reference and age, self- reported emotional abuse, and self-reported sexual abuse, is unique for impaired self-reference. Insecure attachment only has a unique
association with self- reported emotional abuse. Since the interrelatedness between insecure attachment and impaired self- referenced is controlled for in the path analyses, these results tell us the associations found in the hierarchal regression still are unique for the examined constructs and are not based on interrelatedness between the dependent variables.
Discussion
The main objective of this study was to examine the informative nature of the different types of reports on child maltreatment in relation to insecure attachment and impaired self- reference among young adult females who transitioned out of residential care. In practice, treatment decisions are based on information from substantiated data obtained by the Child protection board (Ministère de la Santé et des Service sociaux, 2007). Our findings show that self-reported child maltreatment, over and above substantiated data, was related to both insecure attachment and impaired self- reference. Substantiated data did not significantly contribute to the explained variance of insecure attachment and impaired self-reference. These findings are consistent with previous studies, showing that substantiated data may not capture the full experience of the traumatic event (Finkelhor, Ormrod, Turner, & Hamby, 2005). In this study, self-reported child maltreatment explained between 18.3% and 29% more of the variance over substantiated data, in terms of insecure attachment and impaired self- reference. A possible explanation for this finding is given by Finkelhor, Ormrod, Hamby, and Turner (2005), they showed in their study that only a small percentage of cases are substantiated due to lack of evidence. In addition, Child protection Services tend to only classify one type of child maltreatment even in case of multiple forms of child maltreatment. These flaws in the process may affect the usefulness of the substantiated data for clinical purposes (Collin- Vezina, Diagneault, & Hebert, 2013).
Secondly, this study examined the unique association of the reported forms of child maltreatment with insecure attachment and impaired self- reference, among young adult females who transitioned out of residential care, after controlling for the intercorrelation between the two dependent variables. The path analyses demonstrated that in this sample of female adolescents in residential care, emotional abuse was associated with insecure
with impaired self- reference. These outcomes demonstrate that specifically for young adult females self-reported emotional abuse was associated with both insecure attachment and impaired self-reference. This result may be explained by the fact that females, compared to males, tend to focus on the social aspect of the maltreatment, and as such experience more emotional and physiological distress in response to conflicts characterized by a lack of trust, love and closeness with significant others. Furthermore, girls seem to value their feelings and self-esteem more on the evaluations and opinions of others, whereas boys’ development proceeds through their clear distinctions between themselves and others (Gore et al., 1993; Topitzes et al., 2011; Rudolph, 2002). Previous research supports the found association between sexual abuse and impaired self- reference. They found that the continued experience of shame, which is often seen after sexual abuse, may affect essential processes to
self-development and self-representations in a negative way (Alessandri & Lewis, 1996; Feiring et al., 1999; Trickett, Noll, & Putman, 2011; Westen, 1994).
In addition, a higher age of the girls was associated with higher levels of impaired self-reference. This finding is in line with Kensinger and Leclerc (2009), who showed that skills related to self-reference develop with age such as the ability to think about who you are as a unique individual, to self-monitor behavior and to reflect on others’ behavior. These self- reference skills are affected by the experiences of child maltreatment, especially by emotional abuse.
Strengths and limitations
The current study has several strengths. First, we were able to include a large sample of young adult females who transitioned out of residential care, who were highly subjected to maltreatment experiences – this enabled us to test the informative value of both self-reported and substantiated data and the association between maltreatment experiences and later trauma related outcomes among which insecure attachment and impaired self-reference.
Our study also has some limitations. First, we questioned young adults females about their experiences with maltreatment with the CTQ (Briere, 1998), which is a retrospective self-report questionnaire. The CTQ, like other retrospective self-report measures, relies on the accuracy of people’s memories even though memory for childhood experience, in general, is fallible and certain types of psychopathology have been associated with memory biases and distortions (Brewin et al., 1993; Maughan & Rutter, 1997). For instance, a study of Takarangi, Strange and Lindsay (2014) showed that individuals may memorize traumatic events less accurate, resulting in a bias in the data. Another limitation is that this questionnaire focuses on the more severe forms of maltreatment (e.g. beating leaving marks), rather than on milder or less visible forms (e.g. being pushed) (Paivio & Cramer, 2004). In addition the emotional abuse and neglect scales include items that are more subjective of nature, which are more difficult to recall than more objective and concrete behaviors (Brewin et al., 1993).
Regardless the above mentioned criticism on retrospective self-report measures on child maltreatment, there are also several studies emphasizing the importance of self-report as a research method. Everson and colleague’s (2008) and Shaffer (2008) showed that
individuals develop coping strategies to deal with the trauma. These coping strategies will result in less bias with recalling the traumatic event and less avoidant assessment of the participants. Therefore, Compas, Connor-smith, Saltzman, Thomson and Wadsworth (2001) and Collin – Vézina and colleagues (2011) argue that it is because of the retrospective self-report character, that this kind of data can be of larger value than data which is collected at times of the events (e.g., substantiated data). In addition, substantiated data tend to involve the more extreme cases of child maltreatment, because substantiated reports are only build when there is prove of child maltreatment. In practice, this means the cases of child maltreatment which contain the less visible forms of child maltreatment are often not represented within substantiated data. However, research of Hart, Binggeli, and Brassard (1997) and Nicholas
and Bieber (1996) show that less visible forms of child maltreatment e.g., emotional abuse or neglect may affect the development of the child more negatively than more visible aspects of abuse such as physical abuse. In this respect, substantiated data may be less valuable for clinical purposes. To contribute to the process of treatment decisions, the informative value of each kind of data on child maltreatment should be validated.
Current findings indicate that child maltreatment contributes to the social, emotional and behavior problems in females lives (Jordan, Nierzel, Walker & Logan, 2002; Langan & Pelissier 2001; Messina & Grella 2006; Messina, Burdon & Prendergast 2003). A critical question concerns whether these gender-specific risk factors of trauma, dysfunctional relationships, self-esteem, and insecure attachment are affecting a healthy development in terms of prosocial behavior or that these are simply problems that are highly prevalent among females with troubled lives (Blanchette & Brown, 2006). Numerous studies have shown that females have different pathways to problem behavior in comparison to men. These pathways acknowledge the following treatment needs: care for trauma and abuse histories and
development of the self (Bloom et al., 2003; Daly, 1992, 1994; Reisig, Holtfreter & Morash, 2006; Richie, 1996; Tolin & Foa, 2006).
In this regard, intervention programs that are gender-responsive and trauma- informed are important for females in residential care. Interventions for this unique population of young females have to examine how underlying traumas may cause problem behavior and not just focus on behavioral symptoms such anger or aggression only. The National Institute of Corrections (Bloom et al., 2003) has developed guiding principles to ensure
gender-responsive and trauma-informed services. More precisely, They point out that traditional therapy generally reflects the dominant male culture. Because the lives of many women in treatment include trauma, it is essential to use interventions designed for women that are trauma-informed because trauma can have a negative effect on the intervention outcomes
(Lewis et al., 2010). To be able to work according these principles, our findings indicate that residential care centres should use self-report data or a combination of both substantiated and self-report data to guide the intervention and placement to provide this effective help.
These results will leave much to sorted out by policy makers and the current process in the residential care. In practice intervention tends to focus more on the more visible forms of maltreatment e.g., physical abuse and sexual abuse (English, Thompson, White, & Wilson, 2015), while the current study showed the importance of emotional abuse in relation to trauma symptoms. The results stress the importance of integrating services for women to help them understand and cope with their behavioral problems and other forms of trauma, while acknowledging their special psychological needs, by creating supportive and therapeutic treatment environments, and provide women with knowledge and more effective coping skills that they can use in helping to facilitate their own recovery. Although these finding bring new insights, continued research of the needs of women with impaired self-reference, insecure attachment, and/or a history of child maltreatment is needed.
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