Low Child Physical Abuse Risk Research Articles

Identifying injuries suggestive of child physical abuse: An innovative application of the Trauma Quality Improvement Program.

Child physical abuse (CPA) carries high risk of morbidity and mortality. Screening for CPA may be limited by subjective risk criteria and racial and socioeconomic biases. This study derived, validated, and compared age-stratified International Classification of Diseases, 10th revision (ICD-10) diagnosis codes indicating high risk of CPA. Injured children younger than 6 years from the Trauma Quality Improvement Program (TQIP) database were included; years 2017 to 2018 were used for derivation and 2019 for validation. Confirmed CPA was defined as a report of abuse plus discharge with alternate caregiver. Patients were classified as high vs. low CPA risk by three methods: (1) abuse-specific ICD-10 codes, (2) previously validated high-risk ICD-9 codes crosswalked to equivalent ICD-10 codes, and (3) empirically-derived ICD-10 codes from TQIP. These methods were compared with respect to sensitivity, specificity, area under the receiver-operator curve (AUROC), and uniformity across race and insurance strata. A total of 122,867 children were included (81,347 derivation cohort, 41,520 validation cohort). Age-stratified high-risk diagnoses derived from TQIP consisted of 40 unique codes for ages 0 year to 2 years, 30 codes for ages 3 years to 4 years, and 20 codes for ages 5 years to 6 years. In the validation cohort, 890 children (2.1%) had confirmed CPA. On comparison with abuse-specific and crosswalked ICD-9 codes, TQIP-derived codes had the highest sensitivity (70% vs. 19% vs. 54%) and the highest AUROC (0.74 vs. 0.59 vs. 0.68, p < 0.0001) for confirmed abuse across all age groups. Age-based risk stratification using TQIP-derived codes demonstrated low variability by race (25% White vs. 25% Hispanic vs. 28% Black patients considered high-risk) and insurance status (23% privately insured vs. 26% uninsured). High-risk CPA injury codes empirically derived from TQIP produced the best diagnostic characteristics and minimized some disparities. This approach, while requiring further validation, has the potential to improve CPA injury surveillance and decrease bias in screening protocols. Diagnostic Test/Criteria; Level III.

Do High-Risk Parents Use More Aggression During Competitive Play With Children?

The present study examined the extent to which the aggressive tendencies of parents at risk for perpetrating child physical abuse (CPA) generalize to situations other than discipline-related encounters (e.g., a competitive gaming interaction). Participants included parents who were either low (n = 90) or high (n = 75) risk for CPA. Parents were led to believe that they were playing a game against a child opponent with whom they exchanged sound blasts of varying intensities. Parental sound blast selections served as a proxy for aggressive behavior. Parents were randomly assigned to high or low loss conditions. The fictitious child opponent's responses were pre-programed so that sound blasts received by parents became louder (i.e., more provocative) over time. As predicted, high CPA risk parents exhibited higher levels of aggression than low CPA risk parents. Moreover, high-risk parents reported having higher levels of aggressive motives during the game than low-risk parents; and aggressive motives explained the link between parental CPA risk and parents' aggressive behavior. With one exception, higher levels of child provocation during the game prompted parents to send higher levels of sound blasts. The exception to this pattern occurred among low-risk parents who experienced high rates of loss during the game. Specifically, low-risk parents in the high loss condition continued to send low levels of sound blasts even as their child opponent became more provocative. Aggressive motives (and the ability to change motives as situations change) may help explain differences in aggressive tendencies evinced by parents with varying levels of CPA risk.

Perceived Executive Functioning in Parents at Risk for Child Physical Abuse.

Research suggests that deficits in executive functioning are associated with negative parenting behaviors. However, limited research has examined the link between executive functioning and risk for child physical abuse (CPA) perpetration. Early studies examining executive functioning in parents at risk for perpetrating CPA relied on performance-based measures, which are designed to occur under carefully controlled conditions and may not capture difficulties experienced under less optimal conditions (e.g., during chaotic caregiving situations). Moreover, prior studies examining executive functioning in parents at risk for perpetrating CPA have relied on small samples comprised of only mothers. To advance our understanding of the linkage between executive functioning and CPA risk, the present study examined perceived deficits in executive functioning in a sample of general population mothers and fathers (N = 98) using a standardized self-report measure of executive functioning, namely, the adult version of the Behavior Rating Inventory of Executive Function (BRIEF-A). Parents were classified as low CPA risk or high CPA risk using the Child Abuse Potential Inventory. Compared with low-risk parents, high-risk parents had higher rates of clinical elevations on several BRIEF-A subscales, namely, Working Memory Problems, Emotional Control Difficulties, and Difficulties Shifting Thoughts, Feelings, and Behaviors. These findings highlight the potential importance of assessing and strengthening executive functioning in interventions designed to reduce risk of parent-to-child aggression.

Borderline personality features and emotion regulation deficits are associated with child physical abuse potential

The present study extends prior research examining the association between borderline personality disorder (BPD) features and child physical abuse (CPA) risk. We hypothesized that: (1) high CPA risk parents (compared to low CPA risk parents) would more often report clinically elevated levels of BPD features; (2) high CPA risk parents with elevated BPD features would represent a particularly high-risk subgroup; and (3) the association between elevated BPD features and CPA risk would be partially explained by emotion regulation difficulties. General population parents (N=106; 41.5% fathers) completed self-report measures of BPD features, CPA risk, and emotion regulation difficulties. Results support the prediction that BPD features are more prevalent among high (compared to low) CPA risk parents. Among the parents classified as high CPA risk (n=45), one out of three (33.3%) had elevated BPD features. In contrast, none of the 61 low CPA risk parents reported elevated BPD symptoms. Moreover, 100% of the parents with elevated BPD features (n=15) were classified as high-risk for CPA. As expected, high CPA risk parents with elevated BPD features (compared to high CPA risk parents with low BPD features) obtained significantly higher scores on several Child Abuse Potential Inventory scales, including the overall abuse scale (d=1.03). As predicted, emotion regulation difficulties partially explained the association between BPD features and CPA risk. Findings from the present study suggest that a subset of high CPA risk parents in the general population possess clinically significant levels of BPD symptoms and these parents represent an especially high-risk subgroup. Interventions designed to address BPD symptoms, including emotion regulation difficulties, appear to be warranted in these cases.

Pain tolerance, pain sensitivity, and accessibility of aggression-related schemata in parents at-risk for child physical abuse

This study examined whether parents with varying degrees of child physical abuse (CPA) risk differed in pain tolerance, pain sensitivity, and accessibility of aggression-related schemata. Participants included 91 (51 low CPA risk and 40 high CPA risk) general population parents. Participants were randomly assigned to complete either an easy or a difficult anagram task. Pain tolerance and pain sensitivity were assessed using a cold pressor task. Accessibility of aggression-related schemata was assessed at the outset of the data collection session and at the end of the session using a word completion task. Parents’ self-reported negative affect was assessed three times over the course of the study: baseline, after the anagram task, and after the cold pressor task. As expected, high-risk (compared to low-risk) parents reported higher levels of negative affect at each time point. Moreover, after completing the difficult anagram task, high-risk (compared to low-risk) parents exhibited higher pain sensitivity during the cold pressor task. Following completion of the cold pressor task, high-risk (compared to low-risk) parents exhibited greater accessibility of aggression-related schemata. Collectively, these findings indicate that under certain conditions, high-risk parents experience a confluence of aggression-related risk factors (i.e., negative affect, pain sensitivity, and aggression-related information processes) that may predispose them to aggressive behavior.

Child physical abuse risk moderates spontaneously inferred traits from ambiguous child behaviors

The present study examined whether parents at high-risk for child physical abuse (CPA) differed from low-risk parents in their tendency to infer positive traits and negative traits from children's behaviors. The final sample consisted of 58 (25 low CPA risk and 33 high CPA risk) parents. Parents completed a false-recognition task, which involved viewing behavior descriptions paired with child photographs. Half of the behavior descriptions vaguely/strongly implied a trait and half of the implied traits were positive/negative. The contributions of automatic processes and controlled processes to task performance were examined using process dissociation procedures. Low CPA risk parents were significantly less likely to indicate negative traits were present in behavioral descriptions of children when negative traits were vaguely (compared to strongly) implied. In contrast, high CPA risk parents were equally likely to indicate negative traits were present regardless of whether the traits were vaguely or strongly implied. For low (but not high) CPA risk parents, automatic processes contributed significantly less to task performance when negative traits were vaguely implied compared to when the same traits were strongly implied. Given that parenting involves negotiating a seemingly endless series of ambiguous behaviors as children grow and develop, the capacity to refrain from automatically attributing negative traits to children when they exhibit vaguely negative behaviors may serve an important function in reducing risk of aggressive parenting behavior.

The Word Game: An innovative strategy for assessing implicit processes in parents at risk for child physical abuse

ObjectiveContemporary theories of child physical abuse (CPA) emphasize the proximal role of social cognitive processes (many of which are implicit in nature) in the occurrence of parental aggression. However, methods that allow for the systematic examination of implicit cognitive processes during the course of aggressive interactions are needed. To address this need, the present study was designed to examine the utility of the Word Game, an innovative procedure designed to assess implicit changes in schema accessibility during the course of an interpersonal exchange involving aggressive response options. MethodsThe game involves a series of competitive reaction time trials which are actually lexical decision making trials designed to determine the accessibility of schema throughout the game. Each parent was led to believe that they were competing against another player with whom they exchanged sound blasts of varying intensities. Participants in the present study were parents who were either low (n=50) or high (n=20) risk for CPA. ResultsResults revealed that high CPA risk parents behaved more aggressively than low CPA risk parents and that provocation augmented the aggressiveness of all participants. Among high CPA risk parents, positive schema became less accessible (whereas negative schema became more accessible) following lost rounds. At the conclusion of the game, high CPA risk parents reported more aggressive motives than low CPA risk parents. Further, aggressive motives significantly mediated the association between CPA risk status and aggressiveness (i.e., mean sound blast selections). ConclusionsCollectively, results support the potential utility of the Word Game as a means of advancing the study of social cognitive processes involved in parental aggression.

Implicit attitudes toward children may be unrelated to child abuse risk

Objective To explore whether adults possess implicit attitudes toward children and whether those attitudes are especially negative among respondents who are high in child physical abuse (CPA) risk. Methods The present study used an implicit evaluative priming procedure. In this procedure, participants were instructed to make decisions about the evaluative implications of target words. These words were preceded by photographs of child faces or adult faces displaying positive, neutral, or negative expressions. Reaction times for the evaluative decisions were used as an index of the extent to which photos invoked negative or positive evaluative reactions. Results Results from 2 studies, the first conducted on a student sample ( N = 90) and the second on a parent sample ( N = 95), demonstrated that evaluative congruence between the facial expressions displayed in photographs and the target words facilitated responses. Furthermore, the results suggested that regardless of CPA risk, child faces, relative to adult faces, facilitated responses to negative target words, suggesting an out-group bias. This implicit out-group bias was not moderated by respondents’ CPA risk status. Conclusions Faces of children, relative to faces of adults, appear to activate negative information structures that facilitate evaluative decisions of negative stimuli, suggesting an out-group bias. Given that out-group biases typically lead to less favorable treatment of out-group members, additional research is needed to examine the pervasiveness of negative evaluative biases towards children and the potential implications of such biases on children's lives. Further, research examining whether high CPA risk parents and low CPA risk parents differ in how they manage initial negative evaluative reactions is needed.

Does accessibility of positive and negative schema vary by child physical abuse risk?

Objective To examine differences in accessibility of positive and negative schema in parents with high and low risk for child physical abuse (CPA). Methods This study combined picture priming and lexical decision making methods to assess the accessibility of positive and negative words following presentation of child and adult faces. The child and adult faces depicted positive, ambiguous, and negative affective valences. The sample included 67 (51 low and 16 high CPA risk) general population parents. Results CPA risk status was associated with accessibility of positive/negative words only following priming with faces of the opposite affective valence. More specifically, high CPA risk parents were slower to respond to positive (negative) words following priming with negative (positive) faces. Exploratory analyses indicated that this pattern of findings was more clearly apparent when picture primes involved adult faces. Conclusion The present findings suggest that high and low CPA risk parents differ in how they process affectively incongruent information. Research is needed to further examine schema accessibility, as well as to examine whether processes involved in attention and affect integration play a role in CPA risk.

Automatic Encoding of Ambiguous Child Behavior in High and Low Risk for Child Physical Abuse Parents

Recent theory and research suggest that physically abusive parenting behavior might be understood as originating from: 1) greater accessibility of hostile/negative schema, and/or 2) lower accessibility of benign/positive schema. This study examined whether parents at high and low risk for child physical abuse (CPA) differed in the extent to which they spontaneously encoded ambiguous caregiving contexts in negative versus positive terms. Twenty-five high and forty-one low risk for CPA parents were asked to memorize a set of sentences that described ambiguous caregiving situations. After a brief delay, participants were asked to recall the sentences. During recall, cues were given (e.g., negative and positive words) to facilitate recall. According to the cued-recall paradigm, to the extent that recall was facilitated by negative/positive cues, it was inferred that negative/positive meaning was activated when the ambiguous sentences were encoded. Although all parents tended to recall more information in response to negative relative to positive cues, the influence of cue type on recall was greater for high CPA risk parents. That is, high, compared to low, CPA risk parents obtained significantly higher recall difference scores (M = 4.6 versus M = 2.3); with higher recall difference scores indicating greater recall in response to negative relative to positive cues. Present findings are consistent with the proposition that high and low CPA risk parents differ in how they spontaneously encode information in ambiguous caregiving contexts.