Resilience from Child Abuse and Childhood Exposure to Domestic Violence Results of an Extended Longitudinal Study Todd I. Herrenkohl University of Washington,

Resilience from Child Abuse and Resilience from Child Abuse and Childhood Exposure to Domestic Childhood Exposure to Domestic

ViolenceViolence

Results of an Extended Longitudinal StudyResults of an Extended Longitudinal Study

Todd I. HerrenkohlTodd I. Herrenkohl

University of Washington, University of Washington, SeattleSeattle

Presentation OverviewPresentation Overview Researcher-practitioner lens; orientation to Researcher-practitioner lens; orientation to

preventionprevention

Background: child abuse and children’s exposure Background: child abuse and children’s exposure to domestic violenceto domestic violence

Conceptual definitions: Risk, protection, and Conceptual definitions: Risk, protection, and resilienceresilience

Lehigh Longitudinal StudyLehigh Longitudinal Study

Overview and relevant findingsOverview and relevant findings

Trajectories of resilience in maltreated children: Trajectories of resilience in maltreated children: Illustration using case studiesIllustration using case studies

Child MaltreatmentChild Maltreatment A global problem; rates of moderate and severe A global problem; rates of moderate and severe

forms of abusive discipline vary by societies and forms of abusive discipline vary by societies and culture; definitions and data sources.culture; definitions and data sources.

In 2005, approximately 3.3 million referrals for In 2005, approximately 3.3 million referrals for alleged maltreatment were made to child protective alleged maltreatment were made to child protective service agencies in the U.S. (USDHHS, 2007). service agencies in the U.S. (USDHHS, 2007). 899,000 children in the U.S. were officially documented as 899,000 children in the U.S. were officially documented as

having been maltreatedhaving been maltreated

Highest rate of victimization: Children birth to age 3; Highest rate of victimization: Children birth to age 3; just more than half are girls (50.7%). just more than half are girls (50.7%).

Physical child abuse is second to neglect in overall Physical child abuse is second to neglect in overall prevalence.prevalence.

Officially documented cases are a fraction of the total Officially documented cases are a fraction of the total (physical abuse prevalence >10%). (physical abuse prevalence >10%).

Developmental ConsequencesDevelopmental Consequences

ChildhoodChildhood AdolescenceAdolescence AdulthoodAdulthood

Isolation, Shame, Isolation, Shame, Fear, Guilt; Insecure Fear, Guilt; Insecure AttachmentAttachment

Alcohol and Drug UseAlcohol and Drug Use

Early Onset Early Onset Depression/ AnxietyDepression/ Anxiety

PTSD Symptoms/ PTSD Symptoms/ DisorderDisorder

Eating Disorders; Eating Disorders; ObesityObesity

Childhood Childhood Aggression; BullyingAggression; Bullying

Additional Health Additional Health Risks: Smoking; Risks: Smoking; Sexual Risk Taking Sexual Risk Taking (STDs); DUI, Suicide (STDs); DUI, Suicide Attempts…and Attempts…and Teenage PregnancyTeenage Pregnancy

Somatic Somatic Complaints; Complaints; Chronic Pain and Chronic Pain and Fatigue; Fatigue; Cardiovascular Cardiovascular Disease; Poorer Disease; Poorer Overall Health; Overall Health; More Use of More Use of ServicesServices

Overall Less Education and Unemployment

Low Academic Achievement; School Dropout

Context of Family Context of Family ViolenceViolence

DV ExposureDV ExposureChild AbuseChild Abuse

Family stressors

Overlap in Child Abuse and Childhood Exposure to Overlap in Child Abuse and Childhood Exposure to IPVIPV

Low incomeParental unemployment

Parental substance use

and mental health

Community stressors

Community

poverty

Neighborh

ood

disadvanta

ge and

violence

Social

Isolation

Overcrowdi

ng

Compounding Stress in the Surrounding Environment

Additive or Cumulative Risk Additive or Cumulative Risk Exposure and Developmental Exposure and Developmental

EffectsEffects A graded (additive) association: more

adverse childhood events= more risk of serious health and mental health consequences.

A caveat: research on child maltreatment includes numerous findings from cross-sectional studies using retrospective measurement…and few account for overlapping stressors and/or prior and current exposures.

Resilience and Resilience and ProtectionProtection

Some children are “Some children are “resilientresilient”– they overcome ”– they overcome the odds of negative outcomes.the odds of negative outcomes.

Studied as an end-point determination a Studied as an end-point determination a child’s having adjusted well (i.e., achieved child’s having adjusted well (i.e., achieved positive outcomes or avoided negative positive outcomes or avoided negative outcomes) despite earlier risk exposure… outcomes) despite earlier risk exposure…

……but better conceptualized as a dynamic, but better conceptualized as a dynamic, changeable quality, or “relative concept” changeable quality, or “relative concept” influenced by the surrounding environment.influenced by the surrounding environment.

Interaction of Stressors and Interaction of Stressors and Protective Factors-Leadbeater Protective Factors-Leadbeater

et al., 2004et al., 2004

Study of Resilience in Victims of Child Study of Resilience in Victims of Child Abuse—Replicated in Two or More Abuse—Replicated in Two or More

Longitudinal StudiesLongitudinal Studies

IndividualIndividual Family/CommunityFamily/Community

Low Distress (low Low Distress (low emotionality)emotionality)

Maternal Maternal CompetenceCompetence

Affectionate/Affectionate/Engaging Engaging TemperamentTemperament

Close Bond with Close Bond with Primary CaregiverPrimary Caregiver

SociableSociable Supportive Supportive GrandparentsGrandparents

Average or Above Average or Above Average IQAverage IQ

Supportive SiblingsSupportive Siblings

Internal Locus of Internal Locus of ControlControl

Competent Peer Competent Peer FriendsFriends

(Werner, (Werner, 2005)2005)


Started as an Started as an evaluation project evaluation project on a child abuse on a child abuse and neglect and neglect treatment and treatment and prevention prevention program in two program in two counties of eastern counties of eastern Pennsylvania.Pennsylvania.


Longitudinal panel study began in 1976-1977Longitudinal panel study began in 1976-1977 preschool, 18 mths.- 6 yrspreschool, 18 mths.- 6 yrs schoolage (1980-1982)schoolage (1980-1982) adolescence (1990-1991) with 91% retentionadolescence (1990-1991) with 91% retention adult assessment (2008-2010)adult assessment (2008-2010)—extensive —extensive

survey of current and prior experiences, survey of current and prior experiences, interpersonal relationships, mental and interpersonal relationships, mental and physical health, aspirations, child rearing physical health, aspirations, child rearing practices (brief open-ended questions about practices (brief open-ended questions about turning pts and transitions)turning pts and transitions)

Multiple data sources, including parents about Multiple data sources, including parents about their disciplining of children, and children (as their disciplining of children, and children (as adolescents) about their experiences growing adolescents) about their experiences growing up. up.

Study SampleStudy Sample

Sample Composition:Sample Composition:

Child welfare abuse (n=144) Child welfare abuse (n=144)

Child welfare neglect Child welfare neglect (n=105)(n=105)

Head Start programs (n=70)Head Start programs (n=70)

Day care (n=64)Day care (n=64)

Middle income nursery Middle income nursery (n=74)(n=74)

248 (54%) males and 248 (54%) males and 209 females.209 females.

52% (n=155) of families 52% (n=155) of families with 1 child; 43% with 1 child; 43% (n=128) of families (n=128) of families with 2 children; 5% with 2 children; 5% (n=14) with 3-4. (n=14) with 3-4.

80.7% White; 5.3% 80.7% White; 5.3% Black or African Black or African American; 11.2% more American; 11.2% more than one race; 1.3% than one race; 1.3% American Indian/Alaska American Indian/Alaska Native; 1.5% Native; 1.5% other/unknown. other/unknown.

Total: Total:

457 457 children children from from 297 297 familiesfamilies

Measuring Child MaltreatmentMeasuring Child Maltreatment

Developed as a non-equivalent control Developed as a non-equivalent control group design.group design.

However, analyses of case records and However, analyses of case records and then mothers’ own reports of their then mothers’ own reports of their disciplining revealed that abuse and disciplining revealed that abuse and neglect were present in all groups.neglect were present in all groups.

Case records: incidents of child physical Case records: incidents of child physical abuse in the “neglect” group were abuse in the “neglect” group were comparable in severity to those in the comparable in severity to those in the “abuse” group; 46% had been physically “abuse” group; 46% had been physically abused.abused.

Measuring Child Maltreatment Measuring Child Maltreatment (cont.)(cont.)

Mothers’ prospective reports also revealed Mothers’ prospective reports also revealed abuse in other groups.abuse in other groups.

Mother: “hit a child so as to bruise”Mother: “hit a child so as to bruise” 91% in child welfare abuse; 64% in child welfare 91% in child welfare abuse; 64% in child welfare

neglect; 88% in Head Start; 68% in day care; and neglect; 88% in Head Start; 68% in day care; and 40% in the middle income group.40% in the middle income group.

Analyses use original group status and full Analyses use original group status and full group models with prospective and group models with prospective and retrospective data (approach supported by retrospective data (approach supported by evidence that indicators of child well-being do evidence that indicators of child well-being do not differ on the basis of substantiation status --not differ on the basis of substantiation status --NSCAW).NSCAW).

Continuation Study: Continuation Study: Overlapping Forms of Violence Overlapping Forms of Violence

and Resilience in Adulthoodand Resilience in Adulthood Co-occurrence of DV exposure, child

abuse, and other stressors Unique and combined effects of

exposure to DV and direct abuse on outcomes in adolescence and early adulthood

Psychosocial mechanisms leading to adverse outcomes

Sources of protection and resilience, including late-onset, adult recovery from early violence exposure

Typologies, Developmental Typologies, Developmental Outcomes, and Protection from Outcomes, and Protection from Maltreatment and DV ExposureMaltreatment and DV Exposure

Adolescent Outcomes:

o Violence/ Violence/ DelinquencyDelinquency

o DepressionDepression

o Drug/ Alcohol Drug/ Alcohol UseUse

o Running AwayRunning Away

o School DropoutSchool Dropout

o Teenage Teenage PregnancyPregnancy

Sex differences

Child characteristics (e.g., Child characteristics (e.g., IQ; self-reflection)IQ; self-reflection)

Qual and Availability of Qual and Availability of Caregiving Caregiving

Attachment to Attachment to parents/othersparents/others

Peer involvement and Peer involvement and support support

Child Maltreatm

ent

Children’s Exposure to

DV

Ph

ysical E

motio

nal

Sexu

al

Neg

lec

t

Socioeconomic factors

Preschool

N=457

CW Abuse (144)

CW Neglect (105)

Head Start (70)

Middle Income (64)

Nursery (74)

Schoolage

N=345

High Functioning (88)

Moderate (141)

Low Functioning (116)

Adolescence

N=23/25

Resilient: HS completion (14/23~61%)

Fewer assaults, index and property crimes, less juv. detention

Adulthood

Multidimensional Assessment of Resilience:

Employment

Schooling

Interpersonal Connections

Mental Health

Criminal Behavior

child’s average or above-average child’s average or above-average intelligenceintelligence

sporadic-not chronic- abusesporadic-not chronic- abuse

a stable living environment (fewer a stable living environment (fewer transitions) and/or stable caretakingtransitions) and/or stable caretaking

clear expectations from one or more clear expectations from one or more caregivers for success in various life caregivers for success in various life domains (e.g., school)domains (e.g., school)

Of those from child welfare, 25 children were high functioning “resilient”

Who remains resilient?

Who doesn’t?

Who emerges as resilient later?

Resilience from Child abuse and Children’s Exposure to DV

Defining Resilience in Early Defining Resilience in Early AdulthoodAdulthood

McGloin and Widom (2001): Resilience among adults (ages 18-41) who had been maltreated in childhood.

At least 6 of 8 criteria: achieved successful employment avoided becoming homeless graduated high school been involved in social activities not developed a psychiatric disorder not developed a substance use disorder not been arrested not perpetrated violence

Challenges in Defining Adult Challenges in Defining Adult ResilienceResilience

What is it? (e.g., interviewers’ observations vs. research-What is it? (e.g., interviewers’ observations vs. research-derived definitions).derived definitions).

Thresholds of positive functioning. What qualifies as Thresholds of positive functioning. What qualifies as resilient? (e.g., absence of depressive symptoms vs. resilient? (e.g., absence of depressive symptoms vs. absence of diagnosis).absence of diagnosis).

Accounting for developmental shifts toward resilience:Accounting for developmental shifts toward resilience:-- case exclusions based on prior behavior, although an individual -- case exclusions based on prior behavior, although an individual may have experienced--but then overcome– one or more life may have experienced--but then overcome– one or more life challenges.challenges.

Case studies on the dynamic features of resilience:Case studies on the dynamic features of resilience:-- goal to increase understanding of developmental patterns and -- goal to increase understanding of developmental patterns and influence of social, contextual, and situational factors that influence of social, contextual, and situational factors that promote, sustain, and lessen growth and positive change.promote, sustain, and lessen growth and positive change.

Who remains resilient?Who remains resilient?Continuity from childhood to Continuity from childhood to

adulthoodadulthood

achieved successful employment

avoided becoming homeless

graduated high school

been involved in social activities

not developed psychiatric or substance use disorders

not been arrested

(?) not perpetrated violence

Who doesn’t?Who doesn’t? Discontinuity from childhoodDiscontinuity from childhood



(-) graduated high school

(-) been involved in social activities

(-) not developed psychiatric or substance use disorders

not been arrested

(-) not perpetrated violence

Who doesn’t?Who doesn’t? Discontinuity from AdolescenceDiscontinuity from Adolescence





(-) not developed psychiatric or substance use disorders

(-) not been arrested


Who emerges as resilient Who emerges as resilient later?later?





not developed psychiatric or substance use disorders

not been arrested


Overall FindingsOverall Findings Resilience IS a relative concept: individual- Resilience IS a relative concept: individual-

and between-individual differences in and between-individual differences in trajectories and outcomes.trajectories and outcomes.

Person-environment interactions (mix of Person-environment interactions (mix of individual qualities, relationships, and individual qualities, relationships, and surrounding context).surrounding context).

Key factors: IQ; self-reflection and goals Key factors: IQ; self-reflection and goals (attribution of responsibility); social support; (attribution of responsibility); social support; group participation that facilitates prosocial group participation that facilitates prosocial involvement with peers; access to adult involvement with peers; access to adult mentors, community.mentors, community.

Implications for Further Implications for Further ResearchResearch

Further study of resilience as a life course Further study of resilience as a life course process; individual, social, and environmental process; individual, social, and environmental interactions.interactions.

Multidimensional assessments and Multidimensional assessments and measurement of risks, processes, and measurement of risks, processes, and outcomes.outcomes.

Attention to overlapping forms of violence Attention to overlapping forms of violence exposure (and abuse types); unique and exposure (and abuse types); unique and combined effects.combined effects.

Implications for Practice Implications for Practice and Policyand Policy

Primary prevention with attention to multiple Primary prevention with attention to multiple risks and stressors; to lessen violence risks and stressors; to lessen violence potential and strengthen families.potential and strengthen families.

-- Parenting interventions to reduce punitive -- Parenting interventions to reduce punitive disciplining; promote stable, positive relationships.disciplining; promote stable, positive relationships.

Social and emotional skill-building in Social and emotional skill-building in children-- selective and more universal children-- selective and more universal approaches.approaches.

Supports to enhance academic achievement Supports to enhance academic achievement and high school graduation; motivate goals and high school graduation; motivate goals for the future.for the future.

Contact: Contact:

Todd I. HerrenkohlTodd I. HerrenkohlUniversity of Washington University of Washington

School of Social WorkSchool of Social [email protected]@u.washington.edu

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Resilience from Child Abuse and Childhood Exposure to Domestic Violence Results of an Extended Longitudinal Study Todd I. Herrenkohl University of Washington,