Child Neglect Article Review

O R I G I N A L P A P E R

An Exploratory Study of Neglect and Emotional Abuse in Adolescents: Classifications of Caregiver Risk Factors

Cassandra Simmel1 • Darcey Merritt2 • Hillary Mi-Sung Kim3 • Soyoun Kim4

Published online: 5 April 2016

� Springer Science+Business Media New York 2016

Abstract Recent research has advanced exploration of

developmental stage and age-related distinctions in

understanding the perpetration of child maltreatment.

Using longitudinal data from the National Survey of Child

and Adolescent Well-being I (NSCAW-I), this exploratory

study investigated heterogeneity in caregiver risks in cases

of both neglect and emotional abuse of adolescents

(N = 511). Using MPlus software, a person-centered data

analytic strategy–latent class analysis was performed to

identify distinct classes of caregiver risk factors that were

associated with the reports of maltreatment among ado-

lescents. Subsequently exploring the distinct characteristics

of the classes, we examined the related demographic

characteristics, child welfare system variables (e.g., type of

placement status; change in placement type between

waves), and youth factors such as the presence of clinical

range problem behaviors (Child Behavior Checklist).

Results demonstrate four distinct classes of caregiver risk

factors, with a nearly even split between those who have an

absence of risk factors and those who have a whole host of

risk determinants. Differences between the classes

regarding the duration of time in out-of-home placements

between Wave 1 and Wave 3 also emerged significant.

Keywords Latent class analysis � Emotional abuse � Neglect � Adolescents � Child welfare

Introduction

In recent years, it has been widely determined that both

child maltreatment referrals and entrants to child welfare

system supervision have been declining (DeVooght et al.

2014; Institute of Medicine (IOM) and National Research

Council (NRC) 2014; U.S. Department of Health and

Human Services 2013). However, an important qualifica-

tion to this period is that not all forms of maltreatment are

indeed declining. Of note, during this seemingly optimistic

trend, reports of neglect have not changed substantially,

and reports of emotional or psychological abuse have

actually increased (IOM and NRC 2014). Moreover,

although research on the causes, risk factors, and ramifi-

cations of maltreatment (e.g. physical and sexual abuse)

has expanded, research on neglect, and especially emo-

tional abuse is under developed (Merritt and Snyder 2014;

Snyder and Merritt 2014). The need for more research on

child neglect and emotional abuse also coincides with the

need for a developmentally specific research focus

regarding the impact of child maltreatment. Such inquiries

would bolster our understanding of distinct types of mal-

treatment based on the developmental capabilities and

vulnerabilities of all age groups of victims (Cicchetti and

Rogosch 2002; Jones Harden 2004; Simmel 2010).

Historically, research on maltreatment in adolescence

has primarily focused on sexual abuse, since the incidence

of this abuse type is highest in this age group (U.S. DHHS

& Cassandra Simmel csimmel@ssw.rutgers.edu

1 School of Social Work, Rutgers University, 536 George

Street, New Brunswick, NJ 08901, USA

2 Silver School of Social Work, New York University, 1

Washington Square North, New York, NY 10003, USA

3 Department of Pediatrics, Institute for the Study of Child

Development, Rutgers Robert Wood Johnson Medical

School, 89 French Street, New Brunswick, NJ 08901, USA

4 Department of Social Welfare, Ewha Womans University,

52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic

of Korea

123

J Child Fam Stud (2016) 25:2372–2386

DOI 10.1007/s10826-016-0414-9

2015). As an unintentional consequence, other abuse per-

petrated in adolescence receives less focus in research.

Moreover, the characterization of types of neglect (e.g.

supervisory neglect) also suggests the victimization of

younger children and toddlers as more pressing in com-

parison to neglect experienced by young adolescents. For

instance, when examining the definitions of neglect—par-

tially comprising caregivers’ failure to appropriately

supervise their children; impairments in protecting children

from harm; deficits in caring for children’s basic physical

needs (Erickson and Egeland 2002)—these parental

behaviors are largely indicative of neglect of infants, tod-

dlers, and preschoolers. While almost all incidences of

neglect are inherently difficult to discern and recognize,

developmental theory informs us that some of the previ-

ously described features of salient types of neglect seem

less pertinent to older children or adolescents, thus leaving

a definitional vacuum when considering how types of

neglect are manifested in adolescence.

Similar complexities arise with recognizing emotional

abuse. Such conduct is partially defined as ‘‘denying

emotional responsiveness’’ and ‘‘hostile rejection/degrad-

ing’’ (Hart, Brassard, Binggeli, and Davidson 2002).

Consider that one complexity of emotional maltreatment

may be that it is embedded in the parent–child relation-

ship (Hart et al. 2002) and not explicitly evident as abuse.

A long-term dysfunctional pattern of parental behavior

may be at play, leading into the children’s adolescent

years. With adolescents’ changing sensitivities around

notions of their burgeoning autonomy vis a vis their

caregivers (Parke and Buriel 2008), this suggests emo-

tional abuse may have a differential impact and also

associated with meaningfully differential caregiver char-

acteristics. Developmentally, adolescents are generally

more cognitively and emotionally capable of relating and

interacting within their family systems at a more

advanced and interdependent level. They also exhibit

growth in self-care skills and emotional regulation, while

also possessing a keener awareness to parental behavior

(Parke and Buriel 2008; Villodas et al. 2012). Despite this

developmentally appropriate pause from parental reliance,

adolescents are still in need of predictable parenting and

nurturing. As this relationship evolves in developmental

context, it is likely that the vulnerabilities to adverse

parental conduct—as demonstrated in neglect and emo-

tional abuse–also transform. This level of cognitive mat-

uration, in turn, may further affect adolescents’ ability to

recognize parental conduct as abusive. Hence, new chal-

lenges in the caregiving relationship may arise due to

child developmental maturation, thus creating stress on

the parent–child relationship. However, this line of

inquiry has not been examined with respect to emotional

abuse or neglect among this age group.

Recent research and summaries of administrative data

report the presence of all types of maltreatment as children

mature, including neglect and emotional abuse noting that

there are multiple types of maltreatment perpetrated against

adolescents (Simmel 2011; United States Department of

Health and Human Services 2013). For instance, Finkelhor

et al. (2005) found in their large scale national survey of

children and adolescents that self-reported disclosures of

maltreatment by respondents included all forms of mal-

treatment across all age groups. Raissian et al. (2014) used

the National Child Abuse and Neglect Data System

(NCANDS) to examine child maltreatment referrals for

adolescents and younger children. In their study, they

examined how child welfare authorities responded to abuse

allegations and whether age or other demographic charac-

teristics emerged as distinct. Similar to Finkelhor et al.

(2005) study, their findings revealed the presence of all

types of abuse among adolescents, though there was vari-

ation in how child welfare authorities responded to specific

maltreatment referrals for adolescents.

Given cursory accounts in the literature regarding

neglect and emotional abuse among adolescents specifi-

cally, Simmel’s 2011 study of NSCAW data supports the

current literature and highlights distinctions according to

developmental stage finding neglect and emotional abuse

to indeed be prevalent among older youth. In this study,

latency-aged children and adolescents—both boys and

girls—had comparable rates of emotional abuse and all

types of neglect relative to their younger counterparts.

Moreover, recent administrative data from the Children’s

Bureau documents that nationwide, despite their relatively

older age, many young adolescents face initial involvement

with the child welfare system (US DHHS 2013). Although

relative to other types of maltreatment, sexual abuse is the

most frequent type of maltreatment reported for the ado-

lescent age group nationwide, all forms of neglect, as well

as emotional abuse are indeed reported in this age group

(U.S. DHHS, 2015). Thus adolescents continue to face

risks for all types of maltreatment, yet the extent to which

caregiver characteristics to these risks is not well under-

stood. Furthermore, given the developmental uniqueness of

emotional abuse and neglect in older youth, a detailed

descriptive account focused on these forms of abuse solely

in this age group is needed.

Beyond exploring the incidence of specific maltreatment

types in adolescence, it is necessary to explore the impact

of abuse that adolescents experience. For example, in a

recent study of the propensity toward intergenerational

abuse, the history of child maltreatment in caregivers’

backgrounds was found to contribute to subsequent per-

petration of abuse by these individuals as they parented

their own children (Thornberry and Henry 2013). Yet, this

subsequent perpetration was associated only with

J Child Fam Stud (2016) 25:2372–2386 2373

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maltreatment that persisted into the adolescent stage of

development and not maltreatment that was ‘‘childhood-

limited’’ and solely occurred prior to their children reach-

ing adolescence. Hence, the impact of having experienced

maltreatment as an adolescent has long-term effects on

future parenting across developmental stages, insofar as

this study demonstrates.

Understanding the context of caregiving is important. In

the recent Institute of Medicine and National Research

Council (2014) report, the authors emphasize a broader and

more comprehensive framework for understanding multi-

ple aspects of the etiology of maltreatment. For instance,

the report authors posit that due to social and economic

inequality, individuals are ‘‘stratified’’ in society, resulting

in negative influences on their capacity for caregiving (p.

27). This framework provides a useful perspective in which

to examine the confluence of caregiver risk factors asso-

ciated with the onset of maltreatment and they identify

several categories of risk factors spanning micro, meso,

and macro elements: (1) individual parent or caregiver risk

attributes (e.g., history of childhood abuse and neglect;

early childbearing; and parental psychopathology); (2)

individual child factors (e.g., developmental disabilities;

behavioral health difficulties); (3) family characteristics

(e.g., family structure; deficient parenting skills; intimate

partner violence; and social isolation); and, (4) community

and environmental ‘‘contextual factors’’ (e.g., poverty;

unemployment; low socioeconomic status; neighborhood

characteristics) (IOM and NRC 2014, pp. 24–26).

The influence of these factors, as well as how they

conjointly operate on manifestations of distinct forms of

maltreatment in exclusive age groups of children and youth

is an underexplored topic. Moreover, the IOM and NRC

framework is largely represented in the NSCAW study (the

basis for our current study), which includes comprehensive

data on many of these caregiver risk conditions. To what

extent are these risk factors apparent in caregivers of

adolescents? The limited research available does reveal

intriguing comparisons. Contextual factors such as poverty,

unemployment, and inadequate housing have been clearly

tied with the potential for abuse generally (Merritt 2009);

impairing reunification efforts (Fowler et al. 2013); neglect

in early childhood (Fallon et al. 2011; Moore et al. 2002);

and to a lesser measureable degree, abuse among adoles-

cents as well (Simmel 2011). Other risk factors that have

been gleaned from recent studies include that adolescents

may be vulnerable to maltreatment due to their own indi-

vidual level risk factors (e.g., socio-emotional challenges,

behavioral health difficulties) perhaps in conjunction with

impaired parental response to these factors (Simmel 2010).

Taken together, our research builds on empirical work

investigating developmental stage-specific indices of mal-

treatment. Here, we explore two related but individual

forms of child maltreatment (discrete categories of neglect

and emotional abuse) among adolescents, with a particular

focus on how the caregiving context is associated with

reports of such abuse. This is an important step in

advancing prevention, detection, and ultimately protection

efforts for adolescents, who may potentially be under-

served by child welfare systems and agencies (Raissian

et al. 2014).

This study is considered exploratory in nature and

therefore guided by the following research aims: (1) mea-

suring the extent to which adolescents in the NSCAW

dataset are involved with the child welfare system due to

emotional abuse and neglect as the primary maltreatment

report type; (2) exploring how the caregiver risk factors,

both historical and current conditions are related to these

maltreatment reports and cluster together; and (3) exam-

ining differences between these classes in terms of ado-

lescents’ subsequent child welfare involvement and

behavioral outcomes.

Method

Participants

This study used data from the National Survey of Child and

Adolescent Well-being (NSCAW I), a nationally repre-

sentative longitudinal study that investigated the compre-

hensive functioning of children and families involved with

the child welfare system. NSCAW I uses a stratified cluster

sampling design resulting in a final cohort of 6228 children.

Further, this sample comprises two sub-samples aged birth

to 16 years: the Child Protection Service sample (CPS:

5,501 children who had been investigated by Child Pro-

tection Service agencies for child abuse or neglect) and the

Long-Term Foster Care sample (LTFC: 727 children who

had stayed in out-of-home placement for approximately

1 year at the time of sampling). Data were collected at

multiple time points from children, caregivers, child wel-

fare caseworkers, and teachers, inclusive of administrative

records. The baseline interviews were conducted at

2–6 months after the initial contact in 1999–2000 (Wave

1). Subsequently, data were collected at 12 months (Wave

2), 18 months (Wave 3), and 36 months (Wave 4) after the

initial investigation. Wave 5 data were collected at

59–96 months after the close of investigation (Dowd et al.

2006). Our study used the Wave 1 to 3 data from the CPS

sample only.

The primary focus of our study is on the measurement of

neglect and emotional abuse in adolescence and therefore

had the following inclusionary criteria: (1) children enter-

ing the child welfare system due to neglect or emotional

abuse; and (2) the age of children at Wave 1 was between

2374 J Child Fam Stud (2016) 25:2372–2386

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11 and 15 years. Because we wanted to examine certain

system factors at Wave 3 (e.g., placement type), we capped

the maximum age at Wave 1 to 15 years so the youth

would not be 18 years or older as we followed-up at Wave

3. This resulted in a final sample size of 511 youth

(weighted N = 268,594). The bulk of the sample consisted

of those who had experienced a combination of neglect

types (e.g. failure to supervise and moral/legal/educational

neglect) (59.43 %) followed by those who experienced

physical neglect (24.52 %) This youth sample had an

average age of 12.6 years (linearized SE = .09) at Wave 1,

and was composed of 53 % girls and 47 % boys. Close to

half of the sample was Caucasian (43 %), 30 % were

African American, 17 % were Hispanic, and 10 % were

from other ethnicities (e.g., Asian, Hawaiian, Pacific

Islanders). The majority (77 %) of the children lived in

urban areas and the remaining 23 % in non-urban areas.

Detailed demographics of the youth and their primary

caregivers are presented in Table 1.

Measures

In Table 2 we provide information on maltreatment and

child welfare involvement. Types of maltreatment. The

alleged primary maltreatment types were recorded by the

caseworkers (indicated as the most serious type of mal-

treatment—notwithstanding co-occurrence among types)

at Wave 1, providing the basis of the CPS reports. For the

present study we solely focused on neglect and emotional

abuse. Four types of primary maltreatment were assessed:

(1) emotional abuse (14.1 %), (2) physical neglect (failure

to provide) (24.5 %), (3) supervisory/other types of

neglect (consisting of failure to supervise and moral/legal/

educational neglect) (59.4 %), and (4) abandonment

(1.9 %). While it is more than likely that these youth

endured other types of abuse as well, we opted to focus

on the primary allegation only, as a means for investi-

gating collective parental risks apparent among these

relatively understudied forms of maltreatment among

adolescents.

Out of Home Placement Status

The caseworkers recorded whether the youth stayed at

home or were placed in out-of-home (OOH) care at each

wave (commonly referred to as ‘‘foster care’’). These OOH

placement types included non-relative foster care, kin care,

group homes, and other placements. However, we exam-

ined OOH care placements collectively and not by each

placement type. The length of OOH placement through the

youths’ life was reported as well. Unfortunately, we do not

have data on the youths’ child welfare involvement prior to

Wave 1 of NSCAW.

We measured OOH placement status according to the

following three metrics. The first metric defines the in-

home or OOH care group at each wave (i.e., Wave 1 or

Wave 3). The second metric classified the youth into four

groups regarding placement changes from Wave 1 to Wave

3: (1) remained in-home, (2) moved from in-home to OOH,

(3) moved from OOH to in-home, and (4) remained in

OOH care. Finally, we calculated the third metric by

determining the proportion of OOH care days from Wave 2

to Wave 3. We used this method because baseline Wave 1

data did not provide the length of previous time spent in

OOH care, and thus the proportions from Wave 1 to Wave

3 could not be generated. Further, the interval between

Wave 2 and Wave 3 varied largely across the sample, so

the proportion of OOH care days were calculated with the

interval as a denominator.

In Table 3, we provide information on caregiver and

youth risk factors. Caregiver and environmental risks. This

information was gathered at Wave 1 by caseworkers at the

time of the case investigation, with each item recorded as

presence versus no-presence on risk assessment instru-

ments. NSCAW utilized established risk assessment

information yielded from the respective states’ child wel-

fare investigation techniques. We therefore had 14 risk

assessment items for the caregivers who were associated

with referrals to the state child welfare systems. The 14

items for caregivers include measures of: previous reports

of child maltreatment (58.4 %), high stress in family

(49.4 %), poor parenting skills (39.4 %), low social sup-

port (32 %), economic difficulties (26.8 %), mental health

difficulties (18.7 %), recent history of arrest (13.3 %),

substance abuse (alcohol = 11.1 %; drug use = 9.93 %),

ongoing intimate partner violence (9.6 %), caregivers’ own

childhood history of child abuse (9.6 %), cognitive

impairments (9.2 %), inappropriate parenting (7.8 %), and

physical impairment (6.6 %).

Youths’ special needs. Presence of special needs was

gathered on risk assessment tools at Wave 1 by case-

workers and indicated as presence vs. no-presence. This

risk assessment variable reflects the general category of

children’s developmental disabilities or special socio-

emotional needs.

Youths’ behavioral/emotional functioning. The Child

Behavior Checklist (CBCL: Achenbach 1991) was used to

measure behavioral health of the youth and examine

associations over time with the perpetration of emotional

abuse and neglect. In this study we used the subscales on

the CBCL: externalizing, internalizing, as well as the

cumulative total problem behavior scale. Caregiver report

of the CBCL was the source of the behavioral rating at the

Wave 3. T-scores standardized by age and gender were

used, with higher scores indicating more problem behav-

iors. The youth were also grouped into the clinical range

J Child Fam Stud (2016) 25:2372–2386 2375

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and the non-clinical range (e.g. normal, borderline) group

for externalizing, internalizing, and total problem behav-

iors, respectively. The clinical range was defined as a

T-score of 64 or above on the respective scale. The CBCL

is norm-referenced for large populations, and therefore

socioeconomic status and race have little effect on the

scores.

Data Analyses

Missing Value Analysis

Before conducting our primary analysis we examined the

data for missing values, which were less than 10 % across

all variables, except for the four caregiver/environmental

risk items (10 % for alcohol and drug abuse, respectively;

and 26 % for one’s own history of abuse) and the CBCL

measures (13 %). To test whether data were missing

completely at random (MCAR) we used Little’s MCAR

test (Little 1988), which indicated that the data were

missing completely at random, v2 (22) = 23.06, p = .40. Thus, latent class analysis (LCA) using caregiver/envi-

ronmental risk items were conducted with the entire sample

(n = 511), utilizing the Full Information Maximum Like-

lihood (FIML) method (Muthén and Muthén 2010).

Primary Analysis

To test if there were discrete classes identified by different

constellations of caregiver risks, latent class analysis

(LCA) was conducted using Mplus 5. Next, to explore

distinguishing characteristics among the identified classes,

a series of bivariate analyses, using uncorrected v2 for categorical variables or adjusted Wald F test for continuous

variables with STATA 11, examined whether the identified

classes were related to abuse type, OOH placement status,

Table 1 Types of Maltreatment and OOH status (unweighted

n = 511, weighted

N = 268,594)

Variable Min. Max. Weighted % Weighted

mean

Linearized

SE

Type of maltreatment

Emotional abuse 14.11

Physical neglect 24.52

Other forms of neglect 59.43

Abandonment 1.94

OOH status

At W1

In-home 77.98

OOH 22.02

Foster care 5.49

Kin care 4.94

Group home 2.29

Other OOH 9.30

At W3

In-home 83.41

OOH 16.59

Foster care 6.11

Kin care 4.93

Group home 3.08

Other OOH 2.47

From W1 to W3

Stay in-home 71.71

In-home to OOH 5.85

OOH to in-home 4.03

Stay OOH 9.22

Not ascertained 9.20

Proportion of OOH days bw

W2 and W3

0.00 100.00 6.58 1.60

Categories of Neglect include: physical neglect (failure to provide); supervisory (failure to supervise); other

(moral/legal/educational neglect); abandonment

2376 J Child Fam Stud (2016) 25:2372–2386

123

Table 2 Descriptives of demographics (unweighted

n = 511, weighted

N = 268,594)

Variable Min. Max. Weighted % Weighted mean Linearized SE

Characteristics of caregiver

Country of birth

U.S. 92.12

Non-U.S. 7.85

Not ascertained 0.03

Gender

Male 14.05

Female 84.02

Not ascertained 1.03

Age 19.00 79.00 38.44 .60

Education

[HS 30.26 =HS 34.99

\HS 31.68 Not ascertained 3.07

Romantic relation

Married 27.96

Separated 13.88

Divorced 14.39

Widowed 3.86

Never married 21.11

Live-in partner 15.27

Not ascertained 3.52

Relation to the child

Bio-parent 70.66

Other relatives 20.79

Non-relatives 8.55

Urbanicity

Urban 77.42

Non-urban 22.58

Characteristics of child

Race

White 43.33

Black 29.74

Hispanic 16.79

Other 9.64

Not ascertained 0.39

Gender

Boy 46.99

Girl 53.01

Age at W1 (years) 11.00 15.00 12.60 .09

11 23.33

12 23.82

13 27.53

14 20.37

15 4.96

Special needs

Yes 24.84

No 72.81

Not ascertained 3.35

J Child Fam Stud (2016) 25:2372–2386 2377

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and characteristics of the youth and their primary care-

givers, as well the youth’s behavioral/emotional function-

ing. Subsequent post hoc analyses were conducted, using

multinomial logistic regression or Wald F test. To address

the complex sampling design attributes, Taylor Series lin-

earization methods were applied in all analyses.

Results

Results of the LCA resulted in four classes of caregivers’

risks, among those who were involved with the child

welfare system due to the following types of maltreatment:

emotional abuse, physical neglect, supervisory/other

neglect, or abandonment. Several models were compared

using a different number of classes in order to determine

the overall fit of the models and arrive at substantive

meanings of the classes (Muthén and Muthén 2009). Ulti-

mately, a four-class solution was determined most appro-

priate, resulting in four subtypes of caregiver risks among

this population of maltreated youth (See Table 4).

Profiles of the four classes are displayed in Fig. 1. The

majority of the primary caregivers belonged to either Class

1 (49.0 % of the caregivers) or Class 2 (42.6 %). Class 1

caregivers were more likely to have no other risk but

personal history of abuse and we therefore call this group

‘‘Historical Risk’’. The group of Class 2 caregivers was

differentiated by the following indicators: recent history of

arrest, serious mental health problems, inappropriate

parenting, low social support, and problems in paying

necessities, as well as history of abuse. As such, we refer to

this group as ‘‘Comprehensive Risk.’’

Class 3, consisting of 4.9 % of the caregivers was pri-

marily characterized by the following two risk factors: low

social support along with history of abuse. We thus refer to

this group as ‘‘Relational Risk.’’ Finally, Class 4 consisted

of 3.5 % of the caregivers, who manifested no salient risk

factors. We labeled Class 4 as the ‘‘No Risk’’ group. The

four-class model showed a clear distinction between clas-

ses, resulting in only one class with a high probability of

membership in that class and the other classes having a low

probability. For example, primary caregivers in Class 1

(Historical Risk) had an average probability of .935 of

classifying in that group, and probabilities of grouping in

Class 2 (Comprehensive Risk), Class 3 (Relational Risk),

and Class 4 (No Risk) was .065, .000, and .000,

respectively.

The conditional probabilities endorsing each risk item

within each group contributed to the categorization of the

four classes. Those risk items with high probabilities (that

is, probabilities greater than .40) were considered highly

endorsed by individuals in that particular class.

In this analysis, we investigated whether the four pre-

viously identified latent classes of caregiver risks were

related to a host of child welfare case characteristics,

caregiver attributes, and child factors both at baseline and

subsequently at Wave 3. These results are displayed in

Table 5.

Types of Abuse

There were no significant differences between the latent

classes regarding maltreatment reports (emotional; physi-

cal neglect; supervisory/other neglect; abandonment). This

may be due in part to the co-occurrence of these types of

maltreatment inherent in the NSCAW derived variable

(‘‘most serious form of abuse’’ notwithstanding co-

occurrence).

Table 2 continued Variable Min. Max. Weighted % Weighted mean Linearized SE

Behavioral/emotional outcome a

Internalizing 31.00 86.00 55.60 .99

Clinical range b

25.28

No 61.60

Not ascertained 13.11

Externalizing 32.00 88.00 59.86 .92

Clinical range b

37.51

No 49.38

Not ascertained 13.11

Total problems 23.00 86.00 59.48 1.03

Clinical range b

36.88

No 50.00

Not ascertained 13.11

a T scores of the Achenbach‘s Child Behavior Check List (CBCL)

b T scores C 64

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Changes in Placement Status

There were, however, significant differences regarding

OOH placement between the four classes at Wave 3

(v2 = 43.29, df = 3, p = .012), whereas such differences were not significant at Wave 1. Post-hoc comparisons

indicated that at Wave 3, youth from the Comprehensive

Risk class were more likely to be placed in OOH care than

those from either the Historical Risk class (Post-hoc: log-

odds = 1.75, p = .002, 95 % CI .69, 2.81, relative risk

ratio = 5.76) or No Risk classes (Post-hoc: log-

odds = 21.20, p = .000, 95 % CI 19.61, 22.78, relative

risk ratio = 1.61e?09); and youth from Historical Risk

were more likely to be placed in OOH care than those from

No Risk (Post-hoc: log-odds = 19.45, p = .000, 95 % CI

17.67, 21.22, relative risk ratio = 2.79e?08). Further, the

proportion of days in OOH care between Wave 2 and 3 was

different across the classes (Wald F = 6.67, df = 1, 80,

p = .012). The children from the Comprehensive Risk class

were more likely to stay longer in OOH care than those

from all other classes (post hoc: t = 2.61, p = .011;

t = 4.16, p = .000; and t = 2.36, p = .021, respectively).

Demographic Characteristics of the Caregiver

The latent classes differed significantly by sociodemo-

graphic characteristics of primary caregivers with regard to

gender and age. However, country of birth, levels of edu-

cation, marital status, and relation to the child were not

related to class membership.

Caregivers’ gender was different by the classes

(v2 = 55.98, df = 3, 81, p = .009). Compared to the Comprehensive Risk class, caregivers in the No Risk and

Relational Risk classes tended to consist of male caregivers

rather than female caregivers (post hoc: log-odds = 3.35,

p = .023, 95 % CI, relative risk ratio = 28.62: .47, 6.24;

log-odds = 1.65, p = .014, 95 % CI .35, 2.96, relative risk

ratio = 5.23, respectively).

Table 3 Caregiver/environmental risks (unweighted n = 511, weighted N = 268,594)

Variable Weighted %

Prior report of abuse

Yes 58.44

No 37.35

Not ascertained 4.11

High stress in family

Yes 49.37

No 47.89

Not ascertained 2.74

Poor parenting skills

Yes 39.44

No 57.63

Not ascertained 2.94

Low social support

Yes 32.04

No 64.82

Not ascertained 3.14

Trouble to pay necessities

Yes 26.82

No 69.27

Not ascertained 3.91

Mental health problems

Yes 18.66

No 74.29

Not ascertained 7.05

Recent arrest

Yes 13.31

No 77.10

Not ascertained 9.59

Active drinking

Yes 11.14

No 78.49

Not ascertained 10.37

Active drug use

Yes 9.93

No 79.70

Not ascertained 10.37

Active domestic violence

Yes 9.85

No 83.89

Not ascertained 6.26

History of abuse

Yes 9.55

No 64.03

Not ascertained 26.42

Cognitive impairment

Yes 9.22

No 84.32

Table 3 continued

Variable Weighted %

Not ascertained 6.46

Inappropriate parenting

Yes 7.84

No 87.66

Not ascertained 4.50

Physical impairment

Yes 6.62

No 88.48

Not ascertained 4.89

J Child Fam Stud (2016) 25:2372–2386 2379

123

Caregivers’ age was also significantly related to the

classes (Wald F = 7.42, df = 1, 81, p = .008). As such,

No Risk caregivers were more likely to be younger than

those from the other classes (post hoc: t = -4.93,

p = .000; t = -3.19, p = .002; and t = -9.44, p = .000,

respectively). And, Comprehensive Risk caregivers were

more likely to be older than caregivers in the Historical

Risk class (post hoc: t = 2.60, p = .011).

Characteristics of the Youth

In the analysis of Wave 1 youth related factors that could

be associated with the classes, we found only two that were

significant: gender and presence of special needs. Youths’

gender was associated with the classes (v2 = 17.65, df = 3, 81, p = .023). Three of the classes (Historical,

Relational, and Comprehensive Risk) were more likely to

contain boys, compared to the No Risk class (post hoc: log-

odds = 3.23, p = .004, 95 % CI 1.06, 5.37, relative risk

ratio = 24.93; log-odds = 3.98, p = .001, 95 % CI 1.72,

6.23, relative risk ratio = 53.35; log-odds = 3. 39,

p = .001, 95 % CI 1.39, 5.39, relative risk ratio = 29.99,

respectively). Alternatively, girls were more likely to be

children of caregivers associated with this No Risk class.

Documentation of youths’ special needs at Wave 1 was

also associated with the classes (v2 = 78.46, df = 3, 81, p = .000). As such, those with special needs were more

likely to come from the Relational and the Comprehensive

Risk classes, compared to the Historical Risk class (post

hoc: log-odds = 1.76, p = .000, 95 % CI 1.05, 2.47, rel-

ative risk ratio = 7.25; log-odds = 1.68, p = .001, 95 %

CI 1.07, 4.29, relative risk ratio = 4.69, respectively).

Compared to the No Risk class, caregivers in the Relational

and the Comprehensive classes were also more likely to be

related to raising youth with special needs (post hoc: log-

odds = 19.31, p = .000, 95 % CI 18.60, 20.02, relative

risk ratio = 2.44e?09; log-odds = 20.23, p = .000, 95 %

CI 18.62, 21.84, relative risk ratio = 2.44e?09, respec-

tively). Finally, the No Risk caregivers relative to the

Historical Risk caregivers were less likely to be associated

Table 4 Latent Class Analysis Fit Indices by Number of Classes

Fit index Number of classes

1 2 3 4 5

Log likelihood -4868.92 -4385.49 -4052.24 -3948.64 -3838.63

AIC 9793.82 8884.97 8276.47 8127.28 7965.26

Adj-BIC 9823.57 8945.52 8367.82 8249.43 8118.22

Entropy N/A .985 .892 .916 .895

Vuong-Lo-Mendel Rubin LRT N/A 960.70 (p = .68) 674.13 (p = .65) 114.54 (p = .69) 203.46 (p = .77)

AIC Akaike information criteria, Adj-BIC adjusted Bayesian information criteria, LRT likelihood ratio test

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

C on

di tio

na l P

ro ba

bi lit

y

Historical 49.0% Comprehensive 42.6% Rela�onal 4.9% No Risk 3.5%Fig. 1 Profiles of parents’ risks for each of the latent classes.

Note: Class 1 = historical risk,

Class 2 = comprehensive risk,

CLASS 3 = relational risk,

Class 4 = no risk

2380 J Child Fam Stud (2016) 25:2372–2386

123

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J Child Fam Stud (2016) 25:2372–2386 2381

123

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2382 J Child Fam Stud (2016) 25:2372–2386

123

with youths’ special needs (post hoc: log-odds = -31.55,

p = .000, 95 % CI -33.64, -29.46, relative risk

ratio = 1.83e-14).

The second longitudinal outcome we explored (in

addition to placement status across Wave 1 and Wave 3)

was the presence of behavior problems at this subsequent

time point. Although there were high rates of total

behavioral problems (36.9 %) overall (externaliz-

ing = 37.5 % and internalizing = 25.3 %), these difficul-

ties were not significantly related to the classes.

Discussion

This exploratory study builds on the current research lit-

erature in a number of ways. First, it extends on the recent

progress in examining specific categories of child mal-

treatment (Merritt and Snyder 2014; Simmel and Shpiegel

2013; Snyder and Merritt 2014; Snyder and Merritt 2015),

especially neglect and emotional abuse. Given the hetero-

geneity in characteristics associated with types of neglect

among Western definitions of child rearing, understanding

each type of neglect and associated parental characteristics

is a complex task. Current research lacks consensus on

refined definitions of the meaning of specific types of child

maltreatment (e.g. emotional neglect), based on child and

parental characteristics. There are many complexities to

consider when assessing what parental behaviors are

neglectful and for whom (e.g. child’s developmental stage).

Second, our study offers new directions for exploring risk

factors that culminate in the perpetration of maltreatment

of adolescents (e.g., Trickett et al. 2011; Villodas et al.

2012). Third, this study advances the methodological

approaches utilized in recent research on child maltreat-

ment and child welfare (Fowler et al. 2013; Li and Godinet

2014) by using the person-centered method of Latent Class

Analysis (LCA) in a large, nationally representative sample

of adolescents involved with the child welfare system. It is

important to underscore the uniqueness of this study sam-

ple as a channel for exploring risks associated with neglect

and emotional abuse. By using a broad population involved

with child welfare systems, but not necessarily placed in

out of home care (OOH), we thus have ample heterogeneity

in the families’ presentation of risk conditions and out-

comes in children. Whereas some of our results are curious

and suited for speculative interpretation, our discussion of

the overall story and implications are framed around the

most salient and meaningful results.

The identification of four distinct classes of caregiver

risk (Historical Risk, No Risk; Relational Risk; Compre-

hensive Risk) among child neglect categories provides the

template for an assessment of covariates at the child, par-

ental, and situational level. Caregiver risk among parents inT a b le

5 c o

n ti

n u

e d

V a ri

a b

le P

e rc

e n

ta g

e (M

e a n

)

C la

ss 1

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to ri

c a l

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C la

ss 2

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m p

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sk

C la

ss 3

R e la

ti o

n a l

ri sk

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ss 4

N o

ri sk

v 2

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f p

C li

n ic

a l

ra n

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b 2

8 .1

3 1

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5 .0

8 .7

N o

rm a ti

v e

7 1

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8 .4

7 5

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1 .3

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te rn

a li

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s 3

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(5 9

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ta l

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m s

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7 3

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F o

r c a te

g o

ri c a l

v a ri

a b

le s,

u n

c o

rr e c te

d C

h i

sq u

a re

te st

s w

e re

u se

d .

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r c o

n ti

n u

o u

s v

a ri

a b

le s,

a d

ju st

e d

W a ld

F te

st s

w e re

u se

d a

T sc

o re

s in

th e

A c h

e n

b a c h

‘s C

h il

d B

e h

a v

io r

C h

e c k

L is

t (C

B C

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w e re

u se

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s in

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sc a le

o f

6 4

o r

m o

re

J Child Fam Stud (2016) 25:2372–2386 2383

123

this sample is nearly evenly split between those who have a

personal history of abuse or neglect (‘Historical Risk,’

Class 1) and those who have a whole host of risk deter-

minants (‘Comprehensive Risk,’ Class 4). Fewer parents

proportionally suffer from both a history of abuse and lack

of social support or those with no risk factors than those

with a comprehensive set of risk factors or only a history of

abuse. This supports initiatives that intentionally maximize

services with particular attention to the intergenerational

transmission component of learned behavior, as well as

cases wherein there are a multitude of co-occurring risk

factors.

This study supports the work of Thornberry and Henry

(2013), in that parents who have suffered previous abuse

have a propensity for maltreatment of their children into

the adolescent stage of development of their children.

Despite the dearth of research demonstrating a salient link

between the history of abuse as a sole predictive factor

related to types of neglect, a cycle seems to be at play,

worthy of future research and accompanying appropriate

service design and delivery. Above and beyond any expe-

riential or environmental risk factors manifesting in

adulthood, the sole experience of having a history of

childhood abuse should be considered a risk to address in

preventative services. Services should begin with the

identification of prior exposure to child maltreatment fol-

lowed by efforts to encourage positive parenting tech-

niques in an attempt to minimize the impact of negative

learned behavior. Moreover, parents with only a history of

abuse and those with a comprehensive set of risks would

benefit from tailored services to address their individual

and environmental challenges and encourage positive par-

enting behaviors.

Our results did not provide insight as to how caregiver

risk factors manifest among the assessed maltreatment

types. This is an interesting finding that child neglect types

(e.g. emotional abuse; physical neglect; supervisory/moral/

legal/educational neglect; abandonment) do not signifi-

cantly differ across caregiver risk classes. This is quite

likely due to the co-occurrence of maltreatment types

inherently captured in the NSCAW derived variable, thus

muddying potential associations. An additional potential

limitation here is that our sample size was relatively small

for detecting significant differences between the abuse

types. Future assessments regarding the correlates of

specific types of maltreatment would be beneficial pro-

viding the sample size was ample to make reliable infer-

ences. Our sample did not allow for an inquiry specific to

the maltreatment types comprised in the ‘other forms of

neglect’ category. We entered into this research without

specific expectations regarding how classes of caregiver

risk might associate differentially with maltreatment type,

however, these findings suggest a need for service

development suitable to address the co-occurrence of

multiple types of neglect in a broad manner.

Additionally, given risk factors are more salient once

families are subjected to the oversight of the child welfare

system (post baseline data collection), perhaps the risk

determinant’s of parents is less so linked to initial child

welfare involvement (i.e. precipitating factors inciting an

investigation and caseworker determination) than the

trauma triggered when parents are placed under the

supervision of the child welfare system. Such that it fol-

lows, caregiver risk factors play a larger role once children

are placed in OOH care, which may play a role in children

being ultimately placed in care and the increased length of

time in placement between Waves 2 and 3. Policy and

service enhancements would be best designed foremost in

consideration of the placement outcomes, both based on

maltreatment type and resulting from involvement with the

child welfare system. Secondarily with respect to the

caregiver traits most closely associated with the type of

maltreatment in addition to parental report of a history of

maltreatment.

Moreover, given there were no significant associations

with the specific types of maltreatment and caregiver risk

factors at baseline data collection, these results are most

useful for understanding how caregiver risk factors are

related to specific child/caregiver demographic character-

istics. Consistent with previous research (Simmel 2010),

our study finds types of child maltreatment are best

assessed through the identification of associations between

specific child and caregiver demographic characteristics.

Not surprisingly and perhaps as validation of cautious

caseworker decision making, youth under the care of par-

ents plagued by multiple maltreatment risk factors are

placed in out of home care and remain for longer periods of

time (between the last two waves of data collection) under

the purview of child welfare oversight. Further, youth

cared for by parents indicating a history of child abuse

were deemed more likely in need of OOH placements than

parents without salient risk factors for maltreatment.

Whereas, we cannot speculate as to why these youth were

flagged as a more pressing consideration for services, there

is clearly a prevalence of maltreated youth in out of home

care among caregivers who endured child maltreatment as

well.

Of note, more men classified by either the absence of

risk factors, or a history of maltreatment coupled with low

social support, compared to women were more likely to

display multiple risk factors (Comprehensive Risk). These

findings suggest at the very minimum, the need for services

to provide basic parenting support for men, while

addressing any indication of a history of maltreatment.

Additionally, women whom are considered primary to the

rearing of children are especially vulnerable to co-

2384 J Child Fam Stud (2016) 25:2372–2386

123

occurring parental challenges, indicating a need for com-

prehensive services in an effort to prevent child neglect

based on their particular individual and environmental

contexts.

Whereas, one might assume younger parents would have

a more difficult time with fulfilling a new parental role, it

seems younger parents in this sample are less likely to

display noticeable caregiver risk factors. Similarly and

perhaps due in part to the trials that come along with life

experience, older parents are more likely to classify in the

group enduring multiple challenges (Comprehensive Risk)

related to parenting. Older parents, who have endured a

longer time in the more challenged strata of our society,

have likely experienced myriad parental challenges. Fur-

ther, by the sheer virtue of having experienced more life,

one might be understandably more prone to a compre-

hensive set of risks.

In addition to the gender differences among caregivers,

our results indicate some striking youth gender differences

as associated with caregiver risk factors. As such, the

findings suggest that support for parents of boys may need

heightened attention based on the finding that boys are

more likely cared for by parents classifying in the three

classes indicating a range of risk factors from solely a

history of abuse to multiple challenges. Comparatively,

girls are significantly more likely to be cared for by those

parents without any identified risk factors.

The challenges of parenting are even more heightened

when caring for a youth with special needs (i.e., emo-

tional and behavioral health difficulties). Not surprisingly,

youth with special needs are less likely associated with

parents without salient risk factors than those parents with

a history of personal experiences of abuse and neglect.

Similarly, special needs children are more likely cared for

by parents with low social support and multiple risk

factors, including a history of abuse and neglect than

parents with an absence of risk determinants. Good

practice would support flagging parents displaying mul-

tiple risks and also caring for youth with special needs in

an effort to buffer the extraneous parenting challenges of

caring for a special needs youth.

As child behavior differs according to age group, so fol-

lows parental behavior as a response to these developmental

stages, and based on the parent–child relationship. In order to

address distinct forms of maltreatment, particularly neglect

and emotional abuse, one must understand how develop-

mental stages are associated with each of these forms of

abuse. Because our study emphasized caregivers risk factors

associated with collective types of emotional abuse and

neglect—as opposed to between these types of maltreat-

ment–we were able to highlight demographic characteristics

distinctly associated with certain classes of caregiver risk

factors. In addition to a need for useful intervention

approaches that focus attention on specific caregiver traits

according to age related levels of risk, prevention efforts

should be driven by early assessments of these risk factors

prior to children and adolescents being placed and spending

an inordinate amount of time in OOH care.

Our findings should be interpreted with caution due to

certain inherent limitations in this secondary dataset. For

instance, our analyses were limited in that our research

questions were confined to the parameters of the dataset. Of

note is that the measures of caregiver risk factors, though

culled from protocols used by state child welfare profes-

sionals, are only dichotomous indices of such risks and do

not reflect the degree to which these difficulties manifest in

families’ lives. Missing data on certain variables across

waves may have hindered our sample size. Although we

were able to include a comprehensive set of covariates due

to the richness of the dataset, we cannot be certain that we

have captured all the possible explanatory associations

with each of the classes. For instance, the out of home

placement (OOH) variable is comprised of quite distinct

caregiver settings, and thus doesn’t allow us to comment on

differences between these types of settings, such as foster

care versus kinship care or group homes. Further, the

maltreatment type variable is limiting in that it assesses the

most serious type of maltreatment in the context of likely

co-occurrence among types.

In sum, this exploratory research indicates parents with

a history of childhood abuse and those with multiple

combined risk factors are clearly vulnerable to poor par-

enting practices. Although our results confirm reasonable

expectations, our study further supports the notion that

intergenerational transmission of abusive behavior is a

salient characteristic to address in efforts to prevent the

perpetuation of maltreatment (Pears and Capaldi 2001;

Thornberry and Henry 2013; Thornberry et al. 2012).

Further, addressing comprehensive risk factors, especially

for female caregivers, is paramount in supporting families

with adolescents at risk for maltreatment, as well as

decreasing the time spent in OOH care. Ideally, com-

prehensive services are needed to address the complexi-

ties of co-occurring risk factors at multiple levels (i.e.

endogenous, micro level, as well as environmental) with

specific attention to understanding risk factors affecting

caregivers of adolescents. We would suggest future

research continue to tease out ways in which parents can

be supported (based on their specific circumstances and

accompanying challenges) and youth (based on their

endogenous issues) can be protected from harm, particu-

larly nebulous forms of maltreatment, such as neglect and

emotional abuse. Our research findings reinforce the

existing literature suggesting that the child welfare system

lacks a comprehensive prevention focus for families with

adolescents.

J Child Fam Stud (2016) 25:2372–2386 2385

123

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