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Child Abuse & Neglect,Vol. 19, No. 2, pp. 233-249, 1995

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THE

MEASUREMENT

OF

MALTREATMENT:

A

COMPARISON

OF

APPROACHES

ROBIN

A.

MCGEE,DAVID A.

WOLFE,

AND

JEAN

A.

CARNOCHAN

SANDRA

YUEN,

SUSAN

K.

WILSON,

The University of Western Ontario, London. Ontario, Canada

Abstract--This study examined the comparability and predictive validity of three approaches to the measurement of child maltreatment. Adolescents (N = 160, aged I I-17) were randomly selected from the open caseload of a child protection agency. Global ratings of maltreatment severity were made by three reporting sources: researchers on the basis of protection agency case files, protection agency social workers, and the adolescents themselves. Ratings were made of five types of maltreatment: physical, sexual, emotional, neglect, and exposure to family violence. Self- reported (YSR) and caretaker-reported (CBCL) adjustment measures were also obtained for each subject. Results

indicated that over 90% of the sample had experienced more than one type of maltreatment. Comparison of ratings across sources indicated considerable disagreement with respect to judgments of maltreatment occurrence and severity.

and internalizing symptom-

Relative to professional ratings, adolescent ratings were better predictors of externalizing atology in both univariate and multivariate analyses.

Key Words--Maltreatment, Measurement, Adolescents.

INTRODUCTION

THE DOCUMENTATION AND measurement of maltreatment is a critical issue in child abuse and neglect research. Several authors have stressed the crucial importance of adequate conceptual and operational definitions of maltreatment (Aber & Zigler, 1981; Besharov, 1981; Cicchetti & Barnett, 1991; McGee & Wolfe, 1991b; Plotkin, Azar, Twentyman, & Perri, 1981). The purpose of the present study was to compare and contrast three approaches to the measurement of maltreatment: ratings obtained through child protection social workers, researchers of protection agency case history files, and adolescent victims. Each reporting source was scrutinized with respect to the information it provided regarding maltreatment occurrence, maltreatment severity, and potency in the prediction of externalizing and internaliz- ing adjustment problems in adolescence. In 1981, Aber and Zigler outlined three perspectives that have influenced the research definition of maltreatment: the medical-diagnostic approach, the legal approach, and the socio- logical approach (Cicchetti & Barnett, 1991). In the medical approach, maltreatment is defined by physical injury to the child (e.g., Kavanagh, 1982). In the legal approach, maltreatment is

The data for this study were part of the doctoral dissertation of the first author, who was supported by a Social Sciences and Humanities Research Council of Canada Doctoral Fellowship. Data collection was supported by a grant from the Medical Research Council of Canada to the second author.

Received for publication

December 8, 1992; final revision received November 22, 1993, accepted November 29,

1993.

Requests for reprints should be addressed to Robin McGee, Ph.D., Child & Adolescent Mental Health Services, Valley Regional Hospital, 150 Exibition St., Kentville, Nova Scotia, Canada B4N 5E3,

233

234 R. A. McGee,D. A. Wolfe, S. A. Yuen, S. K. Wilson, and J. Camochan

that which results in measurable serious harm to the child (although not necessarily physical harm). In the sociological approach, maltreating acts are defined by society or the state. The sociological perspective is the conceptual approach to definition employed most com- monly in previous maltreatment research. Using this perspective, maltreatment is operationally defined by a family's involvement with a child protection agency. Most commonly, the specific type of maltreatment is defined by the official reason for service identified by the protection agency (e.g., Wolfe & Mosk, 1983). Recent studies have extended this approach to include severity ratings made by child protection workers (e.g., Strainer & Thieman, 1991; Wolfe, Gentile, & Wolfe, 1989). Although the sociological approach has the advantage of ensuring social relevance, opera- tional definitions based on this approach will vary across nations and cultures. In an effort to improve reliability, some researchers have sought to quantify maltreatment on the basis of protection agency records (e.g., Barnett, Manly, & Cicchetti, 1991). Researchers may not rely solely on state-derived definitions; rather, they seek to develop their own criteria for the operational definition of maltreatment using previous theory and research. Recently, a new approach to measuring maltreatment has emerged. In this "subjective" tradition, maltreatment is defined by the victim. Maltreatment is operationally defined by respondents' self-report of occurrence and severity, rather than "objective" criteria dictated by legal or statutory requirements. Self-report methods of quantifying maltreatment are most evident in retrospective studies of the maltreatment history of adults (e.g, Briere & Runtz, 1988; Rausch & Knutson, 1991) and adolescents (Powers, Eckenrode, & Jaklitsch, 1990; Stiffman, 1989). Typically, this approach has involved global severity ratings (e.g., Ney, Moore, McPhee, & Trought, 1986) or frequency ratings of specific items (e.g., Berger, Knutson, Mehm, & Perkins, 1988). Regardless of the conceptual approach employed, much of the previous research has opera- tionally defined maltreatment using broad labels (e.g., "physically abused") to categorize children. An occurrence/nonoccurrence judgment is made on the basis of information from a reporting source. This practice suffers from two important limitations. First, it disregards the heterogeneity and co-occurrence of maltreatment--most maltreated children experience more than one type of abuse. Second, it ignores the variance in outcome attributable to maltreatment severity. These problems have led several authors (e.g., Barnett et al., 1991; McGee & Wolfe, 1991a, 1991b) to argue for the continuous measurement of maltreatment using designs that acknowledge the reality of multiple maltreatment experiences. Another methodological consideration in maltreatment impact research concerns the opera- tional definition of "outcome." The legal approach to maltreatment definition suggests that psychological harm to the child should be quantified using standardized, norm-referenced measures of adjustment. Unfortunately, much maltreatment research has employed arbitrary indices of behavior and emotional problems (e.g., Vissing, Straus, Gelles, & Harrop, 1991). The source that reports on victims' adjustment has also varied across studies. Operational definitions of "adjustment problems" have included opinions of social workers (e.g., Conte & Schuerman, 1987), impressions of trained observers (e.g., Claussen & Crittenden, 1991), parent- report measures (e.g., Jaffe, Wolfe, Wilson, & Zak, 1986), and self-report measures (e.g., Briere & Runtz, 1988). As meta-analytic research has revealed considerable discrepancies between self- and third-party reports of adjustment (Achenbach, McConaughy, & Howell, 1987), equivocal findings in the previous literature may be due to this plethora of measurement approaches. Despite the increasing sophistication of our measurement practices, there is no information on the basic concordance or equivalence of different approaches to maltreatment measurement. Multimethod quantification is vital to the establishment of validity in nonexperimental research

Measurementof maltreatment

235

(Cook & Campbell, 1979). The present investigation sought to represent the major conceptual traditions while simultaneously refining the operational definitions of maltreatment and adjust- ment. The study compared two operational definitions from the sociological tradition with one from the "subjective" self-report tradition. In consideration of the sociological tradition, subjects were adolescents from a child protection agency. To assess the state-derived sociologi- cal approach, global ratings of the severity of adolescents' maltreatment experiences were obtained from the adolescents' protection workers. To assess a more research-based sociologi- cal perspective, global ratings were also obtained by researchers who rated the protection agency files. In consideration of the "subjective" tradition, global ratings were also obtained from the adolescent him or herself. To ensure comprehensive measurement, each of five types of maltreatment were measured distinctly and continuously: physical, sexual, emotional, neglect, and exposure to family violence. Standardized norm-referenced measures of symptom- atology were employed to ensure reliability, validity, and clinical relevance. To avoid mono- source bias, adolescent adjustment was evaluated using two sources: the adolescent's caretaker and the adolescent him or herself.

METHOD

Subjects

Two hundred and fifty-nine adolescents were invited to participate in the study. All adoles- cents were randomly selected from the open caseload of a Canadian child protection agency.

A control group could not be employed in the study design, as nonagency youth do not have

records describing their maltreatment histories. Apart from age, there were no other selection

criteria for potential participants; that is, they were not selected on the basis of maltreatment history or any other characteristic. One hundred and sixty-two adolescents elected to participate

in the study. Of these, two teens returned unusable data. Thus, 160 adolescents (70 males, 90

females) were retained in the study (62% participation). Subjects were between the ages of

11 and 17 years, with a mean age of 13.8 years. The data presented were part of a larger study

of the impact of maltreatment on adolescent adjustment.

Approximately half the sample (56%) resided with their biological mother at the time of recruitment, a quarter (23%) were in agency care, and the remainder lived with other relatives. The adolescents and/or their families had been involved with the protection agency for an average of 6 years. Most of the respondents (69.4%) had entered agency care at least once. The average age at which subjects first entered care was 8.8 years for an average duration of 12.5 months. The adolescents and/or their families were involved with the agency for a wide variety of family problems. For each family, the child protection agency codes an "official reason for service." Based on this code, most subjects were serviced for parent-child conflict (47%), followed by neglect (17%), physical abuse (15%) and personal counselling (12%). Smaller proportions were coded as sexual abuse (6%), family violence (2%), or emotional

abuse (1%).

MEASURES

AND

PROCEDURES

Maltreatment Ratings

In the protection agency, each youth is assigned a primary social worker who is responsible for protection as well as other service issues. The worker is also required to maintain a case

236 R. A. McGee, D. A. Wolfe, S. A. Yuen, S. K. Wilson.and J. Carnochan

file on the adolescent. Global severity ratings were obtained from each reporting source (social workers, file researchers, and adolescent victims) using the same rating scale. Each source was asked to rate "the extent to which the adolescent had experienced five types of maltreatment":

physical, sexual, emotional, neglect, and exposure to family violence. Maltreatment experiences were rated along a four-point scale: 0 ("not at all"), 1 ("mildly"), 2 ("moderately"), and 3 ("severely"). Separate ratings were made for each of three possible perpetrators: biological mother, biological father, or "other" (step, adoptive, and foster parents were considered to be "other"). A score for each type of maltreatment was obtained by taking the maximum rating across perpetrators.

File researcher ratings. Two file researchers were employed in the current study: the first author and a trained research assistant with 3 years experience in child protection. The criteria employed by the researchers in determining severity ratings were based on a system developed for a more complex and detailed measurement instrument. On the basis of conceptual arguments made elsewhere (McGee & Wolfe, 1991a, 1991b), researchers' ratings were based upon the parental behavior described in the case file, not its impact on the child. This fundamental principle was employed to avoid the conceptual tautology inherent in defining maltreatment by adjustment. Each maltreatment type was defined by gradations along a specified dimension. Thus, severity of sexual abuse was defined by gradations in penetration and force (Russell, 1983). Family violence and physical maltreatment were quantified by the degree of violence employed (Straus, 1979). Neglect was quantified by the pervasiveness and extent of the viola- tion of basic needs (Zurvain, 1991). Emotional maltreatment was defined as verbal abuse and aggression (McGee & Wolfe, 1991b; Vissing et al., 1991). Severity of emotional maltreatment was defined through minor insensitivity through to direct assaults on the child's sense of self or safety. For all maltreatment types, chronicity and frequency of the caretaker behaviors were often taken into account when making the rating. The specific criteria were determined through a priori consultation and consensus with experts, and established through practice using actual and hypothetical case information. The coding scheme employed by the file researchers is described in the Appendix. The names of potential participants were selected at random from the open caseload of the protection agency. Once a name was selected, the research coordinator contacted the youth's primary social worker. The worker could elect to approach the family personally regarding participation. Alternatively, the worker could authorize sending the family a letter that described the project and indicated that research personnel would telephone them shortly regarding their willingness to participate. The research was explained to parents and teens as a study on the relationship between background life events in childhood and current adjustment in adoles- cence. If family members were willing to participate, a research assistant visited them at home. During this visit, the assistant obtained informed consent from both the adolescent and the parent. Once an adolescent and the caretaker agreed to participate, one of the two researchers examined the target adolescent's protection agency case history file. These files included caseworker notes, police reports, assessments compiled by intervening professionals (e.g., physicians, psychologists, public health nurses), foster or residential care progress reports, juvenile and family court summaries, school records, documents pertaining to legal issues (e.g., wardship status), all the agency's correspondence regarding the adolescent, and any other relevant material. Using this wealth of information, the researchers completed a detailed mea- sure summarizing the adolescent's maltreatment history. They then made global ratings of each type of maltreatment, using the format described previously. The first author and the assistant reviewed 40% and 60% of the cases, respectively. For 20% of the sample, both

Measurement of maltreatment

237

researchers rated the same cases: interrater reliability (Pearson r) on the global ratings was very good. They were as follows: .79 for both neglect and emotional maltreatment, .87 for family violence, .89 for physical maltreatment, and .96 for sexual abuse.

Social worker ratings. After completing the file ratings, a researcher met with the primary protection worker of the target adolescent. The protection worker was asked to complete the global ratings of the adolescent's maltreatment experiences. Although the worker made his or her ratings in the presence of a file researcher, the worker was blind to the ratings made by the researcher. Workers were not given the severity definitions developed by the researchers; rather, they were asked to complete the ratings on the basis of their professional judgment and training (and, of course, their experience with the target family). This was done to allow for an uncontaminated estimate of the state-determined sociological approach to the definition of maltreatment severity. Approximately 40 protection workers were involved in the study. On average, workers had

worked with the target adolescent for 18 months (SD =

they knew the case, on a scale of 1 ("do not know at all") to 5 ("know extremely well"). For the majority of the 160 subjects (58.8%), the workers indicated that they knew the case very well or extremely well. For an additional 33.1%, workers knew the case somewhat well. The remainder (8.1%) were rated as cases of which the worker knew very little. In no instance did a worker indicate that he or she did not know a case at all. Unfortunately, test-retest and interrater reliability estimates could not be obtained for agency social workers. Because the amount of time agency personnel could spend on the project was limited, and because they were already extensively involved in other project tasks, it was not feasible to have them rate each other's cases or to rate several cases twice. However, previous psychometric research has suggested that protection workers are sensitive to differences be- tween cases and substantially agree on maltreatment when examining the same case (Alter, 1985; McGee & Wolfe, 1990).

14.02). Workers also rated how well

Adolescent ratings. Each target adolescent was individually interviewed by the two researchers. This interview occurred approximately 2 weeks after the researchers and social workers had made their ratings. During the interview, each subject completed the global ratings of his or her maltreatment experiences. Adolescents were not specifically instructed in the definitions developed by the researchers to ensure that the "subjective" measurement tradition was represented without undue influence. Nevertheless, in the interests of ensuring comprehension and reliable interpretation across adolescents, each type of maltreatment included brief and broad behavioral examples. The examples were as follows: physical maltreatment was prompted as "hit or slapped;" sexual maltreatment was "touched in a sexual way that made you uncomfortable;" exposure to family violence was "witnessing physical fighting between parents and/or their partners;" emotional maltreatment was "being criticized, yelled at, or treated unfairly;" and neglect was "not being cared for properly (e.g., lack of food, medicine), ignored, or not paid attention to." To avoid the minimization that can occur when experiences are labelled "abuse" (Berger et al., 1988), prompts referred to the experiences as "mal- treatment." Test-retest reliability of adolescent ratings was established on a subsample of 33 subjects (20% of the sample). The retest interval ranged from 10 days to 113 days, with a mean of 31 days. Retest reliability coefficients (Pearson r) were very good, and were as follows: .70 (emotional), .89 (neglect), .90 (physical), .92 (family violence), and .93 (sexual).

238 R.A. McGee,D. A. Wolfe,S. A. Yuen, S. K. Wilson,and J. Carnochan

Adjustment Measures

Two measures were used to quantify internalizing and externalizing symptomatology. These measures were completed by the adolescent and the caretaker during a home visit that took place 1 week prior to the personal interview with the adolescent.

The Child Behavior Checklist. The CBCL (Achenbach & Edelbrock, 1983; Achenbach, 1991a) is a well-standardized measure of the social competence and behavior problems of children aged 4 to 18. It is completed by the child's primary caretaker. The CBCL yields an Externalizing and Internalizing scale. The present study employed the 1991 norms for this instrument. The CBCL has excellent test-retest reliability, with an mean test-retest reliability for behavior problems of .89 over a 1-week interval. The mean stability coefficient for behavior problem scores was .75 at 1 year and .71 at 2 years. Mean interparent agreement ranged from .65 to .75. The CBCL has also demonstrated excellent construct validity, correlating .82 with the Conner's Parent Questionnaire and .81 with the Quay-Peterson Revised Behavior Problem Checklist (Achenbach, 1991a).

The Youth Self-Report. The YSR (Achenbach & Edelbrock, 1987; Achenbach, 1991b) is a self-report measure of social competence and behavioral difficulties appropriate for adolescents aged 11 to 18. It is virtually identical to the CBCL in format and content, but is completed by the adolescent. Like the CBCL, the YSR was reformed in 1991 (Achenbach, 1991b). On the new revision, the subscales that comprise the Internalizing and Externalizing factors are entirely consistent with those on the CBCL. Reliability estimates at 1-week retest for the YSR total scores are very good, ranging from .79 to .81. Longer-term stability is moderate, with a mean of .49 at 7-month retest (Achenbach, 1991b). In the present study, CBCL and YSR internalizing and externalizing scales correlated moderately with their counterparts on the other measure, at .36 and .41 respectively; these findings are consistent with those reported by Achenbach (1991 b).

RESULTS

Analyses are reported in two sections. The first section concerns the degree of concordance among reporting sources; that is, the degree of agreement regarding maltreatment occurrence, and the agreement regarding maltreatment severity. The second section concerns the predictive validity of the measurement approaches. The multivariate and univariate correlation of mal- treatment ratings from each reporting source with each adjustment measure are reported. Also, the increment in prediction of adjustment due to one reporting source relative to the others was explored using hierarchical regression analyses.

Concordance Between Reporting Sources

Occurrence. For each reporting source, for each type of maltreatment, ratings were coded into occurrence/nonoccurrence judgments. A nonoccurrence judgment was coded when the source rated the maltreatment dimension as "not at all" for all possible perpetrators. Table 1 reports the percentage of the sample experiencing each type of maltreatment, according to each source. It illustrates the extent of multiple maltreatment in a child protection population. According to the "official" sources (file researchers and social workers), more than one-third of the sample had been sexually abused, two-thirds had been physically maltreated and/or witnesses to family violence, nearly 80% had experienced neglect, and virtually all (approximately 90%)

Measurement of maltreatment

239

Table 1. Percentage of the Sample Experiencing Maltreatment, According to Each Reporting Source

Percentage Maltreated

By

By

Maltreatment

Biological

Biological

By

 

Type

Mother

Father

Other

Overall

Social Workers

 

Physical

47.5

31.2

31.9

73.1

Family violence

58.7

40.0

37.5

61.3

Sexual

0.0

8.1

32.5

37.5

Emotional

76.9

51.9

45.0

94.4

Neglect

64.4

45.6

25.6

80.6

File Researchers

 

Physical

45.0

25.6

30.0

68.8

Family violence

60.6

40.6

34.4

61.3

Sexual

0.6

10.0

34.4

39.4

Emotional

76.9

52.5

45.0

91.9

Neglect

77.5

49.5

32.5

87.5

Adolescents

 

Physical

49.4

37.5

41.3

83.8

Family violence

46.9

32.5

30.0

53. l

Sexual

0.6

7.5

28.7

34.4

Emotional

53.7

41.3

42.5

81.9

Neglect

35.6

36.2

27.5

62.5

N=

160.

had been emotionally maltreated. Moreover, according to official sources,

agency youth had experienced four of the five types of maltreatment, and 20% had experienced them all. Only 6.3% of the sample had encountered one type of victimization alone. It is worth noting that the "officialreason for service code" supplied by the agency greatly underestimated the co-occurrence of maltreatment in these cases. Percentage agreement regarding the occurrence of each maltreatment type is presented in Table 2. The percentages reported include agreement regarding both presence or absence of maltreatment. Concordance levels are greatest between social workers and file researchers, who were in agreement on an average of 87% of the cases. Approximately three-quarters of the

36% of the protection

Table 2. Percentage Agreement among Reporting Sources on the Occurrence/

Nonoccurrence of Maltreatment

Reporting Source

Maltreatment Type

 

File Researcher

Adolescent

Physical

Social Worker

81.9

73.1

File Researcher

72.5

Family Violence

Social Worker

88.7

72.5

File Researcher

77.5

Sexual

Social Worker

93. l

88.1

File Researcher

90.0

Emotional

Social Worker

92.5

81.3

File Researcher

81.3

Neglect

Social Worker

81.9

59.4

File Researcher

65.0

N=

160.

240 R.A. McGee, D. A. Wolfe, S. A. Yuen, S. K. Wilson, and J. Carnochan

time, adolescents agreed with the occurrence judgment of social workers and/or file researchers. Concordance between the adolescent and official sources is greatest for sexual abuse (over 90%), and poorest for neglect (approximately 60%). Thus, reporting sources are in agreement whether maltreatment has occurred in a background of a given adolescent the majority of the time. However, there is also considerable disagreement about the occurrence of maltreatment between the reporting sources. Table 3 illustrates the percentage of disagreements where the adolescent denied documented abuse or indicated the presence of a type of maltreatment unknown to the agency. As can be seen, patterns of disagreement vary with the type of maltreatment. For sexual abuse, the disagreement was fairly low, with adolescent denials (7.5%) slightly outnumbering new disclosures (2.5%). For physical maltreatment, 18.8% of the adolescents reported being physically maltreated, even though the agency had no information of this kind. However, for all other types of maltreatment, adolescents tended to deny documented occurrences. Over 16.3% denied family violence, 14.4% emotional maltreatment, and 29.4% neglect--all in instances where social workers and agency records indicated that these forms of maltreatment had occurred. These findings suggest considerable discrepancies in the percep- tions of victims and official sources regarding the definition of maltreatment occurrence.

Severity. Multiple measures of the same construct (e.g., physical maltreatment) existed for each subject. Therefore, repeated measures MANOVA was employed to compare overall mean differences in maltreatment severity ratings. The results indicated mean differences in severity ratings for physical maltreatment (F(2, 158) = 19.9, p < .0001), emotional maltreatment (F(2, 158) = 6.9, p < .001), and neglect (F(2, 158) = 11.7, p < .0001). Planned contrasts were conducted to compare adolescent reports to those Of "official" sources (the mean ratings of social workers and file researchers are averaged by the contrast procedure). The results indicated that adolescents' ratings of physical maltreatment (M = 1.61) were greater than those of officials (M = 1.20), p < .0001. Adolescents' ratings of emotional maltreatment (M = 1.61) and neglect (M = 1.29), however, were lower than those of official sources (M = 1.95 and M = 1.61, respectively, ps < .002). There were no mean differences between sources for either family violence or sexual abuse. On average, therefore, adolescents appeared to regard

Table 3. Percentage Disagreement between Adolescents and Official Sources Regard-

ing the OccurrencefNonoccurrence

of Maltreatment

Type of Disagreement with Adolescent

Official Source

Official Source

 

Yes/

No/

Maltreatment Type

Official Source

Adolescent No

Adolescent Yes

Physical

Social Worker

8.1

18.8

File Researcher

6.3

21.3

Family Violence

Social Worker

18.8

8.8

File Researcher

16.3

6.3

Sexual

Social Worker

7.5

4.4

File Researcher

7.5

2.5

Emotional

Social Worker

15.6

3.1

File Researcher

14.4

4.4

Neglect

Social Worker

29.4

11.3

File Researcher

30.0

5.0

N

=

160.

Measurement of maltreatment

241

Table 4. Correlations Among Reporting Sources' Maltreatment Severity Ratings (All Sources Agree that Maltreatment Occurred)

MaltreatmentType

Reporting Source

File

Researcher

Adolescent

Physical (N = 91)

Social Worker

.63

.30

File Researcher

.31

Family Violence (N = 67)

Social Worker

.47

.01

File Researcher

.06

Sexual (N

= 47)

Social Worker

.80

.42

 

File Researcher

.37

Emotional (N = 121)

Social Worker

.49

.13

File Researcher

.16

Neglect (N = 79)

Social Worker

.52

.32

File Researcher

.02

their physical maltreatment experiences to be more severe than did official sources, but charac- terized their experiences of emotional maltreatment and neglect as milder. Adolescents and official sources also disagreed substantially regarding the severity of the adolescents' experiences, even when they agreed on occurrence. Table 4 shows the correlations between adolescents and official sources regarding severity ratings when the sample is restricted to those instances in which all sources agreed the maltreatment had occurred. The correlations are all remarkably low. Particularly poor agreement was obtained on the severity of exposure to family violence (r = .06). The best agreement was still modest (r = .42) for sexual abuse. Indeed, it would almost appear that maltreated youth and official report sources are rating different experiences.

Patterns among maltreatment types. To determine the dimensions along which the various sources conceptualized maltreatment, maltreatment ratings within each source were subjected to a principal components analysis with varimax rotation. A three-factor solution emerged for each source. For file researchers and social workers, the first factor was comprised of physical maltreatment, emotional maltreatment, and family violence while neglect and sexual abuse emerged as the second and third factors, respectively. Among adolescents, the first factor was comprised of physical maltreatment, emotional maltreatment, and neglect, with family violence and sexual abuse emerging independently. It would appear that professionals conceptualized maltreatment along the dimensions of aggression and violence, whereas adolescents conceptual- ized it along the dimension of parenting. Factor structures are based on the intercorrelations of ratings within each source. For simplicity and ease of interpretation, these intercorrelations are reported in Table 5. As can be seen, adolescents do not report a relationship between emotional maltreatment and family violence, whereas social workers and file researchers do. Emotional maltreatment was associated with family violence (r =.43) in the opinions of professionals. However, among adolescents, emotional maltreatment correlated most highly with physical maltreatment (r = .59) and neglect (r = .59), and had a poor relationship with family violence (r = .18). Nevertheless, all sources perceived similar association between physical and emotional maltreatment (r = .49 to .59), reflecting the co-occurrence of these maltreatment forms. Thus, relative to adolescents, official sources appeared to have a different perception of how maltreatment types cluster or covary.

242 R. A. McGee, D. A. Wolfe, S. A. Yuen, S. K. Wilson, and J. Carnochan

Table 5. Intercorrelations of Maltreatment Ratings within each Reporting Source

Family Violence

MaltreatmentType

Sexual

Emotional

Neglect

Social Workers

 

Physical

.38*

.29*

.55*

.29*

Family Violence

.17

.43*

.23*

Sexual

 

.18

.14

Emotional

 

.44*

File Researchers

 

Physical

.30*

.27*

.49*

.30*

Family Violence

.06

.42*

.27*

Sexual

 

.28*

18

Emotional

 

.50*

Adolescents

 

Physical

.27*

.18

.59*

.41"

Family Violence

.06

.18

.23*

Sexual

 

.14

.11

Emotional

 

.60*

N =

160.

*p

<

.005.

Predictive Validity of Each Reporting Source

Correlations with behavior problems. Professionals and adolescent victims may disagree about the occurrence or nature of the maltreatment experience. Which reporting source best predicts current adolescent adjustment problems? Table 6 displays the univariate correlations obtained between ratings of each maltreatment type and the four adjustment measures, for each of the three reporting sources. It also displays the multivariate correlation obtained by simple regression in which all five maltreatment ratings are used to predict each adjustment measure. Some robust relationships were detected. Sexual abuse severity was significantly associated with caretaker-reported (CBCL) internalizing across sources, and physical maltreatment was associated with self-reported (YSR) internalizing by both researchers and adolescents. Gener- ally, however, few significant correlations between maltreatment and adjustment resulted from either social workers' or file researchers' ratings. In the multivariate context, the severity ratings made by social workers were not associated with any measure of adjustment. Ratings by file researchers fared somewhat better: in a multiple regression, they were able to predict a significant amount of variance in caretaker-reported (CBCL) internalizing (R -- .29, p < .05). On a univariate level, researchers' ratings of emotional maltreatment correlated .22 (p < .01) with caretaker-reported (CBCL) internalizing. In contrast, adolescent maltreatment ratings predicted a significant amount of variance in three of the four adjustment measures: self-reported (YSR) internalizing (R = .38, p < .001) and externalizing (R = .30, p < .01), as well as caretaker-reported (CBCL) internalizing (R = .27, p < .05). At the univariate level, the largest correlations were obtained between self- reported (YSR) internalizing and severity ratings of emotional maltreatment (r = .37, p < .001) and neglect (r = .25, p < .01),

Incremental predictive value. Hierarchical regressions were computed to determine if addition of information from one reporting source improved prediction of adjustment beyond the infor- mation afforded by another reporting source. Controlling for the contribution of one reporting

Measurement of maltreatment

Table 6. Uulvariate and Multivariate Correlations of Maltreatment Ratings with Adjustment Measures

Adjustment Measures

243

 

Maltreatment

CBCL

CBCL

YSR

YSR

Source

Type

Internala

Externalb

Internalc

Externald

Social Workers

Physical

.12

.12

.12

--.03

Family violence

.10

.07

-.05

--. 10

Sexual

.21"*

.15

.11

.00

Emotional

.11

.l 5

.12

.01

Neglect

.11

.00

.11

--.03

Multiple R

.23

.22

.21

.13

Researchers

Physical

.14

.15

.19"*

.01

Family violence

.04

.00

.05

--.10

Sexual

.23**

.18"*

.11

.00

Emotional

.22**

.12

.12

--.02

Neglect

.06

-.01

.05

--.09

Multiple R

.29*

.25

.20

.14

Adolescents

Physical

.18**

.05

.22**

--.02

Family violence

.08

.07

.11

.03

Sexual

.18"*

.13

.10

.05

Emotional

.16

.01

.37***

.20**

Neglect

.04

-.03

.25'*

.03

Multiple R

.27*

.17

.38***

.30**

*p

<

.05; **p < .01; ***p < .001.

N=

160.

aChild Behavior Checklist Internalizing scale. bChild Behavior Checklist Externalizing scale. Youth Self Report Internalizing scale. dYouth Self Report Externalizing scale.

source, how much more variance in adjustment can be predicted if ratings from another source are added to the regression equation? The results indicated that ratings made by adolescent victims significantly improved prediction of self-reported behavior problems above and beyond the ratings of "official" sources. In contrast, ratings made by other sources never added unique variance above that explained by adolescent ratings. Above and beyond social worker ratings, adolescent ratings added 8% (p < .05) and 10% (p < .01) to the prediction of self-reported (YSR) externalizing and internalizing, respectively. Above and beyond file researcher ratings, adolescent ratings added 9% (p < ,01) and 11% (.001) to self-reported (YSR) externalizing and internalizing. Ratings by file researchers or social workers did not add significant variance to the prediction of adjustment above that contributed by adolescent ratings, nor did they add significant variance when controlling for each other.

DISCUSSION

The results underscore an important point--adolescents from a protection agency population have typically experienced multiple maltreatment. In the present sample, over 90% experienced more than one type. "Pure" maltreatment types do not exist in reality. These findings highlight the importance of recognizing the complexity of maltreatment. Future researchers may need to critically examine the utility of the "category" approach to the measurement of mal-

244 R. A. McGee, D. A. Wolfe, S. A. Yuen, S. K. Wilson,and J. Carnochan

treatment. The "official" agency label for service, used so frequently in previous research, can often be an extremely inaccurate and simplistic representation of the actual maltreatment status of many children and youth. It behooves researchers to thoroughly document the mal- treatment histories of potential subjects, and to use statistical or design controls (e.g., protection agency control groups) to assess the unique effects of any given maltreatment type. The present study conceptually defined maltreatment using the sociological and the subjec- tive approaches. The results suggest that there are important conceptual and methodological differences in the definitions employed by each reporting source and that these differences have important implications when investigating the impact of maltreatment on adjustment. Overall, there was more agreement than disagreement regarding the presence of various types of maltreatment in the backgrounds of protection agency youth. Occurrence judgments made by social workers and file researchers were often highly concordant. The extent of concurrence of official sources with adolescents varied with the type of abuse under examina- tion. Official sources and adolescents concurred the most regarding the presence of sexual abuse, and the least regarding neglect. There were also considerable discrepancies between reporting sources. Two kinds of discrep- ancy were examined: disagreement regarding maltreatment occurrence, and disagreement re- garding maltreatment severity. With respect to occurrence, adolescents reported more physical maltreatment but less family violence, emotional maltreatment, and neglect relative to the official sources. When the entire sample was considered, disagreement regarding severity was evident for physical maltreatment, emotional maltreatment, and neglect. When the sample was restricted to those individuals for whom all sources agreed the maltreatment occurred, disagreement regarding severity was evident for all maltreatment types in that the correlations among severity ratings were remarkably low. Disagreement among reporting sources is a longstanding finding in child psychopathology research. Several studies document disagreement between children, parents, clinicians, and public officials with respect to stressful life events (Johnson, 1986) and behavioral disturbance (Achenbach et al., 1987). There are several reasons why official and subjective estimates of maltreatment might disagree. Each reporting source may possess unique information. For example, official sources often have access to information regarding experiences in the youth's infancy and toddlerhood that the adolescent cannot remember, and youth will be privy to family events that are not recorded by the agency. Also, each reporting source may employ overlapping conceptual definitions that nevertheless have unique elements. The different pattern of intercorrelations among maltreatment types found between official sources and adolescents suggests that adolescents construct or conceptualize their experience differently than profes- sionals. Adolescents appeared to view maltreatment along the dimension of inadequate parent- ing: their ratings of physical maltreatment covaried with neglect and emotional maltreatment. However, social workers and file researchers appeared to view maltreatment along a dimension of aggression: their ratings of physical, verbal, and spousal aggression covaried. Both profes- sionals and adolescents regarded sexual abuse as unlike other maltreatment types. Reporting sources may also employ different heuristics, standards, or thresholds for evaluat- ing what is considered maltreatment. Mandated by law to focus on child protection, agency personnel and their records will reflect statutory requirements when determining whether maltreatment occurred. Moreover, they will define severity in relative terms. That is, they will compare a given case to others they have seen. Lacking this basis for comparison, victims will evaluate whether an event qualifies as maltreatment by the distinctiveness and painfulness of the experience. For example, adolescents concurred with professionals most often regarding the occurrence of sexual abuse, perhaps because all sources consider this maltreatment type distinctive. However, agreement regarding sexual abuse severity was low. Examination of the

Measurementof maltreatment

distribution of self-reported sexual abuse shows that virtually all sexual abuse victims regarded their experience as severe. Thus, even when the criterion for judging occurrence is similar between sources, the heuristic for judging severity may differ. Adolescents reported greater and more severe experiences with physical maltreatment than did official sources. This finding may result from the more stringent standards for physical maltreatment employed by professionals. Some protection-related laws emphasize physical maltreatment that leaves marks or injuries; lesser types of maltreatment may not be recorded by workers. Similarly, if a family is involved with the protection agency for reasons other than physical abuse, this kind of information may be superseded in favor of more immediate casework concerns. The possibility that adolescents were exaggerating their maltreatment experiences was not supported by the relative minimization they exhibited with most other types of abuse. Moreover, previous research has found minimization of physical abuse to be common among self-reports of agency subjects (Femina, Yeager, & Lewis, 1990). Adolescents may include a broader range of parental behaviors (e.g., slapping, spanking) in their definition of physical maltreatment. Relative to professionals, adolescents underreported the occurrence of emotional mal- treatment and neglect. Verbal hostility has been found to be chronic among troubled families (Burgess & Conger, 1978; Patterson, 1982). Some protection agency youth may fail to see such interaction as abusive or even distinctive. Similarly, conditions of neglect and deprivation may be so pervasive that some victims are unaware that better parenting exists. Agreement regarding emotional maltreatment severity may be low because of the relatively greater sophis- tication of professionals' concepts of emotional maltreatment. Professionals may include such subtle but damaging dynamics as parent-child role reversal and exposure to criminal influences in their definition of emotional maltreatment--patterns that some victims may not recognize. That is, whereas adolescents may reflect on hostile verbal exchange, the social worker and file researcher may concentrate on dysfunctional and chronic family patterns. Similarly, the lack of agreement regarding neglect severity may be due to differing breadth in definition. Professionals may use specific statutory definitions to rate neglect, whereas adolescents ap- peared to have included emotional neglect and rejection in their definition. Neglect may be regarded as more of a context, and not a set of behaviors or omissions. The fact that file researchers and social workers disagreed between themselves most often regarding the occur- rence of neglect illustrates the nebulous nature of this maltreatment type. Approximately 17% of this sample denied the presence of documented domestic violence in their backgrounds. Even when teens and professionals agree that family violence occurred, their concordance regarding severity was virtually nonexistent. Some subjects may have denied or minimized the family violence for fear that their parent would be criminally charged. Others may have regarded such marital behavior as normative. Professionals quantified family violence in terms of injury or severity of the violent act; adolescents may have quantified it in terms of chronicity. Further multimethod research on the perceptions of teens regarding family violence is warranted. Another hypothesis for the discrepancies in occurrence for sexual and physical abuse bears examination. Some memory theorists (Rubin & Kozin, 1984) have proposed that life events involving physically painful stimuli are more deeply encoded and better recalled than less physically threatening experiences. Noncontact maltreatment experiences such as neglect may be more difficult to identify or remember. Because physical maltreatment and sexual abuse involve physical contact, these forms of maltreatment may be better identified or recalled in memory. Thus, adolescents may report such experiences more accurately. Overall, subjective estimates of victimization appear to be more predictive of behavior problems than objective estimates. Relative to those of professionals, victims' assessments of

245

246 R. A. McGee, D. A. Wolfe, S. A. Yuen, S. K. Wilson, and J. Carnochan

their own maltreatment severity were more predictive of current behavioral adjustment. Knowl- edge of "official" maltreatment added little to the prediction of adjustment once the victims' perceptions were accounted for. Why were adolescents' perceptions of their maltreatment histories more predictive of adjustment than those of professionals? Some of the predictive potency of self-reported maltreatment may be due to shared method variance with self-reported adjustment measures. However, that is not the whole story: Adolescents' reports of mal- treatment were also associated with caretaker-reported behavior problems. Previous research has emphasized that subjective appraisals of life events are critical to adjustment generally (Lazarus & Folkman, 1984). In the stress literature, it has been demonstrated that individuals' appraisals of stressors are more strongly associated with symptomatology than are estimates made by "expert" third parties (Lazarus, 1974; Tennen & Affleck, 1990). Victims are in a better position to evaluate the impact of a stressful experience and may incorporate impact judgments into their definition of maltreatment. These findings underscore the importance of exploring the phenomenology of child maltreatment, and the mechanisms by which children and youth appraise and interpret their experiences.

Methodological considerations. Divergence between the reporting sources may also be due to error within each source. A variety of factors can influence the information available to each reporting source and hence the extent to which they will agree. Social worker ratings can be undermined by the rapid job turnover among caseworkers, such that current workers are not familiar with the early history of a case. Also, workers may be most concerned with service provision to families on their caseload and less preoccupied with previously documented abuse. As a worker's caseload increases, it becomes more difficult to know each case intimately. Also, ongoing involvement with families may also influence how "abusive" a family is regarded by the worker. That is, current receptivity or resistance of families to service may influence a worker's perception of a child's background. Ratings by trained researchers also have their pitfalls. Case files often do not contain detailed information on the nature or degree of certain abuse types. This is particularly true for more subtle kinds of maltreatment such as emotional maltreatment. Because exposure to wife assault is not itself legally actionable as a protection issue, case files often do not describe the specific acts of family violence. Global severity ratings can therefore become subjective and prone to error and halo effects from other documented abuses. Often, files contain scant information on those families who are relatively new to the agency. Information on siblings can be rare when the investigation and casework have focused on only one child in the family. Retrospec- tive reports provided by adolescents are influenced by the limitations of memory, denial, and other biases. Adolescents' perceptions of maltreatment may vary over the course of their development. Indeed, the relatively lower test-retest coefficient for emotional maltreatment (r = .70) suggests that this maltreatment type is most subject to variability over time, and may be more likely to be influenced by recent events. On the basis of the present investigation, it appears that ratings provided by file researchers possess a slight edge over social worker ratings in the prediction of adolescent behavioral adjustment. This may occur because file judgments are likely to be more reliable, and hence have a smaller margin of measurement error. The present study sought to compare and contrast the "real life" perceptions of researchers, social workers, and adolesce~ats, respectively. For that reason, each source was free to employ its own definition of abuse occurrence and severity. Of course, if all parties had been provided with explicit definitions and inculcated regarding their application, agreement would have increased. If maximizing cross-source agreement is important to future research questions, researchers ought to fumish specific and consistent criteria to all raters.

Measurement of maltreatment

247

The use of a 4-point maltreatment scale may have resulted in some restriction of range, thereby reducing the size of the correlations in this study. The fact that significant relationships were obtained in this study, even with such restricted variables, speaks to the potency of child mal- treatment. To ensure greater variability, future studies might employ a global scale with greater potential range. Which reporting source provides the most valuable approach to the measurement of mal- treatment? The answer depends on the research question, particularly the criterion one seeks to predict. Each reporting source may be properly regarded as providing a "window" into the experience and impact of maltreatment. If a different criterion was employed (e.g., parenting competence), different results might obtain. However, because previous research has demonstrated that self-reported adjustment often differs from other-reported adjustment (Achenbach et al., 1987), and because both approaches are important to the understanding of mental health, using multiple sources to describe maltreatment and adjustment is highly recommended for future research. Taken together, the results suggest that the conclusions one draws regarding maltreatment occurrence and severity depends upon whether one employs a sociological or subjective approach to the measurement of maltreatment. In summary, the study demonstrated that youth experience a high degree of multiple maltreatment, regardless of reporting source. "Subjective" adolescent reports differed from the "sociological" state-derived or research-derived reports with respect to maltreatment occurrence and severity. Moreover, adolescent reports had greater predictive validity relative to official sources in the prediction of standardized self- and caretaker-reported adjustment measures. The findings underscore that researchers should be aware of the limitations of the methods they use and recognize that the identification of abuse occurrence and severity will vary with the reporting source and the type of maltreatment under consideration.

Acknowledgement

Thanks to Douglas Barnett for his comments on an earlier draft of this paper.

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100-128). New York: Guilford

Rtsumf--Cette 6tude a voulu d&erminer si trois mtthodes pour mesurer la maltraitance 6taient comparables et valides en tam qu'instruments pour prtdire les mauvais traitements. Dans une agence de protection de l'enfance, on a choisi 160 adolescents figts de I 1 h 17 ans, de fa~on altatoire, comme sujets pour l'ttude. On a demand6 h trois groupes de personnes de coter la stvtrit6 des mauvais traitements: les chercheurs qui ont 6tudi6 les dossiers, les agents responsables de la protection des jeunes et les adolescents eux-mSmes. On a class6 les mauvais traitements selon cing cattgories: physiques, sexuels, affectifs, ntgligence et t6moins de violence dans la famille. On a ajust6 les donntes selon que les situations 6talent dtvc~ltes par les jeunes ou par ceux qui avaient les jeunes h leur charge. Les rtsultats ont dtmontr6 que plus de 90 p.c. des jeunes darts l'tchantillon avaient vtcu plus d'une forme de mauvais traitements. En comparant les cotes venant des trois groupes, on a not6 un manque notable de consensus par rapport h la dtcision de considtrer un incident comme de la maltraitance et par rapport/~ sa gravitt. Les cotes accordtes par les jeunes eux-m~mes, compartes ~tcelles des professionnels, se sont av6rtes d'une plus grande valeur pour prtdire des sympt6mes exttriorists et inttriorists, tant dans les analyses h variables simples que les analyses h variables multiples.

249

Resumen--Este estudio examina la comparatividad y validez predictiva de tres enfoques a la medici6n del maltrato a los nifios. Se seleccionaron al azar adolescentes (N = 160, 11-17 de edad) de los casos tratados en una agencia de protecci6n infantil. Evaluaciones globales de la severidad del maltrato se realiz6 por tres fuentes de reporte: de investigadores en base a los archivos de la agencia de protecci6n, de los trabajadores sociales de la agencia de protecci6n infantil, y de los mismos adolescentes. Las evaluaciones se hicieron sobre cinco tipos de maltrato: fisico, sexual, emocional, negligencia, y la exposici6n a violencia familiar. Tambirn se obtuvieron para cada sujeto ajustes de medida con auto-reportes (YSR) y reportes del cuidador. Los resultados indicaron que m~isdel 90% de la muestra habia sufrido la experiencia de mas de un tipo de maltrato. Las comparaciones de las evaluaciones de las diferentes fuentes indicaron considerable desacuerdo respecto a los juicios sobre la ocurrencia y la severidad del maltrato. En relaci6n a las evaluaciones de los profesionales, las evaluaciones de los adolescentes eran mejores predictores de sintomatologias externas e internas tanto en los an~lisis univariados y los multivariados.

Measurement of maltreatment

APPENDIX:

CODING

SCHEME

EMPLOYED

BY

FILE

RESEARCHERS

Neglect was defined as acts of omission that deprive the child of fundamental needs (Zurvain, 1991).

1. Mild neglect was conceptualized as lapses in parenting that could be painful to the child. Examples included failure to: assist the child with important tasks, compliment the child, show respect for the child's opinions, encourage peer activity, be generally attentive, offer comfort, and/or spend time with the child.

2. Moderate items referred to acts of omission that put the child at risk for developmental deviation, and concerned parental consistency and availability. Examples included failure to: provide regular routines, provide stimulation, follow through on opportunities to enhance the child's development (e.g., therapy), provide consistent discipline, and ensure attendance at school.

3. "Severe" neglect referred to parental acts of omission that put the child at physical risk for harm. Examples included failure to: feed the child appropriately, protect from dangerous situations, provide proper medical attention, provide proper supervision, clothe the child appropriately, protect from abusive adults, and keep the home environ- ment safe.

Emotional maltreatment was defined as parental communications that could be damaging to the child's development (McGee & Wolfe, 1991b).

1. Mild psychological maltreatment referred to indirect communications that represent lapses in adequate parenting. Examples included: belittling the child's feelings, giving the child silent treatment, comparing the child to disliked others, refusing to discuss issues of concern to the child, and denigrating others the child cares for.

2. Moderate psychological maltreatment referred to indirect communications regarding the child's worth: blaming the child, denying the child's reality, placing the child in role reversal, punishing the child for failure to meet excessive expectations, ridiculing the child, scapegoating the child for family problems, speaking to the child in hostile or sarcastic manner, having emotional outbursts in front of the child, exposing the child to criminal influences, being unpredictable in discipline, and threatening other family members.

3. Severe psychological maltreatment was considered those parental acts that represent direct attacks on the child's sense of self or safety. Examples included: telling the child s/he is unwanted, destroying something the child values, denigrating the child, threatening with extreme punishment, threatening to kill or abandon, using extreme and humiliating punishment, and deliberate attempts to terrify.

Exposure to Family Violence was defined as exposure to physical violence between parents and/or parents and their partners. It was quantified in terms of the degree of violence employed.

1. Noncontact experiences (e.g., smashing, hitting, or kicking something).

2. Contact experiences that are typically nonlethal (e.g., pushing partner, slapping partner, and throwing something at partner).

3. Potentially damaging or lethal violence (e.g., beating partner, threatening, and/or use of weapons).

Sexual abuse was defined in terms of the degree of force and penetration involved (Russell, 1983).

1. Noncontact experiences (e.g., exposure, inviting the child to engage in sexual activities).

2. Contact experiences that did not involve penetration or force (e.g., fondling).

3. Contact involving penetration or force. Examples included: digital penetration, oral sex, anal sex, sexual intercourse, and all bizarre sex acts (e.g., bestiality, group sex).

Physical maltreatment was quantified in terms of degree of violence employed and the risk of potential physical harm.

1. Typical discipline situations: (e.g., spanking, grabbing).

2. Contact experiences that are typically nonlethal (e.g., shaking a grown child, throwing something at the child).

3. Potentially damaging or lethal behavior (e.g., beating the child, throwing the child, shaking an infant, strangulation, burning, and use of weapons).