Infant Maltreatment and the Targeting of Early Intervention

Background and Purpose: The present study was designed to critically examine the tendency to focus on a direct causal relationship between infant maltreatment and later behavioral outcomes. The variation seen in behavioral outcomes among maltreated children led us to hypothesize that the cumulative level of risk facing children and their families may, at least in part, account for that variation. We must consider the possibility that the precursors of early maltreatment may be sufficient by themselves to explain the adverse associated consequences through impacts on caregiver mental health and parenting capacity. Only through a more complete understanding of the transactional ecological processes in operation in at-risk families will we be able to effectively target early intervention efforts.

Methods: Participants were 842 mothers and their predominantly at-risk infants. Shortly after giving birth, mothers were interviewed using a questionnaire containing items hypothesized to be relevant to the ecological model of child maltreatment. The State Central Registry of Maltreatment was then reviewed until each child reached sixteen years of life. In addition, a subsample of 242 children was given measures for behavioral functioning and mental health at 4, 6, 8, 10, 12 and 14 years of age.

Results: Although early maltreatment does appear to be important to early functioning, the cumulative level of risk carries the day when it comes to predicting long term clinical behavioral outcomes as assessed by the Child Behavior Checklist. High-risk infants who were not maltreated have significantly worse mental health trajectories than low-risk infants who were maltreated in the first year of life. Thus, infant maltreatment itself may be best conceptualized as an important, but not singularly so, risk factor for later behavioral problems.

Conclusions and Implications: The real measure of the child's experience of early maltreatment seems to be what specific emotional and behavioral consequences can be attributed to maltreatment over and above the adverse consequences of the risky circumstances that by themselves might result in the same unfavorable outcomes. Certainly early maltreatment is associated with emotional problems, but so are poverty, maternal depression and isolation, stress, lack of parenting skills, and substance abuse. In over-analyzing maltreatment, we may be under-appreciating what else is going wrong in the lives of these children. Maltreatment gives us a window not just into the level of risk facing a family, but also the family's capacity for dealing with those stressors. In this sense, recent maltreatment is a strong predictor of current family functioning. Our data, however, suggest that in the long run the effects of early maltreatment on mental health outcomes are not as important as the overall level of risk impacting the caregiving context. This suggests that a more nuanced understanding of familial risk processes will be important for focusing our protection efforts not just on maltreatment itself but on the tremendous levels of adversity facing so many in our society. It is in this effort that we must succeed if we ever hope to turn the tide in the battle to protect our most vulnerable children and families.