The Consequences of Unique and Overlapping Forms of Child Maltreatment on Adult Outcomes

Background and Purpose: In 2006, the United States Department of Health and Human Services reported that approximately 905,000 children were substantiated victims of child maltreatment. Longitudinal studies of the consequences of child maltreatment have focused on child and adolescent outcomes, however, some research suggests that the adverse consequences of early child maltreatment may reach into adulthood. Much research on maltreatment consequences focuses on single forms of child maltreatment (e.g. physical abuse, emotional abuse, sexual abuse, neglect) as predictors of later adverse outcomes, however, child maltreatment rarely occurs in isolation, suggesting substantial overlap in experiences of maltreatment. Few researchers have evaluated the consequences of overlapping forms of maltreatment, or whether specific forms of maltreatment have unique consequences, over and above general maltreatment experiences. Thus, hypotheses of the present study were (1) that overlapping, multiple forms of maltreatment would be most detrimental to adult functioning, (2) that sexual abuse and neglect would be uniquely predictive of adult problems over and above general abuse, and (3) that all forms of abuse would predict adult problems over and above general poor family functioning.

Methods: Data are drawn from the Seattle Social Development Project (SSDP), a longitudinal study of the development of positive and problem outcomes that has followed prospectively a panel of Seattle public school children, from age 10 to 30 with over 91% sample retention. The paper examines the contribution child maltreatment (assessed retrospectively at age 24) to alcohol use disorder, drug abuse disorder, depression and crime at age 30. Analyses examine the extent to which abuse experiences before age 10 contribute to difficulties in adult functioning over and above prospectively assessed (age 10-11) poor family functioning, childhood poverty and gender of child. Four maltreatment types were assessed: physical abuse, emotional abuse, sexual abuse and neglect. The long-term consequences of single type and multiple type maltreatment on these adult outcomes are examined using correlation, regression, and structural equation models.

Results: The four early abuse types formed a well fitting general abuse factor, allowing the examination of common and unique variance in abuse to the adult outcomes at age 30. Strongest prediction of adult outcomes came from the general, common-variance abuse factor, which significantly (p < .05) predicted age 30 nicotine dependence, alcohol abuse, drug abuse, major depression, and crime. In addition, early childhood sexual abuse uniquely predicted major depression symptoms over and above the contribution of general abuse and controls. All models controlled for poverty, gender and early family dysfunction (low bonding to parents, poor family management, high family conflict, harsh discipline). Conclusions and Implications: Findings indicate that overlapping, multiple forms of abuse are detrimental to adult functioning over and above early family dysfunction, poverty and child gender, and that early sexual abuse may be particularly predictive of symptoms of major depression in adulthood. The findings support a clinical view of child maltreatment as compound, with long-term consequences in adulthood, and encourage prevention efforts to address all forms of maltreatment.