Parental Distress and Abuse in Low-Income Families of Children with Behavioral Difficulties

Background and Purpose:  Complex relationships exist between poverty, parental stress, child behavior and child abuse. High levels of parental stress have been documented amongst low income families and amongst caregivers of children with behaviour problems. These high levels of parental stress have been shown to play an important role in abusive families. There also appears to be a relationship between abuse and child behavior; children who suffer physical abuse have more problems with attention, and maladaptive internalizing and externalizing behaviors in comparison to non-abused children. This study integrates these variables by investigating the relationship between parental distress and potential abuse amongst families living in poverty and caring for children who are receiving mental health services for behavior problems.

Methods: Participants included 653 caregivers of children who participated in a NIMH-funded study investigating an intervention for youth Disruptive Behavior Disorder, recruited from 14 New York public child mental health outpatient clinics. Participants were randomly assigned at the clinic level to services as usual (n=438) or the 4Rs and 2Ss (n=215) intervention, an evidence-informed, manualized, family-centered, group delivered intervention. Child inattention and oppositional behavior was assessed by the Iowa Conners Rating Scale Oppositional/Defiant and Inattention Subscales. Caregiver stress was measured by the Parenting Stress Index short form. Child abuse information was collected by caregiver self-report to the question: “have you ever been investigated for suspected abuse/neglect of your child?” Clinically significant levels of inattention and oppositional/defiant behaviors were examined using a clinical cut-off established in the literature, leading to investigations of the relationships between stress and abuse among two separate groups: those who did and did not meet clinical cut-off for child inattention and oppositional/defiant behaviors.  Data were analyzed at baseline using independent samples t-tests to examine parental stress by incidence of child abuse investigation.

Results:  Twenty-five percent of caregivers (n=148) endorsed being investigated for child abuse/neglect. Caregivers who were investigated for abuse had significantly higher PSI parent distress sub scale scores (M=32.44) than those who were not investigated (M= 28.86; t(84) = -2.24, p < .05). Caregivers of children who met clinical cut-off for inattention and were investigated for abuse had significantly higher PSI parent distress sub scale scores (M= 34.31) and significantly higher PSI difficult child sub scale scores (M=43.86) than those who were not investigated (M= 40.64; t(95) = -2.51, p < .05). Similarly, caregivers whose children met criteria for inattention and were investigated for abuse had significantly higher PSI parent distress sub scale scores (M=35.77) than those who were not investigated (M= 29.43; t(49) = -2.15, p < .05), and significantly higher PSI difficult child sub scale scores (M=42.29) than those who were not investigated for abuse (M= 39.5; t(115) = -2.02, p < .05). 

Conclusions and Implications:  Consistent with the literature, parental distress is a possible risk factor for investigation of abuse. Child behavior problems may result in parental distress that in turn poses a risk for abuse. Prevention strategies should therefore focus both on child behavior and parental management strategies that can lower levels of distress.