536264

research-article2014

CPJXXX10.1177/0009922814536264Clinical PediatricsZand et al

Brief Report

Parental Risk for the Maltreatment of Developmentally Delayed/Disabled Children

Clinical Pediatrics 2015, Vol. 54(3) 290­–292 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814536264 cpj.sagepub.com

Debra H. Zand, PhD1, Katherine J. Pierce, PhD1, Sohail Nibras, MD1, and Rolanda Maxim, MD1 Introduction The US Department of Health and Human Services (2012) has reported that 27.1% of children younger than 3 years comprise more than one quarter of all maltreatment cases.1 It has been widely reported that children with developmental delays/disabilities are at higher risk for maltreatment than typically developing children.2 It has been documented that these children are at a 1.7 times greater risk than children without disabilities.3 While the American Academy of Pediatrics has published multiple reports and guidelines on child maltreatment, little information is available on specific, modifiable areas of parental risk. Such information is critical when providing relevant anticipatory guidance to the parents of high-risk children. The present brief report begins to fill this gap by identifying parental risk areas for the maltreatment of their developmentally delayed/disabled child and making specific recommendations for pediatric anticipatory guidance to this unique group of parents.

Method Participants The study used baseline data from the Strengthening Families Project, a prevention intervention study that tested Bavolek’s Nurturing Parenting Program4 with parents of children enrolled in a Midwestern state’s early intervention system for developmentally delayed/ disabled children. Participants were recruited through their case managers, early intervention professionals, brochures, and presentations at early intervention events. A total of 154 families agreed to learn more about the project. Eighty-four participants enrolled in the study (54.55%). Reasons for refusals included parental medical problems, scheduling conflicts, lack of interest, intervention length, limited free time, and inability to locate parents. Because there were so few male parents (N = 6) enrolled in the study, they were dropped from the overall analyses leaving a sample of 78 females. Of these

participants, 11 did not have sufficient data to reliably impute missing data so they were dropped from the analyses. Thus, the final sample consisted of 67 participants. The average age of the mothers in the sample was 30.09 years (standard deviation [SD] = 5.73, range = 19-41 years). Fifty-four percent were Caucasian, 42% were African American, and 4% were classified as “other.” Forty-nine percent of the mothers were married. For 39% of the mothers, this was their first child. Thirteen percent of participants had not graduated high school, 18% were high school graduates, 37% had some college, and 31% were college graduates. The average age of the children was 23.04 months (SD = 8.49, range = 2.79-34.60 months). Thirty-seven percent of the children were female (N = 25). Twentyfour percent were premature (N = 17), with the average number of weeks of prematurity being 8.29 weeks (SD = 4.43, range = 2-16 weeks). Diagnoses at entry into the early intervention system included language disorder (22%), global developmental delay (15%), neurological disease (13%), gross motor delay (10%), autism (9%), behavior problems (7%), deafness (4%), Down syndrome (3%), cleft palate (3%), cerebral palsy (1%), cytomegalovirus (1%), blindness (1%), muscle tone deficits (1%), and skeletal dysplasia (1%).

Design and Procedures Prior to the collection of data, all study staff were trained on human subjects’ procedures and human subjects’ approval was secured. At the time of referral, a member of the research team described the nature and purpose of the study to the parents, answered questions, and scheduled an appointment to secure informed oral and written consent, as well as administer the baseline tools. Once 1

Saint Louis University School of Medicine, St Louis, MO, USA

Corresponding Author: Debra H. Zand, Knights of Columbus Child Development Center, Saint Louis University School of Medicine, 3800 Park Avenue, 2nd floor, St Louis, MO 63110, USA. Email: [email protected]

Downloaded from cpj.sagepub.com at DUQUESNE UNIV on March 13, 2015

291

Percentage of Sample

Zand et al

100 90 80 70 60 50 40 30 20 10 0

62.7

62.69

67.16

64.18

58.21 High Risk to Abuse

25.4*

29.85** 20.9 11.9

Expecta ons

7.46 Empathy

14.93

19.4

13.43

19.4

22.39

Corporal Role Reversal Power & Punishment Independence

Medium Risk to Abuse Low Risk to Abuse

*p < .05 **p < .01 (compared to normative sample)

Parenng Domain

Chart 1.  Adult–Adolescent Parenting Inventory–Version 2 results (N = 67).

consent was secured, parents were asked to complete the study instruments. All participants were instructed to complete the tools in terms of their index child. Parents with more than 1 child in the target age-group were asked to respond in relation to the youngest child receiving early intervention services.

Measures The Adult–Adolescent Parenting Inventory–Version 2 (AAPI-2)5 is a 40-item self-report tool designed to assess parents’ attitudes toward child rearing. Items are written at a fifth grade reading level and are rated on a 5-point Likert-type scale ranging from “strongly agree” to “strongly disagree.” Responses are converted to standardized 10 scores (Sten) and subsequently categorized as Low Risk, Moderate Risk, or High Risk for Child Maltreatment across 5 risk indices: (1) Appropriateness of Expectations of Children, (2) Presence of Empathic Awareness of Children’s Needs, (3) Strong Belief in the Use and Value of Corporal Punishment, (4) Appropriateness of Perceived Parent–Child Roles, and (5) Oppressing Children’s Power and Independence. Each of the indices display significant diagnostic and discriminatory validity, distinguishing between the parenting behaviors of known abusive parents and the behaviors of nonabusive parents.6 For the current study, Cronbach’s αs for the subscales range from .64 to .83.

Results Two-sample t tests for comparison of percents were completed using StatPac’s Statistics Calculator Percent Comparison function.7 Results indicated that our sample scored significantly worse on the domains of Expectations (25.4% of current sample) and Empathy (29.85% of

current sample) resulting in a higher percentage of risk for abuse in those specific areas than Bavolek’s normative sample (normative percentage = 15.9% for high-risk group)5 (see Figure 1). No differences were found between the normative sample and our sample in terms of attitudes about corporal punishment, perceived parent–child roles, and oppressing children’s power and independence.

Discussion The present study sought to identify parental risk areas for the maltreatment of children with developmental delays/disabilities. We found that more of our parents harbored inappropriate expectations of their children and less empathetic awareness of their child’s needs than a normative sample.4 According to Bavolek and Keene,4 having inappropriate expectations about the things one’s child can accomplish suggests a parent’s lack of understanding of the developmental capacities of their child. This may result in parents demanding that their child achieve at a much higher standard than they are capable. Their children may be a means by which they measure their own competence and when they overexpect and their children fail to meet the expectations, rejection and abuse may result.8 Difficulty with empathetic awareness indicates that the parent has problems with understanding their child’s needs and accurately recognizing their child’s feelings. The parent may find it hard to understand how to nurture and encourage positive growth in their child. Bavolek and Keene4 report that such parents may be concerned about spoiling their children by spending too much time focusing on their child’s needs. When a parent does not properly understand a child’s needs/feelings, the child may become at higher risk for abuse or neglect.9

Downloaded from cpj.sagepub.com at DUQUESNE UNIV on March 13, 2015

292

Clinical Pediatrics 54(3)

Pediatricians’ Role

Funding

For pediatricians managing cases of developmentally delayed/disabled children, in addition to providing anticipatory guidance recommended by the American Academy of Pediatrics,10 we recommend at each wellchild visit, the following be done:

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The funding for this project came from Missouri’s Department of Elementary and Secondary Education.

1. Assessing parental expectations and providing ongoing education on appropriate developmental expectations to parents. This will require pediatricians to not only be able to educate parents on normative development but also to adapt this information to each child’s specific circumstance. 2. Educating parents about the difference between spoiling a child and attending to the child’s developmental needs. 3. Encouraging parents to find appropriate social support and engage in activities that promote their well-being and sense of competence. 4. Refer the parents to parental education programs that foster the development of effective parent-child communication techniques. This may require the provision of alternative communication forms (sign language) or devices as well. 5. Refer the parents to a home visiting program that can assist the family in improving positive parenting strategies and providing connections to appropriate community resources.

1. US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child Maltreatment 2011. Washington, DC: Government Printing Office; 2012. 2. Hibbard RA, Desch LW, American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatrics Council on Children With Disabilities. Maltreatment of children with disabilities. Pediatrics. 2007;119:1018-1025. 3. Sullivan PM. Violence exposure among children with disabilities. Clin Child Fam Psychol Rev. 2009;12:196-216. 4. Bavolek S, Keene J. Handbook for the Adult and Adolescent Parenting Inventory. Eau Claire, WI: Family Development Resources; 1999. 5. Bavolek S, Keene R. AAPI-2 Online Development Handbook. Park City, UT: Family Development Resources; 2010. 6. Bavolek S, Keene J. Adult–Adolescent Parenting Inventory—AAPI-2: Administration and Development Handbook. Park City, UT: Family Development Resources; 2001. 7. StatPac. StaPac Statistics Calculator for Percent Comparisons [computer program]. Bloomington, MN: StatPac; 2014. 8. Goldman J, Salus M, Wolcott D, Kennedy K. A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice. Washington, DC: Office on Child Abuse and Neglect, Children’s Bureau; 2003. 9. Joosen KJ, Mesman J, Bakermans-Kranenburg MJ, van Ijzendoorn MH. Maternal sensitivity to infants in various settings predicts harsh discipline in toddlerhood. Attach Hum Dev. 2012;14:101-117. 10. Hagen J, Shaw D, Duncan P. Bright Futures General Guidelines for Health Supervision of Infants, Children and Adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008.

Acknowledgments The authors would like to thank Nicole Thomson, Debra O’Neil, Judy Finnegan, and Heidi Atkins-Lieberman for assisting with this study.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

Downloaded from cpj.sagepub.com at DUQUESNE UNIV on March 13, 2015

disabled children.

disabled children. - PDF Download Free
338KB Sizes 0 Downloads 4 Views