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Recent research suggests that traditional family support services may not protect children when warmth and affection are absent from family relationships, writes the NSPCC's Pat Cawson.

Families where child maltreatment occurs have been the subject of much research, but the keys to the origins of abuse and neglect remain elusive. One thing we do know is that it is a complex situation. Simplistic attempts to identify a single cause of child abuse or neglect will probably mislead.

Maltreatment often happens in families beset by a mix of social disadvantage, shifting family composition, strained or violent relationships between parents, lack of family and community support, and long-term physical and mental health problems. But it is also found in prosperous, apparently stable, families. The Department of Health's report, Child Protection: Messages from Research, highlighted the fact that high-risk families were also punitive in their approach to child rearing, as the report put it: "Low on warmth and high on criticism."¹

There has been some controversy about this view, because it seems to play up the personal characteristics of parents, and offers no explanation for the consistent links found in national and international studies between social disadvantage and maltreatment.

Typically, parents who abuse or use harsh punishment have a negative view of their children, seeing them as deliberately disobedient and hostile, with worse behaviour than other children, even when independent assessment does not support this opinion.²

One of the limitations of the research knowledge base is that there has been a reliance on studies of children known to child welfare services, raising the possibility that these were not typical families but had come to notice because their family functioning was problematic. To help to address this, the NSPCC recently surveyed a random UK sample of 2,869 young people aged 18-24. This explored their experience of childhood, including abuse and neglect.³ Interviewed by BMRB International, the young people entered answers directly on to laptops in order to protect confidentiality.

The accounts of family relationships given by young people assessed as maltreated differed markedly from those of the sample as a whole. In the sample as a whole, 92 per cent described themselves as having a, "warm and loving family background", compared with only 54 per cent of those assessed as having been seriously physically abused, 46 per cent of those emotionally maltreated, 60 per cent who lacked adequate physical care, and 77 per cent whose supervision was seriously inadequate.

The answers to questions on their closeness to their parents, and how parents showed affection mirrored these results. Abusive or neglectful parents were much less likely to use all ways of showing affection, from hugs, cuddles and kisses to praise and treats. Fewer than a third of those assessed as emotionally maltreated said that they were ever shown physical affection. A fifth of the sample said that when growing up they were, "sometimes really afraid" of fathers or stepfathers, and 7 per cent of their mothers or stepmothers. It should be noted that most responses referred to people's biological parents and that rates of fear or abuse were no higher for step-parents, although respondents with step-parents were less likely to describe relationships as close. Those assessed as seriously maltreated or reporting physical violence between parents were twice as likely as others to report fear of parents.

Respondents were also asked whether there were adults who, when they were growing up, they had particularly respected or looked up to, or who had set them a good example of the sort of person they wanted to be, or who had helped them, or who gave them a helping hand when they were in trouble. Most named parents in all categories, but those assessed as abused or neglected were consistently less likely to say that parents had filled any of these roles. Failure to do so gave the best of all predictions of childhood maltreatment. It seems that the poor view that abusive parents have of their children is reflected in children holding an equally poor view of their parents.

However, a lack of respect for parents, or an inability to rely on parents for affection and help, did not necessarily mean that there was no love. About half of those seriously physically abused by parents, for example, still say they had warm and loving families. There are likely to be many different explanations for this, rather than a single one.

For example, some of these young people may simply not have understood the meaning of a warm and loving family as it was understood by most of the sample. Also, few young people described equally dire relationships with both parents, and perhaps in their later assessment of family life they chose to focus on the loving parent. Research on the relationship between childhood abuse and neglect, and women's later mental health problems, shows the complexity of relationships between children and parents, and the different ways in which adults comprehend and come to terms with what happened to them as children^.4

The study also asked the young people why they thought their abusers had behaved as they did. Again there were different answers. Some mentioned parents coping with their own violent relationships, stress or health problems. Others took the blame on themselves, something often found in children because abusers attempt to justify their behaviour by saying that the child deserved or had provoked abuse. But some thought that their parents had disliked or resented them, or had abused them because they enjoyed doing it.

The most serious maltreatment of children caused physical injury or occurred regularly throughout childhood. Where abusive or neglectful behaviour was less severe, or happened only occasionally or for a short period, family relationships showed patterns closer to those normal for the sample as a whole. Serious maltreatment seems more likely to indicate a family where relationships have gone very wrong, while lesser levels can happen in a much wider range of circumstances. Consequently this survey adds to growing evidence that attachment disorders may be at the root of child maltreatment where the most serious and long-standing problems are found.⁵

Overall, there was a considerable overlap between different forms of maltreatment, and especially with emotional maltreatment. Ninety-four per cent of respondents reporting this said they also experienced physical abuse, and many of them also cited several kinds of additional forms of victimisation. Almost two-thirds of those seriously physically abused or reporting an absence of physical care said they also experienced other maltreatment.

The small number of those who said they had been sexually abused by parents (27 young people, 1 per cent of the sample) had the most substantial pathological pattern. Almost all of them had also experienced physical abuse (21), emotional maltreatment (18), absence of physical care (16), and absence of supervision (19). It appears that sexual abuse by parents was almost a guarantee that some other form of maltreatment was occurring, usually at a serious level.

On the other hand, absence of supervision was less likely to be linked to poor family relationships than other forms of maltreatment. Although for some young people it appeared to be part of a pattern of general maltreatment and poor relationships, for most it happened in families that were otherwise loving and close.

Not surprisingly, the study also found the familiar links between maltreatment and social disadvantage. Low socio-economic status, parental unemployment, limited education, financial and other stresses, family breakdown and lone parenthood, disability and health problems, were all there in the survey and correlated with abuse and neglect.

The survey results were subjected to analysis using a Chi-squared Automatic Interaction Detector, a tool which assesses interactions between possible predictors of a dependent variable. This allowed for an exploration of the relative importance of all these characteristics or factors as predictors of maltreatment. Overall, poor family relationships consistently proved better predictors of abuse and neglect than did family structure, or social disadvantage.

Of course, asking young people to retrospectively recall their childhoods must take into account the fact or possibility that they may not have full knowledge of stresses or health problems experienced by parents.

Even so, the study provides substantial evidence, which has implications for child protection practice. First, that prevention measures may be best focused on identifying families where children are constantly criticised or put down, and rarely shown demonstrative affection, rather than waiting until bruises are found. Second, it supports the use of family support programmes that directly address poor relationships; these would seem to offer hope of substantial reduction in maltreatment, provided that there is a core of affection to build on.

Where multi-type maltreatment is found, however, this will nearly always include emotional maltreatment, often reflecting a pattern of domination and control similar to that found in physical or sexual abuse of women partners. In these instances the maltreatment may have little to do with parental skill deficits or stresses, and traditional family support or parenting skill programmes seem unlikely to be sufficient to make an impact. In the case of such long-term failures in parent and child relationships, or when parents' behaviour reflects a consistently negative view of their child, programmes which address parents' longer term therapeutic needs may well be crucial in protecting children who remain at home.

Key survey results:

            Weighted base              Affection shown in family

by hugs, cuddles and kisses

Whole sample                           2,869               2,219 (77 per cent)

Serious physical abuse              205                  94 (46 per cent)

Emotional maltreatment             162                  49 (30 per cent)

Serious absence of care            184                  95 (52 per cent)

Serious absence of supervision 140                  86 (61 per cent)

Sexual abuse (parents)              27                    7 (29 per cent)

Pat Cawson is head of child protection research at the NSPCC.

References

¹ Department of Health, Child Protection: Messages from Research, HMSO, 1995.

² J Gibbons, B Gallagher, C Bell and D Gordon, Development after Physical Abuse in Early Childhood, HMSO, 1995.

³ P Cawson, Child Maltreatment in the Family: the Experiences of a National Sample of Young People, NSPCC, 2002

⁴ A Bifulco and A Moran, Wednesday's Child: Research into Women's Experience of Neglect and Abuse in Childhood, and Adult Depression, Routledge, 1998

⁵ N Morton and K Browne, "Theory and observation of attachment and its relation to child maltreatment: a review", in Child Abuse and Neglect 22 (11), 1998