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Maternal self-esteem has long been associated with the quality of maternal-child interactions and many assume that low self-esteem contributes to the cause of maltreatment. Assessments of the self-concepts of maltreating parents, however, have been done only after maltreatment has occurred. Prospective measurement of self-concept would help to clarify its role in the etiology of maltreatment. In this study, 471 pregnant women completed the Tennessee Self-Concept Scale (TSCS). State protective services' records were reviewed 3 years after these children were born. When records of the 459 women with a known live-born child were reviewed, 29 were found to have maltreated their children (neglect n = 22; physical abuse n = 11; four women found to have both neglected and abused their children). Neglectful mothers had lower scores on scales measuring overall self-esteem, moral self-worth, personal and social adequacy, and perception of self-worth in family relationships than matched nonreported mothers. They described their identity and behavior more negatively and had greater general maladjustment and neurotic symptoms. Physically abusive mothers had lower scores on self-worth in family relationships. When measured prospectively, low self-esteem appears to be a risk factor for child neglect, but is not a strong predictor for physical abuse. Implications for prevention programs are discussed.

This study sought (1) to retest an approach to the prediction of risk of child maltreatment and (2) to test the effect of a comprehensive prenatal and pediatric health services program on the rate of maltreatment. Of 2585 women screened at their first prenatal visit, 1154 qualified for the study. Risk assignment was determined by a structured interview. High-risk women (n = 314) were assigned to receive standard (high-risk control group; n = 154) or intervention (high-risk intervention group; n = 160) services throughout the prenatal period and during the first 2 years of their infants' life. A third group (low-risk control group; n = 295) was selected among low-risk women and received standard care without intervention services. State records were searched for substantive reports of child maltreatment up to 36 months after birth. Physical abuse was found for 5.1% of the study population; neglect was substantiated for 5.9%. Prediction efforts were effective in identifying risk of physical abuse but not of neglect. Comprehensive health services did not alter the reported abuse rate for high-risk parents and was associated with an increased number of neglect reports. Intervention reduced subject attrition and appeared to serve as a bias for detection of maltreatment. Thus this long-term, prospective approach was ineffective for child abuse prevention, perhaps because of detection biases and societal changes.

To determine the prenatal antecedents of child neglect by low-income women, data from a prospective study of child maltreatment were reviewed. Mothers determined to be at high risk prenatally for maltreatment were more likely to be identified as neglectful within 24 months of the interview. Neglectful mothers were less likely to have completed high school, had more children younger than 6 years of age, and had more aberrant responses on parenting skills and support systems scales. Neglected children were lower in birth weight, were rated more difficult temperamentally, and had poorer mental and motor developmental scores.

Feasibility of identifying risk for child abuse prospectively was determined by interviewing 1400 expectant mothers and predicting that 273 were high risk. Nonaccidental child injuries were subsequently reported to authorities for 6% of these versus 1% of the remaining 1127 families. Prediction was only effective for 24 months following interview. Thus prenatal prediction was feasible although the rate of false positive high risk assignment would limit practical application of the interview we used. As a first step to improve prediction accuracy, a group of the 20 strongest predictors was selected from the interview by regression analysis. The correlation of these with abuse was .44 compared to .15 for the original interview. Important predictors included subjective impressions of interviewers, residency transience, untruthfulness, disturbed childhood nurture, unwanted pregnancy, and perhaps conditions that increased parent-child exposure.

Large families and inadequate spacing of children increase the risk of abuse. Twin births incorporate both of these factors, yet the association of twinning with subsequent abuse has not been explored. Forty-eight families with twins from St Vincent Hospital and Medical Center and Nashville General Hospital were compared with 124 single-birth families, matched for hospital of delivery, birth date, maternal age, race, and socioeconomic status. Three control (2.4%) and nine twin (18.7%) families were reported for maltreatment (P less than .001). Mothers of twins experienced greater previous parity than did control subjects (P less than .001). Twins also had significantly longer nursery stays (P less than .001), lower birth weights (P less than .001), and lower Apgar scores at one (P less than .01) and five (P less than .05) minutes. A regression analysis incorporating all of these variables, however, showed that twin status was most predictive of subsequent abuse.

One hundred and seventy-two low-income women were interviewed prenatally to determine risk for later mistreatment of their children. High-risk and low-risk women were then randomly assigned at delivery to either limited or extended postpartum contact with their newborns over the first two days after birth. Mother-infant interaction observations were performed at 48 hours and at one, three, six, twelve and eighteen months postpartum. Infants were tested at nine months with the Bayley Scales of Infant Development. Results indicated that outcome following extended mother-infant postpartum contact varies with maternal risk status and measures employed for evaluation. Low-risk extended-contact mother-infant pairs differed from low-risk controls in observed interaction while high-risk extended-contact and controls did not differ from each other in interaction. High-risk extended-contact infants were more advanced in motor development than control infants at nine months, however, while low-risk extended contact and control infants did not differ in development.

Children who are abused have been said to have more illnesses than children who are not maltreated. The relationship between abuse and illness has been hypothesized to function in 2 ways: (1) that abuse precedes the illnesses and children from abusive homes become ill because of the damaging environment they endure, or, conversely, (2) that the illnesses precede the abuse, with the fussy behavior of ill children eliciting abuse. This study was intended to clarify the temporal relationship between illnesses and maltreatment. Health data were collected on a sample of 80 children: 11 from abusive families, 31 with nonorganic failure to thrive (NOFT), 14 from neglectful families, and 24 from control families. Hospital records (both inpatient and outpatient) for these children from the time of birth until they were 3 years old were searched by data collectors unaware of the child's classification. Children from abusive families or with NOFT appeared to be ill more often than control children, particularly during the first few months after birth, before abuse had been reported, but not necessarily before NOFT had been discovered. Health records of neglected children were not significantly different from those of controls. In addition to the abused. These 6 children also had more illnesses than control children, again particularly during the first few months after birth. Having ill children is described as a source of stress that may trigger abuse in an already stressed family.

The qualities of parents who batter their children have been determined by interviewing known abusers. Because most studies lack controls and because family characteristics may be changed by abuse, a prospective study was instituted. Fourteen hundred low-income mothers were interviewed in a prenatal clinic, and the characteristics of 23 reported for abuse within two years were compared to the characteristics of the remaining mothers. The predominant antecedents of child abuse were: unwanted pregnancy, aggressive tendencies, and aberrant childhood nurture in which disturbed family relationships were more important than outright abuse. Abusive mother had slightly less self-esteem. Factors which increased exposure between parents and children seemed to increase risk for abuse. In contrast to retrospective findings, abusive mothers did not differ in support available from others, age, education, isolation, family alcohol or drug problems, and expectations of child development.

The outcome of experiencing abuse as a child was studied by comparing pregnant women who did recall versus those who did not recall this type of maltreatment. Fourteen hundred low income women were interviewed in prenatal clinic; those who said they were both punished by abuse and beaten by caretakers as children were considered abused. Abuse was recalled by more white than black women but families were followed after delivery and protective service reports of abuse for their offspring were equal. Because of low numbers, black subjects were dropped and the 95 white women who recalled abuse during childhood were compared to the remaining 832 white subjects. The groups did not differ in attitude about current pregnancy, age or marital status, and no differences were found for their children at birth. Abused mothers were more likely to have felt unwanted and unloved as children and to have lower self-images and more isolation than controls. Abused mothers had greater stress, and many of their stresses reflected disturbances in interpersonal relationships. Thus, women abused as children had some characteristics similar to those of known child abusers. Although abused women had more aggressive tendencies, their children were reported to protective services for abuse at the same frequency as control children. Intergenerational transmission of abuse was therefore not demonstrated prospectively. Classic theories of child abuse suggest a special child, special parent and stress act as independent agents to cause abuse. The above data suggest, alternatively, that abuse during childhood may lead to other risk characteristics and to greater stress. These may act together to increase risk for abuse. The special child may have an independent influence on abuse.

Low-income mother-infant pairs were randomly assigned to rooming-in (N = 143) or to routine (N = 158) postpartum contact to determine whether rooming-in affects subsequent adequacy in parenting. At mean age 17 months, two rooming-in and ten control children had experienced inadequate parenting. One rooming-in and eight control children were hospitalized for these problems. One rooming-in and five control families were reported to Protective Services for mistreatment of the study child; five control and no rooming-in children were in the care of adults other than their parents at the time of data analysis. In this study, rooming-in correlated with fewer subsequent cases of parenting inadequacy.