Examining Pregnant Women's Hostile Attributions About Infants as a Predictor of Offspring Maltreatment

Abstract

Importance Child maltreatment is a serious public health problem that disproportionately affects infants and toddlers. In the interest of informing prevention and intervention efforts, this study examined pregnant women’s attributions about infants as a risk factor for child maltreatment and harsh parenting during their children’s first and second years. We also provide specific methods for practitioners to assess hostile attributions. Objective To evaluate pregnant women’s hostile attributions about infants as a risk factor for early child maltreatment and harsh parenting. Design Prospective longitudinal study. Setting A small Southeastern city and its surrounding county. Participants A diverse, community-based sample of 499 pregnant women. Main Outcomes and Measures Official records of child maltreatment and mother-reported harsh parenting behaviors. Hostile attributions were examined in terms of women’s beliefs about infants’ negative intentions (eg, the extent to which infants purposefully dirty their diapers). Results Mothers’ hostile attributions increased the likelihood that their child would be maltreated by the age of 26 months (adjusted odds ratio, 1.26 [90% CI, 1.02–1.56]). Mothers who made more hostile attributions during pregnancy reported engaging in more harsh parenting behaviors when their children were toddlers (β=0.14, P<.05). Both associations were robust to the inclusion of 7 psychosocial covariates. Conclusions and Relevance A pregnant woman’s hostile attributions about infant’s intentions signal risk for maltreatment and harsh parenting of her child during the first years of life. Practitioners’ attention to women’s hostile attributions may help identify those in need of immediate practitioner input and/or referral to parenting services.

Assessment of Maternal Attributions of Infant's Hostile Intent and Its Use in Child Maltreatment Prevention/Intervention Efforts

“…10 For example, although Berlin et al 10 did not report information about the type of child maltreatment alleged or substantiated, if their sample of maltreatment cases paralleled national statistics, 12 the majority (about 70%) of their child maltreatment cases would have been child neglect. To the extent that this was true, it could explain why their measure of self-reported harsh discipline did not predict future child maltreatment-because harsh discipline does not always occur in child neglect cases as it typically does when child physical abuse occurs.…”

“…Indeed, Berlin et al 10 found an association between a brief measure (developed for their study) of maternal attributions and subsequent child maltreatment, leading them to suggest that practitioners should evaluate maternal attributions using their scale (ie, the Infant Intentionality Questionnaire). 11 However, when considering the use of this questionnaire, professionals should be aware that this 8-item assessment tool includes questions about both hostile infant attributions (4 questions) and positive infant attributions (4 questions).…”

“…Furthermore, as Berlin et al 10 point out, the total questionnaire score is an index of the mother's attributions of "negative intentions" relative to their total attributions of "negative intentionallyϩpositive intentionality." As described by Berlin et al, 10 the final scoring algorithm of their scale is rather complex. Although their final scoring algorithm results in a total score of 5 (a score that optimally predicts child maltreatment) for mothers who attribute only hostile intent to infants with a frequency of "always," it should be noted that a total score of 5 can be achieved in a variety of other ways.…”

The Identification of Pregnant Women at Risk for Child Abuse: Methodology

“…[11][12][13][14] Berlin et al showed, for instance, that intergenerational factors increase the risk of child maltreatment 11,14 and Begle found that a low attendance rate in a parenting program (PACE) predicted child abuse. 12 However, the researchers did not develop a specific tool to identify high risk families during pregnancy to guide them to a program for the primary prevent of child maltreatment.…”

“…12 However, the researchers did not develop a specific tool to identify high risk families during pregnancy to guide them to a program for the primary prevent of child maltreatment. [12][13][14] The overall aim of this research is studying the effectiveness of VoorZorg by means of an RCT. In the present study, we describe a two-stage procedure to identify, to select and to include high risk pregnant women in a preventive intervention by combining key components of successful selection procedures with components considered to be necessary, such as trained nurses conducting the interview with the pregnant women.…”