1 The Ability of Parenting Scales to Identify Mothers with a History of Neglect: A Comparison of Three Measures David Bennett 1, Sara Ragland 1, Joanna Herres 1, David Bennett 1, Sara Ragland 1, Joanna Herres 1, Margaret W. Sullivan 2, & Michael Lewis 2 1 GLAD Program 2 Inst. for the Study of Child Development 1 GLAD Program 2 Inst. for the Study of Child Development Dept. of Psychiatry Dept. of Pediatrics Dept. of Psychiatry Dept. of Pediatrics Drexel University Robert Wood Johnson Medical School - Drexel University Robert Wood Johnson Medical School - College of Medicine UMDNJ College of Medicine UMDNJ Philadelphia, PA New Brunswick, NJ Philadelphia, PA New Brunswick, NJ This study was supported by NIMH Grant #MH We appreciate the assistance of This study was supported by NIMH Grant #MH We appreciate the assistance of the Department of Human Services (Philadelphia) and Division of Youth & Family Services (N. J.). Presented at the annual conference of the Eastern Psychological Association, Philadelphia, March 24th, 2007.

2 Abstract Parent reports are often administered to identify parents who are at-risk for child maltreatment, but research comparing their discriminant validity is rare. Mothers of 4- to 6-year-old children ( n = 190; 43% with a history of neglect) completed the Child Abuse Potential Inventory, the Parent-Child Conflict Tactics Scale, and the Parenting Stress Index. Each scale was found to discriminate neglectful families from controls, but sensitivity values were low. Implications for the assessment of neglectful parents are discussed.

3Background Self-reports of risk factors for child maltreatment are often administered in an effort to identify parents at risk for maltreatment. Direct comparison of the discriminant validity of such measures, however, is rare. The present study compared 3 commonly used measures: The Child Abuse Potential Inventory (CAP; Milner, 1994) has been found to predict future occurrences of maltreatment, although changes in CAP scores following family support interventions fail to predict future maltreatment (Chaffin & Valle, 2003). Despite it’s presumed focus on identifying physical abuse, recent findings indicate that the CAP may actually predict future neglect better than physical abuse (Ondersma et al., 2005). Earlier research, however, suggests the CAP is best at predicting physical abuse (Milner, Gold, Ayoub, & Jacewitz, 1984). The Parent-Child Conflict Tactics Scale (CTSPC; Straus et al., 1998), and particularly its Neglect subscale, has been found to distinguish parents with a maltreatment history from those without a maltreatment history (Bennett, Sullivan, & Lewis, 2006). The Parenting Stress Index-Short Form (PSI-SF; Abidin, 1995) scores have been associated with a lack of positive and sensitive parenting (Haskett et al., 2006), risk factors for child neglect.

4 Neglectful Parenting Neglect remains the most common form of child maltreatment.

5 Questions: 1. How well do three commonly used parent reports (the Child Abuse Potential Inventory, Parent-Child Conflict Tactics Scale, & the Parenting Stress Index) identify mothers with a Child Protective Services history of neglect? 2. Do mothers who attempt to conceal their family history of maltreatment also exhibit a positive self- presentation bias on parenting scales, thus lowering the scale’s discriminant validity? 3. Can such concealment be identified by validity scales (i.e., the CAP Lie scale and the PSI Defensive Responding scale)? 4. Does pooling data across the three scales improve the identification of parents who have a history of neglect?

6 Methods: Participants Mothers of 4- to 6-year-old children ( n = 190; 44% boys) were recruited through flyers at community settings (e.g., WIC offices; daycares) for the study. Participants came from urban neighborhoods in Philadelphia and central New Jersey. 44% of mothers had a history of neglect ( n = 84). Among mothers with a history of neglect, 18% also had a family history of physical abuse towards one or more children.

7 Demographics of Neglect & Control groups ________________________________________________________ Neglect Controls Neglect Controls ( n =84) ( n =106) ( n =84) ( n =106)________________________________________________________ Child gender 44% male 44% male n.s. 56% fem. 56% fem. 56% fem. 56% fem. Child age 5.3 (1.0) 5.2 (1.1) n.s. Maternal education (yrs.) 12.0 (1.4) 12.4 (1.8) n.s. Maternal employment 38% 43% n.s. Maternal ethnicity p <.01 African-American 88% 67% African-American 88% 67% European-American 3% 10% European-American 3% 10% Hispanic 5% 21% Hispanic 5% 21% Other 5% 3% Other 5% 3%________________________________________________________

8 Methods: Procedures Mothers completed 3 parenting questionnaires (see next page) as part of their initial visits in a longitudinal study on neglected children’s emotional development. Child Protective Service (CPS) records were abstracted following maternal consent to identify whether each mother/family had a history of child maltreatment and, if so, to code the type of maltreatment (i.e., neglect; physical abuse). Concealment of a CPS maltreatment history was assessed by asking mothers at the end of their initial interview session whether they or their partner had ever been referred to CPS for family services (using the specific names of local CPS agencies). 36% of mothers later found to have a history of neglect concealed their CPS history during this initial interview.

9 Methods: Measures Child Abuse Potential Inventory (CAP; Milner, 1994) is a 160-item parent-report that assesses parental personality characteristics (Distress, Rigidity, Unhappiness subscales) and coping difficulties (Problems with Child and Self, Problems with Family, and Problems from Others). The subscales are combined into an overall Abuse Potential score. Parent-Child Conflict Tactics Scale (CTSPC; Straus et al., 1998) is a 27-item revision of the parent-child version of the Conflict Tactics Scale (Straus, 1979). It contains subscales for Nonviolent Discipline, Physical Assault, Psychological Aggression, and Neglect. Parenting Stress Index-Short Form (PSI-SF; Abidin, 1995) is a 36-item parent-report of parenting stress. It contains subscales for Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child which can be summed into an overall parenting stress score.

10 Results: Interrelations of Parenting Scales ________________________________________________________________________________________________ Parent-Child Conf. Tact. Scale CAP Parenting Stress Index - SF Parent-Child Conf. Tact. Scale CAP Parenting Stress Index - SF Abuse Par P-C Diff Total Abuse Par P-C Diff Total Neg Non Psy Phys Poten Dis Dys Child Stress Neg Non Psy Phys Poten Dis Dys Child Stress (1) (2) (3) (4) (5) (6) (7) (8) (9) (1) (2) (3) (4) (5) (6) (7) (8) (9)________________________________________________________________________________________________ Parent-Child Conflict Tactics Scale 1. Neglect Neglect Nonviolent Discipline.18* Nonviolent Discipline.18* Psychological Aggression.12.52*** Psychological Aggression.12.52*** Physical Assault.15*.38***.57*** Physical Assault.15*.38***.57*** -- Child Abuse Potential Inventory 5. Abuse Potential.41***.02.17*.17* Abuse Potential.41***.02.17*.17* -- Parenting Stress Index – SF 6. Parental Distress.37*** #.57*** Parental Distress.37*** #.57*** Parent-Child Dysfunct..27*** *.55***.66*** Parent-Child Dysfunct..27*** *.55***.66*** -- Interaction Interaction 8. Difficult Child.29***.31***.27***.29***.43***.58***.70*** Difficult Child.29***.31***.27***.29***.43***.58***.70*** Total Stress.36***.16*.14#.23*.61***.85***.89***.88*** Total Stress.36***.16*.14#.23*.61***.85***.89***.88*** --________________________________________________________________________________________________ * p <.05; ** p <.01; *** p <.001.

11 Question 1. Discriminant validity for neglect ________________________________________________________________________________________________ Controls Neglect History Controls Neglect History Mean (SD) Mean (SD) t-value Mean (SD) Mean (SD) t-value________________________________________________________________________________________________ Parent-Child Conflict Tactics Scale (CTSPC) 1. Neglect 0.25 (0.79) 1.97 (3.71) 4.01*** 1. Neglect 0.25 (0.79) 1.97 (3.71) 4.01*** 2. Nonviolent Discipline (5.46) (5.24) Nonviolent Discipline (5.46) (5.24) Psychological Aggression (5.56) (6.21) Psychological Aggression (5.56) (6.21) Physical Assault 7.00 (5.62) 8.09 (6.79) Physical Assault 7.00 (5.62) 8.09 (6.79) 1.16 Child Abuse Potential Inventory (CAP) 5. Abuse Potential score (10.30) (14.11) 4.17*** 5. Abuse Potential score (10.30) (14.11) 4.17*** Parenting Stress Index – SF (PSI-SF) 6. Parental Distress (7.24) (8.22) 3.56*** 6. Parental Distress (7.24) (8.22) 3.56*** 7. Parent-Child Dysfunctional (6.20) (9.00) 3.04** 7. Parent-Child Dysfunctional (6.20) (9.00) 3.04** Interaction Interaction 8. Difficult Child (7.90) (9.71) 3.80*** 8. Difficult Child (7.90) (9.71) 3.80*** 9. Total Stress (18.88) (23.45) 4.01*** 9. Total Stress (18.88) (23.45) 4.01***________________________________________________________________________________________________ ** p <.01; *** p <.001.

12 Discriminant validity for neglect *** ** ***

13 Question 2. Does maternal concealment of neglect hinder discriminant validity?________________________________________________________________________________________________ CONTROLS NEGLECT HISTORY CONTROLS NEGLECT HISTORY Acknowledged Concealed Acknowledged Concealed Mean (SD) Mean (SD) Mean (SD) F-value Mean (SD) Mean (SD) Mean (SD) F-value________________________________________________________________________________________________ Parent-Child Conflict Tactics Scale (CTSPC) 1. Neglect 0.25 (0.79) 2.19 (4.27) 1.84 (2.72) 8.89*** AN, CN > C 1. Neglect 0.25 (0.79) 2.19 (4.27) 1.84 (2.72) 8.89*** AN, CN > C 2. Nonviolent Discipline (5.46) (5.64) (4.88) Nonviolent Discipline (5.46) (5.64) (4.88) Psychological Aggression (5.56) (6.59) (5.02) Psychological Aggression (5.56) (6.59) (5.02) Physical Assault 7.00 (5.62) 9.51 (7.35) 5.67 (5.27) 3.99* AN > CN 4. Physical Assault 7.00 (5.62) 9.51 (7.35) 5.67 (5.27) 3.99* AN > CN Child Abuse Potential Inventory (CAP) 5. Abuse Potential score (10.30) (14.54) (13.73) 8.87*** AN, CN > C 5. Abuse Potential score (10.30) (14.54) (13.73) 8.87*** AN, CN > C Parenting Stress Index – SF (PSI-SF) 6. Parental Distress (7.24) (8.16) (8.74) 6.20** AN > C 6. Parental Distress (7.24) (8.16) (8.74) 6.20** AN > C 7. Parent-Child Dysfunctional (6.20) (9.43) (8.30) 5.17** AN > C 7. Parent-Child Dysfunctional (6.20) (9.43) (8.30) 5.17** AN > C Interaction Interaction 8. Difficult Child (7.90) (9.12) (10.81) 7.39*** AN > C 8. Difficult Child (7.90) (9.12) (10.81) 7.39*** AN > C 9. Total Stress (18.88) (23.41) (23.96) 7.91*** AN > C 9. Total Stress (18.88) (23.41) (23.96) 7.91*** AN > C________________________________________________________________________________________________ ** p <.01; *** p <.001. Note. AN = Acknowledged Neglect group; CN = Concealed Neglect group; C = Control group.

14 Discriminant Validity Questions 1 & 2. Discriminant Validity Only the Neglect subscale of the CTSPC discriminated the neglect and controls groups. In contrast, each of the PSI subscales, as well as the CAP Abuse Potential scale, discriminated groups. Mothers with a history of neglect reported higher scores on each subscale. Maternal concealment of a history of neglect was related to self-report of the parenting measures. Mothers who acknowledged neglect (AN) consistently reported higher scores on the negative parenting measures than did controls, whereas mothers who concealed neglect did not differ from controls. In addition, acknowledgers reported more physically assaultive parenting behaviors on the CTSPC than did concealers.

15 No. Neither the CAP Lie scale ( t (77) = 1.10, p >.10) nor the PSI Defensive Responding scale ( t (67) = 0.90, p >.10) discriminated mothers who reported vs. concealed a history of neglect. Question 3. Was concealment identified by validity scales?

16 Question 4. Does pooling data across parenting measures enhance the identification of mothers with a history of neglect? No. Each measure was entered into separate logistic regressions and found to have moderate to good specificity, but poor sensitivity in identifying mothers with a history of neglect. The Neglect subscale of the CTSPC had a sensitivity (i.e., correctly identified those with a neglect history) of 33.8% and a specificity (i.e., correctly identified those without a neglect history) of 92.5%; the CAP Abuse Potential score had a sensitivity of 39.7% and a specificity of 81.7%; and the PSI Total Stress score had a sensitivity of 48.6% and a specificity of 72.8%. Entering all three measures into a single simultaneous logistic regression did not substantially alter sensitivity (46.6%) or specificity (86.3%) rates. The CTSPC Neglect subscale was the only significant predictor when all three measures were entered into the simultaneous regression (β =.43, p <.01).

17 Summary & Discussion Significant relations were found between parenting measures and CPS neglect history, consistent with prior research (Bennett, Sullivan, & Lewis, 2006; Ondersma et al., 2005). However, the practical utility of the parenting measures was limited as sensitivity was poor (i.e., below 50%), although specificity was high. Validity scales (i.e., the CAP Lie scale and PSI Defensive Responding scale) did not help to identify mothers who concealed a family history of neglect during their initial interview. The ability of the 3 measures to identify mothers with a history of neglect was roughly comparable. Overall, high scores on these parenting self-reports are consistent with, though not necessarily indicative of, a history of neglect. Low scores, however, are less informative given the low sensitivity rates. Examining the relations among scales, the CAP Abuse Potential score was more highly correlated with the Neglect scale ( r =.41, p <.001) than the Physical Assault scale ( r =.17, p <.05) of the CTSPC (Fisher r to Z transformation, Z =3.32, p <.001). This provides further support that the Abuse Potential scale assesses risk for neglect, and not just physical abuse.

18 Consistent with an earlier sample of neglectful and physically abusive parents (Bennett et al., 2006), about a third of mothers concealed their maltreatment history. Those who acknowledged their history of neglect had significantly higher scores than controls on most of the parent measures. In contrast, those who concealed their neglect history generally did not report higher scores than controls on the parenting measures, with the exception of the CAP Abuse Potential score. Moreover, they reported lower scores than Acknowledgers on the CTSPC Physical Assault scale. These findings suggest that, as a group, those who concealed their history of neglect also presented in a somewhat socially desirable manner when completing the parenting self-reports.

19 The best single predictor based on the logistic regression was the 5-item CTSPC Neglect scale. The scale’s brevity and at least limited ability to identify mothers with a history of neglect suggests that it may be of some use and should be considered for study in clinical settings where only a brief screen can be practically administered. The Neglect scale was the only measure to directly assess neglect, as the others measured more general risk factors related to neglect (e.g., parental distress). It is possible that the use of a similarly direct, but more comprehensive measure (e.g., the Mother-Child Neglect Scale; Lounds et al., 2004) might better identify neglectful parents. In addition, future research should compare the ability of parent report to child report (e.g., the Multidimensional Neglectful Behavior Scale - Child Report; Kantor et al., 2004) in identifying parents with a history of neglect.

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