Jennifer E. Lansford, Jennifer Godwin, Robert J. McMahon, Max Crowley, Gregory S. Pettit, John E. Bates, John D. Coie and Kenneth A. Dodge
Pediatrics January 2021, 147 (1) e20200873;
BACKGROUND: Because most physical abuse goes unreported and researchers largely rely on retrospective reports of childhood abuse or prospective samples with substantiated maltreatment, long-term outcomes of physical abuse in US community samples are unknown. We hypothesized that early childhood physical abuse would prospectively predict adult outcomes in education and economic stability, physical health, mental health, substance use, and criminal behavior.
METHODS: Researchers in two multisite studies recruited children at kindergarten entry and followed them into adulthood. Parents completed interviews about responses to the child’s problem behaviors during the kindergarten interview. Interviewers rated the probability that the child was physically abused in the first 5 years of life. Adult outcomes were measured by using 23 indicators of education and economic stability, physical health, mental health, substance use, and criminal convictions reported by participants and their peers and in school and court records.
RESULTS: Controlling for potential confounds, relative to participants who were not physically abused, adults who had been abused were more likely to have received special education services, repeated a grade, be receiving government assistance, score in the clinical range on externalizing or internalizing disorders, and have been convicted of a crime in the past year (3.20, 2.14, 2.00, 2.42, 2.10, and 2.61 times more likely, respectively) and reported levels of physical health that were 0.10 SDs lower. No differences were found in substance use.
CONCLUSIONS: Unreported physical abuse in community samples has long-term detrimental effects into adulthood. Pediatricians should talk with parents about using only nonviolent discipline and support early interventions to prevent child abuse.Abbreviations:CDP — Child Development ProjectCPS — Child Protective ServicesDSM — Diagnostic and Statistical Manual of Mental DisordersFT — Fast TrackSES — socioeconomic status
What’s Known on This Subject:
The converging evidence on a range of detrimental outcomes associated with abuse is impressive, yet findings in US studies have relied on children in the Child Protective Services system, cross-sectional designs, adults’ retrospective reports of childhood experiences, or short-term prospective designs.
What This Study Adds:
In a community sample of 1048 children followed from kindergarten into adulthood, negative economic, health, and criminal outcomes in adulthood were more than twice as likely for adults who were abused early in childhood compared with those who were not.
Approximately 1 in 4 children have a lifetime history of maltreatment, and 1 in 7 children have been maltreated in the last year.1 About 18% of maltreated children have been physically abused.2 However, physical abuse is often undetected, particularly if it does not result in injuries severe enough to require medical attention. In high-income countries, prevalence estimates obtained through self- or parent reports are >10 times higher than official rates of substantiated maltreatment.3
Children who have been abused and identified by Child Protective Services (CPS) are at heightened risk for physical and mental health problems during childhood and later in life, as well as being at risk for dropping out of school, becoming teenage parents, and perpetuating cycles of abuse by victimizing intimate partners and their own offspring.4–9 The converging evidence on a range of detrimental outcomes associated with abuse is impressive, yet most findings have been based on studies with children who are in the CPS system, cross-sectional designs, adults’ retrospective reports of childhood experiences, or short-term prospective designs. With few notable exceptions,10 long-term prospective studies following community samples from early childhood into adulthood are lacking. Risk levels for children who have been abused but not detected might be higher than for children in the CPS system because the system intervenes to lower risk, or risk levels for community samples might be lower because children in the CPS system represent a more severely abused group or involvement in the CPS system actually increases risk. This study is the longest known investigation of a community sample of abused and nonabused children followed into adulthood.
Adults who retrospectively report physical abuse during childhood experience more health problems and behavioral maladaptation during adulthood than adults who do not report having been abused during childhood.11–13 Adults’ retrospective reports of adverse childhood experiences (including abuse) are poorly to moderately correlated with those experiences assessed prospectively.14,15 Retrospective reports also are subject to factors that bias individuals toward over- and underreporting adverse childhood experiences.14 In addition, participants in retrospective studies often are recruited through treatment programs, which may bias samples by including individuals who are experiencing negative outcomes severe enough to warrant treatment.
Prospective longitudinal studies of children from the child welfare system who were identified through substantiated reports of maltreatment also have shown that children who were maltreated are at greater risk for negative outcomes during adulthood.16–18 One drawback of relying on substantiated cases of abuse is that these may represent only cases severe enough to be brought to the attention of CPS, when most cases of abuse go unreported.3 In substantiated cases, experience of abuse may be confounded with experiences deriving from contact with the child welfare system, such as placement in foster care.
To avoid possible biases in retrospective reports of abuse or from samples drawn from the child welfare system, in the current study, we use data from two prospectively followed community samples. The main research question is whether early childhood physical abuse prospectively predicts adult outcomes in education and economic stability, physical health, mental health, substance use, and criminal behavior. Associations between childhood abuse and adult outcomes may be confounded by other risk factors, such as poverty and family stress, which predict both the experience of abuse and later negative outcomes. Therefore, we controlled for a range of potential confounds.