Article summary with Annual Research Review: Umbrella synthesis of meta-analyses on child maltreatment antecedents and interventions: differential susceptibility perspective on risk and resilience by Van IJzendoorn a.o. - 2020

What is child maltreatment?

Child maltreatment is defined as any interaction or lack of interaction reasonably within the control of a parent or person in a position of caregiving responsibility, that does (potential) harm to the health of the child or physical, mental, moral, spiritual, or social development in the context of the society in which the child grows up. There are different types of maltreatment, including child sexual abuse, emotional abuse, physical abuse, neglect including physical neglect, emotional neglect, educational neglect, and witnessing family violence. There exists a high degree of comorbidity, co-occurrence, and poly-victimization in child maltreatment.

What are risk factors of child maltreatment?

• From an evolutionary perspective it can be argued that humans have an innate bias to promote one´s inclusive fitness which might be accompanied by abuse and infanticide of infants that compete with procreation of one´s own offspring. Also, the distribution of scarce resources to the infant with the best chances to survive may result in neglect of less fit and passive infants.
• Intergenerational transmission of maltreatment. Parents who have been the victims of child maltreatment are at heightened risk of maltreating their offspring.
• The spillover hypothesis states that marital quality is related to parent-child relationship quality. Interpersonal or intimate partner violence is predictive of child abuse.
• Psychological and neurodevelopmental factors. Parental characteristics and psychopathology may interfere with normative caretaking of young children. Think of low inhibitory control, a low threshold for aggression, major depressive disorder, or borderline personality disorder.
• New research indicates that children with certain neurodevelopmental features such as the presence of a learning disorder and/or an autism spectrum disorder may be at increased risk of maltreatment.
• Dysregulation of the neurophysiology of perpetrating parents would make them more liable to become abusive. If the balance between the sympathetic and parasympathetic systems is dysregulated, over- or underreactivity to stressful stimuli may result in neglect or harsh parenting.
• Single parenthood.
• Lack of social support.
• Low socioeconomic status.

What are protective factors of child maltreatment?

Protective factors may act as moderators of the association between risk factors and maltreatment. They may decrease the chances of child maltreatment even when risk factors are present. The following protective factors are identified:

• A social support network.
• Intervention.
• The presence of stable, safe, and nurturing relationships with intimate partners.
• High levels of maternal warmth.

What is the umbrella synthesis approach?

An umbrella synthesis involves the systematic collection and assessment of multiple meta-analyses published on a specific topic. The results from the meta-analyses are integrated and reviewed following a uniform approach to allow their comparison. This approach leads to comparable estimates of combined meta-analytic effect sizes, a systematic stratification of the evidence, an evaluation of the heterogeneity and potential biases, and sensitivity analyses to identify potential reporting biases.

Based on the umbrella synthesis, which antecedents of child maltreatment were identified?

Five categories of antecedents of child maltreatment were identified, namely parental experience of childhood maltreatment, parental personality characteristics, parental experience of intimate partner violence, parental baseline physiology and physiological reactivity, and socioeconomic status.

Which interventions can prevent or reduce child maltreatment risks?

Effective interventions appeared to be parenting programs involving parent training, such as Multisystemic Therapy for Child Abuse and Neglect, and parent-child interaction therapy. Nurse home visitations did not reduce reports of child maltreatment, but did lead to improvements in other domains such as health and cognitive developments. The umbrella synthesis revealed that certain interventions did not manage to affect the risk of child maltreatment, including interventions providing only support to the families, promoting healthy behaviors during pregnancy and early parenthood, establishing social support networks, and screening for developmental delay.

Why should more knowledge be gathered with regards to the antecedents of child maltreatment?

From the antecedents that have been shown to relate to child maltreatment, the underlying mechanisms are still unclear. Additionally, the antecedents that have been identified only account for a small percentage of the variance in child maltreatment. Finally, there is an absence of replicable evidence on potentially divergent precursors of different types of maltreatment.

Why should future research gather more information about the neurobiological antecedents of child maltreatment?

There exists no meta-analytic evidence on parental neural or genetic antecedents of child maltreatment. Also, intergenerational transmission of maltreatment may occur due to heritable characteristics of parent and child. If parents were maltreated themselves, prevention efforts can be helpful, independently of the genetics behind transmission.

What is recommended with regards to current and future interventions aimed at reducing and preventing child maltreatment?

More effective interventions need to be developed to protect more children and support more families. Currently, interventions are barely capable of preventing or decreasing child abuse and neglect in the next generation. Research into the effects of changing the socioeconomic conditions of families in low-resource environments is necessary. Limited social and material resources for families are one of the strongest correlated of elevated maltreatment risks. Universal health care, affordable education, paid parental leave, and more and better paid jobs may lead to less stress and better parental coping with challenging child behavior, which may lead to lower basal physiological levels and lower risks of maltreatment.

How can the vicious cycle of maltreatment and the failure to develop effective interventions be broken?

Two ways are recommended. Firstly, parents should be empowered to cope more sensitively with challenging child behavior and to set gentle but consistent limits to oppositional and coercive interactions. Secondly, attention should be paid to differential susceptibility. Differential susceptibility refers to the idea that some individuals are more open to environmental influences than others. The efficacy of intervention effects on child maltreatment may be hidden in susceptible subgroups of participants, which goes unnoticed now due to the evaluation of average effects across all parents involved.

According to differential susceptibility theory, what differentiates the more susceptible from the less susceptible individuals?

Differential susceptibility theory proposes three markers on the levels of genetic, stress regulatory, and temperamental makeup.

• Genetic markers have been found in genes involved in the dopaminergic and serotonergic system. The carriers of the dopamine receptor D4 7-repeat alleles seem to be open to the environment and this genotype may be embedded in larger dopamine-related genetic pathways or polygenetic susceptibility scores.
• Individuals may have a biological sensitivity to context, involving heightened stress and immune reactivity to negative stimuli in a chaotic and stressful environment.
• Individuals may differ in temperamental difficultness. Difficultness is broadly defined as encompassing negative emotionality, surgency, and effortful control. It predicts higher levels of internalizing and externalizing behavioral problems, as well as a heightened openness to the influence of change in the environment for the better.

How does differential susceptibility theory explain why there is not always intergenerational transmission of child maltreatment?

According to this theory, resilient individuals are characterized by a lower degree of susceptibility to the environment. Less susceptible individuals can rely on their constitutional resilience which is rooted in a less reactive temperament and neurobiological makeup. More susceptible individuals on the other hand must rely more on a supportive environment as a buffer against adversities. These individuals may do very well if they grow up in a warm and sensitive caregiving scaffold, highlighting the role of social context in resilience.