1. Child Maltreatment
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Child Physical Abuse With and Without Other Forms of Maltreatment: Dysfunctionality Versus
Dysnormality
Marie-Claude Larrivée, Marc Tourigny and Camil Bouchard
Child Maltreat 2007; 12; 303
DOI: 10.1177/1077559507305832
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3. 304 Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE
studies that tell us anything about co-occurrence of of cases of physical abuse that occur along with other
maltreatment or mult-type maltreatment are rare (Higgins forms of maltreatment, then the interaction compo-
& McCabe, 2001; National Research Council, 1993; nents between group differences and risk factors are
Ney, Fung, & Wickett, 1994; Rossman, Hughes, & in the error term. That, at least, is the hypothesis that
Hanson, 1998). Some researchers believe that we have formulated on the basis of data obtained
co-occurrence is fairly frequent among maltreated from the only three CPS studies we are aware of that
children (Barnett, Manly, & Cicchetti, 1991; Briere & document the correlates of physical abuse by clearly
Runtz, 1990; Higgins & McCabe, 2001; Kinard, 1994, distinguishing cases in which it occurs with and with-
1998; Mash & Wolfe, 1991; Silverman, Reinherz, & out other forms of maltreatment (Bath & Haapala,
Giaconia, 1996; Trickett & McBride-Chang, 1995). 1993; DiLauro, 2001; Hartley, 2002).
For example, in studies of children enrolled at a sum- These data paint two different etiological pic-
mer camp, children using health-care services, or tures, depending on whether the physically abused
children taken into the child protective services children are victims of other forms of maltreatment
(CPS) system, estimated rates of multitype maltreat- or not. Physically abused children who are also neg-
ment range from 34% to 95% (Manly, Kim, Rogosch, lected (PA+Neg) (Bath & Haapala, 1993; DiLauro,
& Cicchetti, 2001; McGee, Wolfe, Yuen, Wilson, & 2001) or exposed to spousal violence (PA+SV)
Carnochan, 1995; Ney et al., 1994; Van Hasselt, (Hartley, 2002) seem to have more negative sociode-
Ammerman, Glancy, & Bukstein, 1992). mographic characteristics (single-parent, low-income
If co-occurrence of different forms of maltreat- family) and live in a more difficult family climate
ment is that frequent, it seems likely that some pro- (higher parental stress, more episodes of spousal
portion of the studies of physical abuse would be violence) than those who are only physically abused.
based on samples of children who were solely victims of Similarly, such children and their parental figures
physical abuse (PA) as well as children who were victims of seem to have more physical and mental health prob-
physical abuse plus other forms of maltreatment (PA+). lems. These results corroborate those reported by
That, at least, is the hypothesis we have formulated on Daro (1988) and Higgins and McCabe (2000) (who
the basis of a review of studies of physical abuse distinguished between forms of abuse that occurred
reported to North American CPS agencies that have alone and cases of co-occurrence but without speci-
clearly distinguished cases of physical abuse alone fying the different forms of maltreatment): multi-
from cases of multitype maltreatment (Larrivée, 2005). type maltreatment seems to be associated with
According to the eight studies reviewed, co-occurrence families that have more problems.
is found in an average of 57% of cases of physical The data obtained by Bath and Haapala (1993),
abuse (minimum 24% and maximum 85%). DiLauro (2001), and Hartley (2002) suggest that the
Any attempt to determine the extent of co-occurrence exhaustive list of characteristics associated with cases
in cases of physical abuse runs up against the of physical abuse, as seen in the contemporary liter-
methodological problem of a mixed sample (Jonson- ature, should be split into two lists, one for cases of
Reid, Drake, Chung, & Way, 2003; Mash & Wolfe, physical abuse that occurs with other forms of
1991), which arises when a child experiences more maltreatment (PA+) and another for cases without
than one form of maltreatment but only one form is co-occurrence (PA). The small number of studies on
identified (Jonson-Reid et al., 2003). This is the case, which this observation is based, and especially the
for instance, in some studies based on administrative small samples from which this differential picture
data generated by CPS. The architecture of comput- emerges (60 to 292 children) and the use of only
erized information systems often reduces the classifi- bivariate analysis, means that caution should be used
cation of maltreatment to one main form, although in interpreting the differences noted between the
there may well be several forms of abuse involved two groups of physically abused children. Our scien-
(Barnett et al., 1991). tific knowledge of this area is still embryonic. As a
The large number of unidentified mixed samples result, it is currently hard to provide CPS agencies
casts serious doubt on the validity of our etiological with information adapted to the profile of physically
knowledge, which very likely does not reflect the abused children, that is, which takes into account
specificity of physical abuse that occurs alone. There whether they are solely physically abused or the vic-
may well be evidence of risk factors (or correlates) tims of more than one form of maltreatment. In
associated with samples that are either specific or short, Belsky’s (1993) statement that “one focus for
mixed, but we cannot tell which are which. From a future research would be to more clearly specify the
statistical standpoint, if the etiology of the cases of nature and degree of comorbidity and the conditions
physical abuse that occur alone is different from that that give rise to it” (p. 413) still seems to apply.
CHILD MALTREATMENT / NOVEMBER 2007
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4. Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE 305
OBJECTIVE form,1 for which they had received 3 hours of train-
The main objective of this study is to contribute to ing to introduce them to the study and review the
more specific knowledge about cases of physical form and data collection procedures. A training
abuse reported to CPS by taking into account co- video was available in each CPS unit. To help them
occurrence. We aim to identify the characteristics complete the survey form, caseworkers could also
that distinguish the cases of children who are solely refer to a guidebook explaining each question and
physically abused (PA) from those of physically consult a regional research assistant. It took an aver-
abused children who are also the victims of other age of 20 minutes to complete the form. The mean
forms of maltreatment (PA+) (neglect, sexual abuse, completion rate for investigated reports was 86%.
abandonment, psychological abuse, or other). Instrument
The survey form, designed for the purposes of the
METHOD QIS, was largely based on those of similar surveys,
such as the Ontario Incidence Study (Trocmé,
Sample
McPhee, & Tam, 1995), the Canadian Incidence
The data are taken from the Quebec Incidence Study (Trocmé, Tourigny, MacLaurin, & Fallon,
Study of Reported Child Abuse, Neglect, Abandonment 2003), and the American National Incidence Study
and Serious Behavioural Problems (QIS) (Tourigny (Sedlak & Broadhurst, 1996). The Child Well-Being
et al., 2002), which prospectively documented Scale (Vézina & Bradet, 1990) was another major
9,790 reports received between October 1 and source of inspiration.
December 31, 1998, by 16 of the 19 CPS centers in The form consisted of 52 questions about the
Quebec. report, the child, his or her living environment,
During the survey period, CPS investigated 4,929 parental figures, abuse, and decisions made after
reports. The sample used in the study consists of all investigation.
the substantiated cases of physical abuse (N = 514) The form gave uniform clinical definitions of six
brought to the attention of CPS during the survey forms of abuse (physical abuse, sexual abuse, neg-
period. Of this number, 269 (52%) were solely phys- lect, abandonment, psychological abuse, other) that
ically abused, while there was co-occurrence of phys- go beyond the legal definitions in force in Quebec.
ical abuse and other forms of maltreatment in 245 Physical abuse was described in terms of six clinical
(48%) cases. categories: (a) abusive corporal punishment, the use of
In the few cases where there was more than one physical force to correct the child; (b) excessive phys-
report concerning the same child during the survey ical deprivation, depriving the child of food or water;
period, we chose the earliest report. The unit of (c) excessive physical restrictions, locking the child in;
analysis is therefore the child and not the report. (d) irrational, impulsive brutality, assaulting the child
This choice is in line with Quebec’s official strategy in a disorganized emotional state unrelated to the
for receiving and handling reports. child’s behavior; (e) shaken baby syndrome; and (f) any
other type of physical abuse.
Procedure
To ensure that cases involving multiple forms of
When a report is investigated, a caseworker looks maltreatment were tracked, the survey form had
into the allegations and determines whether they are room to detail up to three types of maltreatment,
substantiated. The caseworker also has a legal and for each of them, the caseworker could make a
responsibility to investigate not just the primary com- clinical judgment of whether the allegation was sub-
plaint but also whether the child has suffered other stantiated or not. This study examines substantiated
forms of maltreatment. The caseworker then ana- cases of physical abuse, that is, cases for which there
lyzes the situation in terms of the consequences to was sufficient evidence that the physical abuse had
the child and of the parents’ capacities and living actually taken place.
conditions, and makes a decision as to whether the
Dependent Variable
child’s safety or development is compromised
(Ministère de la Santé et des Services sociaux, 1998). Among the 514 children whose cases involved at least
The Child Well-Being Scale (Vézina & Bradet, 1990), one form of substantiated physical abuse, co-occurrence
a validated tool designed for the systematic assess- was defined as the presence of one or two other forms of
ment of these aspects, supports the caseworker in his substantiated maltreatment (n = 245) (sexual abuse,
investigation. For the QIS, at the very end of each neglect, abandonment, psychological abuse, other) (see
investigation, caseworkers (n = 814) filled out a survey Table 1). Table 2 shows the breakdown of categories
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5. 306 Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE
TABLE 1: Proportional Co-occurrence of Child Physical Abuse variables: CPS intervention, number of problems
(PA+) with Other Forms of Maltreatment (n = 245) experienced by reported child, mean number of
Form of Maltreatment n % problems experienced by parental figures living with
child, cooperation of parental figures during CPS
Physical abuse + psychological abuse 79 46.7 investigation, and duration of maltreatment.
Physical abuse + neglect 78 46.1
Physical abuse + abandonment 5 3.0
All variables have acceptable metric qualities in
Physical abuse + sexual abuse 4 2.4 terms of variance and missing data (less than 10%).
Physical abuse + other form of maltreatment 3 1.8 The 32 selected variables were grouped into four
Co-occurrence = 1 169 100.0 broad categories: (a) characteristics of the reported
Physical abuse + neglect + psychological abuse 61 80.3 child, (b) characteristics of the family, (c) character-
Physical abuse + abandonment + psychological abuse 8 10.5 istics of the parental figures living with the child, and
Physical abuse + sexual abuse + psychological abuse 4 5.3
(d) characteristics of the physical abuse (see Table 3).
Physical abuse + neglect + sexual abuse 2 2.6
Physical abuse + neglect + abandonment 1 1.3
Co-occurrence = 2 76 100.0
Analytical Strategies
Chi-square tests and t tests were first performed to
compare the children who were solely physically
TABLE 2: Categories of Physical Abuse with (PA+) or without
(PA) Co-Occurrence
abused with those who were also victims of other
forms of maltreatment, based on the 32 variables.
PA PA+ Total The comparisons revealed 23 significant differences
(n = 269) (n = 245) (N = 514) (p < .10) between the two groups of children. We
Categories of physical abuse n % n % n % then performed a direct logistic regression analysis
to control for colinearity between the 23 variables.
Abusive corporal punishment 185 69.0 147 60.0 332 65.0 An examination of multiple correlations revealed
Excessive physical deprivation 1 0.4 8 3.0 9 2.0
Excessive physical restrictions 5 2.0 7 3.0 12 2.0
that the tolerance for two variables was problematic
Irrational, impulsive brutality 72 27.0 80 33.0 152 30.0 (less than 0.20). As a result, those two variables (num-
Shaken baby syndrome 5 2.0 3 1.0 8 1.0 ber of problems experienced by the reported child and mean
Other type of physical abuse 1 0.4 0 0.0 1 0.2 number of problems experienced by parental figures living
with the child) were eliminated to avoid a problem of
multicolinearity. We therefore used 21 variables in
of physical abuse according to whether there was a the regression analysis to assess the unique contribu-
co-occurrence of another form of maltreatment. tion of each variable to the explanation of the pres-
ence or not of co-occurrence in cases of physical
Independent Variables
abuse. The asterisks in Table 3 identify the 21 vari-
We selected 32 variables to determine the differ- ables examined.
ential etiological patterns of cases of physical abuse Direct logistic regression analysis was performed
occurring alone or with other forms of maltreat- solely on cases not missing any data on any of the 21
ment. These variables were chosen for the frequency variables selected. This condition brought the number
with which they appeared in the literature as risk fac- of children down from 514 to 426, an attrition rate of
tors associated with physical abuse and other forms 17% of the original sample. A check was done to deter-
of maltreatment (Black, Heyman, & Smith Slep, mine whether the cases of children excluded from the
2001, 2001a; Schumacher, Smith Slep, & Heyman, regression analysis (n = 88) were significantly differ-
2001). Furthermore, given the small number of stud- ent from those included (n = 426), on the basis of all
ies surveyed (Bath & Haapala, 1993; DiLauro, 2001; 32 selected variables. The series of chi-square tests and
Hartley, 2002), we were careful to select variables t tests (with Bonferroni correction: p = .05/32 = .002)
that made it easier to draw comparisons with those indicates that only 2 of the 32 variables significantly
used in these three studies as well as with other large- distinguished the two groups of children. Fewer of the
scale incidence studies (Sedlak & Broadhurst, 1996; excluded children (26%) than the included children
Trocmé, McPhee, & Tam, 1995; Trocmé et al., 2003). (54%) had been abused by their fathers [χ2 (1, N =
However, considering what is known about the cooc- 514) = 21.3, p < .002], whereas more of the
currence of cases of physical abuse, some variables excluded children (19%) than the included children
that do not appear in the survey of the literature (7%) were abused by a relative or person outside the
were also selected. This was true of the following family [χ2 (1, N = 514) = 12.3, p < .002].
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6. Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE 307
TABLE 3: Name and Description of 32 Selected Variables
Name Description Categories or Interval
Characteristics of reported child
Gendera male / female
Age 0-17 years
Previous report Child has been subject of investigated report in year before current dichotomy
report
CPS intervention Child has been subject of CPS intervention in 5 years before current dichotomy
report
Developmental disabilitiesa Developmental delay or impaired hearing, vision or speech dichotomy
Learning difficultiesa Learning disorder or attention deficit and disruptive behavior dichotomy
Mental health problemsa Psychiatric disorder or depression and/or anxiety dichotomy
Behavioral problemsa Violence toward others, running away, irregular school attendance, etc. dichotomy
Number of problems 4 problems above plus any others (e.g., substance abuse-related birth 0 to 5
defects or chronic health condition)
Characteristics of family
Number of childrena Number of children in household (including reported child) 0 to 10
Family structure Two-parent family (e.g., original or adoptive family, blended family) two parents / single parent
or single-parent family (one parental figure)
Characteristics of parental
figures living with child
At least one parental figure is Mother’s partner or father’s partner is living with child dichotomy
step-parent
At least one parental figure is in Person receives welfare benefits or employment insurance or dichotomy
a difficult financial situationa has no income
At least one parental figure is Born outside Canada dichotomy
immigranta
At least one parental figure During investigation, person actively resists any contact with agencies dichotomy
does not cooperate fullya or is only slightly involved in planning care and services
At least one parental figure is Person is or has been physically, sexually or verbally abused dichotomy
victim of spousal abusea
At least one parental figure has Person abuses or has abused alcohol or illegal drugs dichotomy
alcohol or drug problema
At least one parental figure has Person appears to have or to have had mental health problems dichotomy
mental health problemsa
At least one parental figure is Person is going through difficult separation or divorce dichotomy
going through difficult
separation or divorcea
At least one parental figure has Inadequate social or family support (social isolation or lack of social dichotomy
social problemsa support in crisis)
At least one parental figure has Person is or has been in delicate health (chronic disease, frequent dichotomy
physical health problem hospitalizations, etc.)
At least one parental figure has Person has or has had frequent or ongoing financial crises dichotomy
financial problems a
At least one parental figure is Person engages in criminal activity (rape, prostitution, drug dealing, etc.) dichotomy
involved in criminal activitya
Mean number of problems 8 problems above plus cognitive impairment and any other type of 0 to 10
problem (irregular lifestyle, gambling problems, etc.)
Characteristics of physical abuse
Context of physical abusea Physical abuse is abusive corporal punishment or any other category of disciplinary other
physical abuse (excessive physical deprivation or restrictions; irra-
tional, impulsive brutality; shaken baby syndrome; other type of
physical abuse)
Single incidenta Physical abuse is chronic (going on for at least six months) or is one- dichotomy
time incident
Number of other children Number of other children in same household reported at same time 0 to 6
reported or during investigation
Alleged perpetrator: mother Biological or adoptive mother dichotomy
Alleged perpetrator: father Biological or adoptive father dichotomy
Alleged perpetrtor: stepparent a Mother's or father's partner dichotomy
Alleged perpetrator: other Relative or nonfamily dichotomy
Number of alleged perpetratorsa Number of alleged perpetrators from list above 1 to 4
a. The 21 variables examined in the regression analysis.
NOTE: Dichotomy (yes/no). CPS = child protective services.
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7. 308 Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE
RESULTS The large proportion of cases of co-occurrent
Table 4 shows the results of chi-square tests and physical abuse strongly supports the hypothesis con-
t tests comparing physically abused children with cerning mixed samples that might not have been
(PA+) and without (PA) co-occurrence. Like the identified in most etiological studies on physical
adults taking care of them, the PA+ children seemed abuse. Mixed samples cast serious doubt on the
to have more social and health problems and their validity and specificity of etiological knowledge of
families were more likely to be financially insecure. physical abuse that occurs alone. In fact, our find-
These children also suffered worse physical abuse— ings, most of which corroborate those of the three
the situation was more likely to be chronic—and studies reviewed (Bath & Haapala, 1993; DiLauro,
there were more siblings who could potentially have 2001; Hartley, 2002), indicate that children who are
been maltreated in the same way. solely physically abused (PA) are different from the
Table 5 shows the results of the direct logistic others (PA+). Based on the results of bivariate analy-
regression analysis of the 21 variables selected. ses, we suggest that the profile of cases of physical
Overall, the logistic regression model [χ2 (21, N = abuse alone (PA) is evidence of what we refer to as a
426) = 109.2, p < .01] significantly distinguishes dysnormal environment, whereas the profile of cases
the children who were solely physically abused (PA) of physical abuse co-occurring with one or two other
from those who suffered physical abuse plus one or forms of maltreatment (PA+) is evidence of a dys-
two other forms of maltreatment (PA+). The model functional environment.
correctly categorizes 69% of the 210 PA children and Among children solely physically abused (PA), the
69% of the 216 PA+ children. The results of the abuse seemed more often to occur in a context of
regression show no problem with convergence and abusive corporal punishment. The children of this
the standard errors for parameters are not exceed- group, most of them boys, displayed more behavioral
ingly large. Therefore, no multicolinearity is evident. problems. Although we do not claim to have estab-
Of the 21 characteristics selected, 8 favor belong- lished a causal relationship, it is possible that in some
ing to the (PA+) group of children. Boys were thus half cases, physical abuse may be precipitated by the
as likely as girls to be both physically abused and the child’s disruptive behavior (Herrenkohl et al., 1983;
victim of one or two other forms of maltreatment. Trickett & Kuczynski, 1986). The child’s more erratic
Children with behavioral difficulties were also half as behavior might overload the parents, who might
likely as those without to be in the PA+ group. Having adopt an authoritarian parenting style and harsher
an immigrant parent (rather than a parent born in disciplinary measures (Urquiza & McNeil, 1996).
Canada) reduced a child’s probability of being in the It is also possible that in other cases, abusive cor-
PA+ group by more than half. Conversely, if at least poral punishment may be associated with child-rear-
one parental figure failed to cooperate with the CPS ing standards and disciplinary strategies not shared
(versus parental figure who cooperate with the CPS) by the majority of parents and citizens born and
or had economic problems (versus no economic raised in Canada. It has been observed that there are
problem) or little social support (versus adequate a greater number of immigrant parents who engage
social support), the child was twice as likely to be a vic- in abusive corporal punishment in the PA group
tim of PA+. Last, when the physical abuse occurred in (82%) than in the PA+ group (52%) [χ2 (1, n =
a disciplinary context (rather than in another context, 120) = 11.84, p < .01]. The cultural component
e.g., irrational, impulsive brutality, shaken baby syn- associated with the use of excessive physical force to
drome, etc.), the probability of co-occurrence was discipline or correct children has been documented
reduced by a third. When the physical abuse was a sin- in some studies (Clément & Côté, 2004; Tourigny &
gle incident (rather than a chronic situation), the Bouchard, 1990).
probability was reduced by half. In the group of children who were solely physi-
cally abused, the physical abuse was more frequently
a one-time occurrence rather than recurrent. The
DISCUSSION
larger proportion of single incidents may be associ-
Co-occurrence is a very real problem in the lives ated with the presence in this group of a greater
of physically abused children reported to Quebec number of abusers who were related to the child or
CPS agencies: close to half of them suffered other third parties in positions of authority. In these cases,
forms of maltreatment. The estimate of frequency the physical abuse would not be likely to recur, as the
determined in our study (48%) is therefore close to parents would take steps to protect their child from
the mean estimate (57%) calculated on the basis of these people. In other cases, abuse that occurs only
the eight American studies reviewed (Larrivée, 2005). once may be more likely related to a temporary loss
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8. Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE 309
TABLE 4: Statistical Associations between 21 Variables and Presence (PA+) or Absence (PA) of Co-Occurrence in Cases of Physical
Abuse (N = 514)
PA (n = 269) PA+ (n = 245)
Characteristics of Reported Child n % N % χ2 p
Previous report (yes) 48 18 48 20 0.4 0.533
CPS intervention (yes) 30 11 37 16 1.8 0.175
Gender (male) 154 58 118 49 3.7 0.055*
Developmental disabilities (yes) 17 7 32 13 6.4 0.012*
Learning difficulties (yes) 54 21 78 33 8.5 0.003*
Mental health problems (yes) 18 7 41 17 12.2 0.000*
Behavioral problems (yes) 57 21 36 15 3.7 0.056*
M SD M SD t p
Age (years) 9 4.6 8 4.5 1.4 0.159
Number of problems 0.6 0.9 0.9 1.0 -3.0 0.002*
Characteristics of family
Number of children 2.2 1.1 2.5 1.2 –3.1 0.002*
n % n % χ2
p
Family structure (single parent) 78 29 64 26 0.6 0.436
Characteristics of parental figures living with child
At least one parental figure . . .
is a stepparent (yes) 75 28 80 33 1.2 0.272
is in a difficult financial situation (yes) 131 53 165 69 12.9 0.000*
is an immigrant (yes) 78 30 42 17 11.5 0.001*
Does not cooperate fully (yes) 79 30 126 52 24.7 0.000*
is a victim of spousal abuse (yes) 75 28 110 45 15.7 0.000*
has an alcohol or drug problem (yes) 51 19 91 37 20.8 0.000*
has mental health problems (yes) 48 18 78 32 13.3 0.000*
is going through a difficult separation or divorce (yes) 69 26 82 34 3.6 0.058*
has social problems (yes) 31 12 87 36 41.2 0.000*
has a physical health problem (yes) 30 11 25 10 0.1 0.707
has financial problems (yes) 60 23 129 53 50.1 0.000*
is involved in criminal activity (yes) 20 8 38 16 8.2 0.004*
Mean number of problems 1.1 1.2 2.1 1.4 -7.7 0.000*
Characteristics of physical abuse
Number of other children reported 0.8 1.1 1.2 1.2 –3.7 0.000*
Number of alleged perpetrators 1.2 0.5 1.3 0.5 –1.4 0.160
n % n % χ2 p
Alleged perpetrators:
Mother (yes) 118 45 120 49 1.0 0.314
Father (yes) 131 49 120 49 0.0 0.918
Stepparent (yes) 40 15 52 21 3.2 0.072*
Other perpetrator (yes) 31 12 15 6 4.8 0.028*
Context of physical abuse (disciplinary) 185 69 147 60 4.3 0.038*
Single incident (yes) 76 32 37 16 15.6 0.000*
*p < .10.
NOTE: Missing data percentage ranges from 0% to 10%.
of control on the part of the abuser (very often a par- between corporal punishment and physical abuse
ent). Such parents may see corporal punishment as (Gershoff, 2002). A Quebec-wide telephone survey
a necessary means of correcting their child’s behavior, indicates that the prevalence of serious physical vio-
and their discipline crossed the line into abuse. A lence is six times higher in families in which the
meta-analysis has highlighted the close relationship mothers questioned also reported minor physical
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9. 310 Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE
TABLE 5: Results of Direct Logistic Regression Analysis of 21 Variables Predicting Cases of Children Suffering Physical Abuse Plus
One or Two Other Forms of Maltreatment (PA+)
Variable β SD Wald Odds Ratio
Characteristics of reported child
Gender (male) –0.74 0.24 9.61** 0.47
Developmental disabilities (yes) 0.32 0.41 0.60 1.37
Learning difficulties (yes) 0.54 0.29 3.54 1.72
Mental health problems (yes) 0.48 0.39 1.52 1.61
Behavioral problems (yes) –0.63 0.31 4.02* 0.53
Characteristics of family
Number of children 0.08 0.16 0.25 1.08
Characteristics of parental figures living with child
At least one parental figure . . .
is in a difficult financial situation (yes) 0.27 0.25 1.16 1.31
is an immigrant (yes) –0.73 0.30 5.76* 0.48
does not cooperate fully (yes) 0.66 0.25 7.07** 1.93
is a victim of spousal abuse (yes) 0.01 0.26 0.00 0.99
has an alcohol or drug problems (yes) 0.24 0.29 0.70 1.28
has mental health problems (yes) 0.03 0.28 0.01 0.97
is going through a difficult separation or divorce (yes) 0.03 0.27 0.01 0.97
has social problems (yes) 0.74 0.31 5.70* 2.09
has financial problems (yes) 0.73 0.26 7.99** 2.08
is involved in criminal activity (yes) 0.13 0.42 0.09 1.14
Characteristics of physical abuse
Number of other children reported 0.11 0.16 0.49 1.12
Alleged perpetrators:
Stepparent (yes) 0.17 0.30 0.32 1.18
Other perpetrator (yes) –0.03 0.48 0.00 0.97
Context of physical abuse (disciplinary) –0.50 0.24 4.45* 0.60
Single incident (yes) –0.68 0.28 6.00* 0.51
(Constant) –1.75 0.55 10.07**
*p < .05. **p < .01.
violence than in families in which the mother did group, physical abuse may be the expression of
not report minor incidents (12% vs. 2%) (Clément, instrumental assault (Mammen, Kolko, & Pilkonis,
Bouchard, Jetté, & Laferrière, 2000). Last, the larger 2002). We would then be dealing with situations of
proportion of one-time incidents of physical abuse what we call dysnormality, in which abuse would be
may perhaps indicate that the process of maltreat- more attributable to parents whose child-rearing
ment is just beginning in the PA group, whereas it standards or repertoire of disciplinary strategies put
may be more advanced in the PA+ group, in which the child at risk and cross the line into what prevail-
other forms of maltreatment in addition to physical ing social standards consider to be abuse.
abuse are more often accompanied by recurrent Dysfunctionality seems to be more applicable to the
physical abuse. surroundings of children who are victims of both physical
These various observations suggest that the etiol- abuse and other forms of maltreatment (PA+). In this
ogy of physical abuse that occurs alone more often group, the children more often seem to suffer as a
goes back to child-rearing practices that diverge result of irrational, impulsive brutality (rather than
from the prevailing social standards, even though abusive corporal punishment) (see Table 2).
the child’s immediate surroundings may not be According to this clinical category of physical abuse,
severely pathological, disorganized, or morbid. Keep parents physically abuse their child more often when
in mind that the parents of children who are solely they are emotionally disorganized, under the influ-
victims of physical abuse have fewer problems of any ence of alcohol, or extremely frustrated. It is possible
kind and are more co-operative with CPS. In fact, that in this group, physical abuse is more frequently
one of Tourigny and Bouchard’s (1990) conclusions the expression of impulsive, emotional aggression
is that at a given socioeconomic level, Haitian immi- (Mammen et al., 2002).
grant families reported chiefly for physical abuse are Furthermore, the high rate of psychological abuse
more stable and have fewer problems than French- in this group of children (62%) (see Table 1) and
Canadian Quebeckers. This suggests that in the PA the recurrence of physical abuse suggest that the
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10. Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE 311
incidents of physical abuse take place in a context of here is obviously not the first attempt to account for
persistent parental emotional distress. Many more heterogeneity in cases of physical abuse. Other
parental figures in this group also have various prob- researchers have tried to illustrate distinct profiles of
lems, such as spousal abuse, substance abuse, crimi- families that are physically abusive (Oldershaw,
nality, mental health problems, separation or Walter, & Hall, 1989) or that resort to corporal pun-
divorce, or a lack of social support. In this group, the ishment (Wissow, 2001). However, in their studies
parental figures are also much more likely to be fac- these authors did not take into account the phe-
ing overwhelming financial problems. Poverty or low nomenon of multitype maltreatment.
income is a major stress factor, which may make it This study, by proposing a framework for analyz-
more difficult for those in this group to fulfill their ing the characteristics associated with physical abuse
parenting role, all the more so as they have twice as according to whether this form of maltreatment
many problems as the parents of physically abused occurs alone (dysnormality) or along with other
children without co-occurrence. Parental stress has forms of maltreatment (dysfunctionality), helps
been repeatedly associated with physical abuse enrich our scientific knowledge of the etiology of
(Whipple & Webster-Stratton, 1991). As to the physical abuse. Of course, this portrait is not
children themselves, more of them have develop- intended to be anything more than a basic concep-
mental disabilities, learning difficulties, or mental tual point of reference that provides a very rough
health problems. The children’s difficulties require map of the contours of the etiology of physical
more attention and care from parents who are abuse. We do not claim that it takes into account the
already struggling to cope with their own problems. dynamics of all cases of physical abuse studied. It is
Add to that the fact that the parents in this group merely a guide, as Crittenden (1996) says: “No
also have more children to take care of. Parental family fully fits any one pattern, and some maltreat-
stress in this group may be related to chronic rather ing families fit none of them” (p. 169). In fact, our
than temporary conditions. The family environ- findings show that cases in which physical abuse
ments also seem to be more dysfunctional, although occurs alone (PA) and in which it co-occurs with
the parents are more often unwilling to cooperate other forms of maltreatment (PA+) partially share a
with CPS. common etiology: It would be surprising if it were
The profile of dysnormality versus dysfunctionality is otherwise. For example, it can be seen that in the AP
supported when the same data are subjected to group, 27% of children were the victims of irra-
direct logistic regression. This type of very conserva- tional, impulsive brutality, whereas in the AP+
tive analysis does not attribute shared variance (col- group, 60% of children suffered abusive corporal
inearity) to any variable, which explains why the punishment.
model produced is stripped down from 21 to 8 sig- That said, our study had to deal with a number of
nificant differences. limitations. Given that our chosen unit of analysis
As far as we know, our study is the first to associate was the child, caution must be exercised in general-
cases of physical abuse that occurs alone (PA) with izing findings specifically concerning the character-
an aspect of dysnormality. With regard to dysfunction- istics of the family and parental figures, because
ality associated with physical abuse co-occurring with brothers or sisters living in the same home as the
other forms of maltreatment (PA+), our results cor- reported child might have been reported at the
roborate those of the three studies reviewed, which same time. It is possible that the interdependence of
found that in such cases, the family and environment these observations about family and parental charac-
had serious shortcomings (Bath & Haapala, 1993; teristics may have increased the probability of detect-
DiLauro, 2001; Hartley, 2002). Our findings also sup- ing significant correlations among these very
port the observations of other researchers who have characteristics. We must also take into account the
studied co-occurrence without regard to the form of fact that all the data on the survey form were pro-
maltreatment (Daro, 1988; Higgins & McCabe, vided by a single informant, a CPS caseworker. That
2000). Research on maltreatment has already shown said, despite potential interpretation biases, psycho-
that maltreating families are obviously dysfunctional metric research indicates that the assessments of CPS
in many ways (Harter, 1998). Erickson, Egeland, and caseworkers are generally sound (Alter, 1985; McGee
Pianta (1989) have also discussed the difficulty in & Wolfe, 1990). Our study does not allow us to deter-
separating maltreatment from family dysfunction. mine whether co-occurrent forms of maltreatment
Our findings describe this dysfunctionality more actually occur at the same time as physical abuse,
specifically: it appears much more clearly in cases of that is, in the same episode, or whether the forms
multitype maltreatment. The profile we are proposing occur sequentially, in separate episodes. What we do
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11. 312 Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE
know is that the different forms were assessed as part and self-reported child abuse and neglect. Child Abuse and
Neglect, 22(11), 1065-1078.
of the investigation of a single report. Last, despite Clément, M.-È., Bouchard, C., Jetté, M., & Laferrière, S. (2000).
the use of the term etiology in this study, it must be La violence familiale dans la vie des enfants du Québec, 1999.
kept in mind that the QIS is a cross-sectional study, [Family violence in the life of the children of Quebec, 1999]
Quebec City, Canada: Institut de la statistique du Québec.
and that cases of physical abuse are compared Clément, M.-È., & Côté, K. (2004). Description et efficacité d’un
among themselves and not with a control group. programme d’éducation parentale offert à une communauté
ethnique minoritaire de Montréal. [Description and effectiveness
of a parent education program offered to a minority ethnic
CONCLUSION community of Montreal.] Intervention, 120(1), 54-63.
Crittenden, P. M. (1996). Research on maltreating families:
From what we have been able to determine from Implications for intervention. In J. Briere, L. Berliner, J. A. Bulkley,
C. Jenny, & T. Reid (Eds.), The APSAC handbook on child mal-
our review of the literature, very few studies done treatment (pp. 158-174). Thousand Oaks, CA: Sage.
with CPS have been methodologically careful about Daro, D. (1988). Confronting child abuse: Research for effective program
distinguishing cases of “pure” physical abuse from design. New York: Free Press.
DiLauro, M. D. (2001). Psychosocial factors associated with types
co-occurrent cases. Our study, which avoids the trap of of child maltreatment. Dissertation Abstracts International Section
mixed samples, makes a significant contribution to A: Humanities and Social Sciences. Graduate School of Social
work in progress. Our findings indicate that the etiol- Service, Fordham University.
Dufour, S., Massicotte, K., & Mayer, M. (2005). Inventaire des fac-
ogy of physical abuse as hitherto known did not really teurs de risque, des facteurs de protection et des facteurs associés aux
take into account the specificity of physical abuse when mauvais traitements intrafamiliaux envers les enfants. [Inventory of
it occurs alone. Our research also raises questions risk factors, protection factors, and factors associated with
child maltreatment.] Montreal, Canada: GRAVE-Ardec.
about the best casework strategies to address the needs Erickson, M. F., Egeland, B., & Pianta, R. (1989). The effects of
and problems of physically abused children and their maltreatment on the development of young children. In
families, depending on the presence or absence of D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and
research on the causes and consequences of child abuse and neglect.
other forms of maltreatment. For physically abusive New York: Cambridge University Press.
families, support and educational information, respect- Gershoff, E. T. (2002). Corporal punishment by parents and
fully stated in terms of their own cultural standards, associated child behaviors and experiences: A meta-analytic
and theoretical review. Psychological Bulletin, 128(4), 539-579.
would seem to be preferable, particularly for immi- Harter, S. (1998). The effects of child abuse on the self-system. In
grant parents. For families where children are also sub- B.B.R. Rossman & M. S. Rosenberg (Eds.), Multiple victimiza-
jected to other forms of maltreatment, longer-term tion of children: Conceptual, developmental, and treatment issues
(pp. 147-169). New York: Haworth Press.
protection and more intense casework would probably Hartley, C. C. (2002). The co-occurrence of child maltreatment
be necessary, because chronic conditions seem to be and domestic violence: Examining both neglect and child
closely associated with family dysfunctionality. physical abuse. Child Maltreatment, 7(4), 349-358.
Herrenkohl, R. C., Herrenkohl, E. C., & Egolf, B. P. (1983).
Circumstances surrounding the occurrence of child maltreat-
NOTES ment. Journal of Consulting and Clinical Psychology, 51, 424-431.
Higgins, D. J., & McCabe, M. P. (2000). Multi-type maltreatment
1. A total of 814 caseworkers completed the survey form for and the long-term adjustment of adults. Child Abuse Review, 9, 6-18.
the 4,929 investigated reports. Higgins, D. J., & McCabe, M. P. (2001). Multiple forms of child
abuse and neglect: Adult retrospective reports. Aggression and
REFERENCES Violent Behavior, 6, 547-578.
Jonson-Reid, M., Drake, B., Chung, S., & Way, I. (2003). Cross-type
Alter, C. F. (1985). Decision-making factors in cases of child neg- recidivism among child maltreatment victims and perpetra-
lect. Child Welfare, 64, 99-111. tors. Child Abuse and Neglect, 27, 899-917.
Barnett, D., Manly, J. T., & Cicchetti, D. (1991). Continuing Kinard, E. M. (1994). Methodological issues and practical prob-
toward an operational definition of psychological maltreat- lems in conducting research on maltreated children. Child
ment. Development and Psychopathology, 3, 19-29. Abuse and Neglect, 18(8), 645-656.
Bath, H. I., & Haapala, D. A. (1993). Intensive family preservation Kinard, E. M. (1998). Classifying type of child maltreatment:
services with abused and neglected children: An examination of Does the source of information make a difference? Journal of
group differences. Child Abuse and Neglect, 17, 213-225. Family Violence, 13(1), 105-112.
Belsky, J. (1993). Etiology of child maltreatment: A developmen- Larrivée, M.-C. (2005). L’abus physique et sa cooccurrence avec d’autres
tal-ecological analysis. Psychological Bulletin, 14(3), 413-434. formes de mauvais traitements. Ampleur du phénomène et contribution
Black, D. A., Heyman, R. E., & Smith Slep, A. M. (2001). Risk à une étiologie différentielle. [Child physical abuse and its co-
factors for child physical abuse. Aggression and Violent Behavior, occurrence with other forms of child maltreatment. Scope of
6, 121-188. the phenomenon and contribution to a differential etiology.]
Black, D. A., Heyman, R. E., & Smith Slep, A. M. (2001a). Risk Unpublished doctoral dissertation, Université du Québec à
factors for child sexual abuse. Aggression and Violent Behavior, 6, Montréal, Montreal, Quebec, Canada.
203-229. Mammen, O. K., Kolko, D. J., & Pilkonis, P. A. (2002). Negative
Briere, J., & Runtz, M. (1990). Differential adult symptomatology affect and parental aggression in child physical abuse. Child
associated with three types of child abuse histories. Child Abuse Abuse and Neglect, 26, 407-424.
and Neglect, 14(3), 357-364. Manly, J. T., Kim, J. E., Rogosch, F. A., & Cicchetti, D. (2001).
Brown, J., Cohen, P., Johnson, J. G., & Salzinger, S. (1998). A lon- Dimensions of child maltreatment and children’s adjustment:
gitudinal analysis of risk factors for child maltreatment: Contributions of developmental timing and subtype.
Findings of a 17-year prospective study of officially recorded Development and Psychopathology, 13, 759-782.
CHILD MALTREATMENT / NOVEMBER 2007
Downloaded from http://cmx.sagepub.com by radu anca on November 28, 2009
12. Larrivée et al. / PHYSICAL ABUSE AND CO-OCCURRENCE 313
Mash, E. J., & Wolfe, D. A. (1991). Methodological issues in Trickett, P. K., & Kuczynski, L. (1986). Children’s misbehaviors
research on physical child abuse. Criminal Justice and Behavior, and parental discipline strategies in abusive and nonabusive
18(1), 8-29. families. Developmental Psychology, 22, 115-123.
Mayer, M. (1997). Les contextes écologiques d’incidence de mauvais Trickett, P. K., & McBride-Chang, C. (1995). The developmental
traitements à l’égard des enfants dans la région de Montréal. impact of different forms of child abuse and neglect.
[Ecological contexts of child maltreatment incidence in Developmental Review, 15, 311-337.
Montreal.] Unpublished doctoral dissertation, Université de Trocmé, N., McPhee, D., & Tam, K. K. (1995). Child abuse and
Montréal, Montreal, Quebec, Canada. neglect in Ontario: Incidence and characteristics. Child Welfare,
McGee, R. A., & Wolfe, D. A. (1990). Development of a record of mal- 74, 563-586.
treatment experiences. Toronto: Institute for the Prevention of Trocmé, N., Tourigny, M., MacLaurin, B., & Fallon, B. (2003).
Child Abuse. Major findings from the Canadian incidence study of reported
McGee, R. A., Wolfe, D. A., Yuen, S. A., Wilson, S. K., & Carnochan, child abuse and neglect. Child Abuse and Neglect, 27, 1427-1439.
J. (1995). The measurement of maltreatment: A comparison of Urquiza, A. J., & McNeil, C. B. (1996). Parent-child interaction
approaches. Child Abuse and Neglect, 19(2), 233-249. therapy: An intensive dyadic intervention for physically abu-
Ministère de la santé et des services sociaux. (1998). Manuel de sive families. Child Maltreatment, 1(2), 134-144.
référence sur la protection de la jeunesse. [Handbook on youth pro- Van Hasselt, V. B., Ammerman, R. T., Glancy, L. J., & Bukstein,
tection.] Quebec City, Canada: Gouvernement du Québec. O. G. (1992). Maltreatment in psychiatrically hospitalized
National Research Council. (1993). Understanding child abuse and dually diagnosed adolescent substance abusers. Journal of the
neglect. Washington, DC: National Academy Press. American Academy of Child Adolescence, 31(5), 868-874.
Ney, P. G., Fung, T., & Wickett, A. R. (1994). The worst combi- Vézina, A., & Bradet, R. (1990). Inventaire concernant le bien-être de
nations of child abuse and neglect. Child Abuse and Neglect, l’enfant en relation avec l’exercice des responsabilités parentales.
18(9), 705-714. [Child well being scale.] Quebec City, Canada: Université
Oldershaw, L., Walters, G. C., & Hall, D. K. (1989). A behavioral Laval, Centre de recherche sur les services communautaires.
approach to the classification of different types of physically Whipple, E. E., & Webster-Stratton, C. (1991). The role of
abusive mothers. Merrill-Palmer Quarterly, 35(3), 255-279. parental stress in physically abusive families. Child Abuse and
Rossman, B.B.R., Hughes, H. M., & Hanson, K. L. (1998). The Neglect, 15, 279-291.
victimization of school-age children. In B.B.R. Rossman & Wissow, L. S. (2001). Ethnicity, income and parenting contexts of
M. S. Rosenberg (Eds.), Multiple victimization of children: physical punishment in a national sample of families with
Conceptual, developmental, and treatment issues (pp. 87-106). New young children. Child Maltreatment, 6(2), 118-129.
York: Haworth Press.
Silverman, A. B., Reinherz, H. Z., & Giaconia, R. M. (1996). Marie-Claude Larrivée, PhD (University of Quebec in
The long-term sequelae of child and adolescent abuse: A Montreal , 2005), is a community psychologist. She is a consult-
longitudinal community study. Child Abuse and Neglect, 20,
709-723.
ant in prevention with the Inuit communities in Nunavik (north-
Sedlak, A., & Broadhurst, D. D. (1996). Third national incidence ern Quebec) to improve the development of children attending
study of child abuse and neglect [Executive summary]. childcare centers. She is teaching psychosocial prevention at Laval
Washington, DC: Department of Health and Human Services. University and is pursuing research on child maltreatment.
Schumacher, J. A., Smith Slep, A. M., & Heyman, R. E. (2001).
Risk factors for child neglect. Aggression and Violent Behavior, 6, Dr. Camil Bouchard (McGill University, 1974) has devoted
231-254. most of his academic career in researching the ecology of family life
Tourigny, M., & Bouchard, C. (1990). Étude comparative des and of child maltreatment. He has been involved in consulting the
mauvais traitements envers les enfants de familles francophones Quebec government on many social policy issues. In this respect,
de souche québécoise et de familles d’origine haïtienne: Nature he has inspired the development of a large nonprofit, low-fee child
et circonstances. [Comparative study of child maltreatment care network. Since 2003, he occupies a siege as an elected member
between Quebecers and Haitian families : Nature and
circumstances.] Prisme, 1(2), 56-68.
of the National Assembly of Quebec.
Tourigny, M., Mayer, M., Wright, J., Lavergne, C., Trocmé, N.,
Hélie, S., Bouchard, C., Chamberland, C., Cloutier, R., Jacob, M.,
Marc Tourigny, PhD, is a professor of psychoeducation in the
Boucher, J., & Larrivée, M.-C. (2003). Quebec incidence study of Department of Specialized Education at the University of
reported child abuse, neglect, abandonment and serious behavioural Sherbrooke (Canada). He has worked extensively on child welfare
problems. Montreal, Canada: Centre de liaison sur l’intervention practices and on treatment outcome studies of sexually abused
et la prévention psychosociales. children and of adolescent sexual offenders.
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