Background

The research on child maltreatment can be divided into three different projects.

• Child abuse and neglect: Epidemiology
• Child abuse and neglect: neurobiological aspects
• Child neglect: Biobehavioural development of children growing up in residential settings

Child abuse and neglect: Epidemiology

How often does child abuse and neglect (CAN) occur in the Netherlands? For more than three de­cades the prevalence and prevention of CAN have been among the most hotly debated problems in Dutch politics and public opinion. Nevertheless, the prevalence of CAN was an unknown parame­ter in these discussions. The widely accepted but rather rough estimate of 50,000 ~ 80,000 cases of child maltreatment per year were based on American studies (in particular the National Incidence Studies, or NIS). The Netherlands’ Prevalence study of Maltreatment of youth (NPM-2005) is the first systematic and nation-wide effort to examine the prevalence of CAN in our country. 

The NPM-2005 used more than 1,100 carefully selected informants (‘sentinels’) across all major regions of the Netherlands. The informants were professionals working with children, and recruited from various health care, child care and educational institutions in society. The informants were instructed in the use of a uniform registration system for CAN, based on detailed definitions and descriptions of the various forms of maltreatment. The overall definition of CAN was derived from Dutch law, and specific descriptions were taken from coding forms used in the American NIS. In ad­dition, the formal registrations of all Dutch Child Protection Services (‘Advies- en Meldpunten Kin­dermishandeling’, AMK) during 2005 were included in the final estimates of the prevalence rates.

In the current NPM-2005 study the prevalence of CAN is estimated to be 107,200 cases in the year 2005. This is a prevalence of 30 cases of maltreatment per 1,000 children in the age range of 0-17. The majority of the maltreated children suffered from neglect, in particular physical, emotional, or educational forms of neglect. About 4,700 children were victims of sexual abuse which is 1.3 cases per 1,000 children. Physical maltreatment occurred in more than 19,000 cases. Almost a quarter of the child abuse or neglect victims suffered from sexual and/or physical abuse.  
In families with very low educated parents the risk for child abuse and neglect increases almost 7-fold. When both parents are jobless the risk is more than 5 times larger. In families with parents from ethnic minorities the risk for child abuse and neglect is about 3.5 times larger, but when their lower educational level is taken into account the risk becomes much smaller. A larger family (three or more children) and single parenthood double the risk for CAN. These risk factors are neither new nor surprising but belong to the ‘usual suspects’. The influence of the various risk factors can now be compared, and the potential effectiveness of (preventive) interventions dealing with the different risks can be evaluated.  
Currently, we conduct a meta-analysis on prevalence studies around the world to examine whether the Dutch prevalence figures are comparable to those in other countries and cultures, and to test whether the prevalence estimates are dependent on the method of data-collection

Child abuse and neglect: neurobiological aspects

Child neglect and psychological abuse are among the most prevalent forms of child abuse, and exert deleterious effects on mental health and development. However, the mechanisms of such deleterious effects remain understudied. One important mechanism may be the effects of recurring unexpected negative feedback and omission of expected positive feedback from the parent, on the development of shame sensitivity vs. positive internal working models. Early experiences, particularly parent-child interactions, are important determinants of internal working models which, in turn, determine the way the child interacts with its social environment (Bowlby, 1988). Positive and informative feedback from the parent help the child construct positive internal working models that facilitate adaptive social interactions and a secure base experience (Gergely & Watson, 1998). Inconsistent or frequent negative feedback will prevent secure working models from developing. The absence of secure attachment patterns and positive internal working models causes sensitivity to social threats such as rejection or exclusion, and dependency on continual positive feedback and reward. In the insecurely attached developing child, and in the adult, this leads to vigilance to signals of negative feedback (rejection sensitivity) and positive feedback (reassurance seeking).  Empirical work on dispositional fear of negative feedback and failure has demonstrated that it leads to a host of deleterious processes and outcomes (see McGregor & Elliot, 2005). Research on the origins of fear of failure suggests that it is rooted in parental socialization and parent-child relations. For instance, parent fear of failure has been shown to be a positive predictor of child fear of failure, and love withdrawal was documented as a mediator of mother-child, but not father-child, fear of failure concordance. Mothers high in fear of failure were more likely to withdraw love from their child when their child made a mistake or failed, and this love withdrawal led to fear of failure in the child. Individuals high in fear of failure were more likely to evidence relational concerns upon failure (McGregor & Elliot, 2005). More precisely, high fear of failure participants, relative to low fear of failure participants, reported feeling less close to their mother after failure, reported that they would be less likely to tell their mother and father about their failure experience, and reported that they would be more likely to tell their mother and father about their success experience. Thus, fear of failure appears to be deeply rooted in affiliation issues, particularly those involving parent-child relations. In a recent study, we found that fear of failure predicted event-related potential (ERP) responses to facial feedback stimuli in 16 healthy female introductory-level psychology students (Tops & Wijers, 2007). The subjects performed an Eriksen Flanker task, in which every response was followed by a picture from a set of pictures that depicted either happy or disgust facial expressions. These pictures were presented in red-white after a subject made an error, and in green-white after a correct response. Valence of the expressions (happy vs. disgust) was divided evenly and randomly over the error and correct trials. As a trait measure of fear of failure, the subjects filled out the Concern over Mistakes (CoM) subscale of the Measure of Perfectionism Scale. CoM predicted more negative ERP amplitudes to negative feedback conveyed by happy faces, i.e. when positive feedback was expected. These effects were maximal 200-400 ms after presentation of the feedback, in an ERP that is called the feedback-related negativity (FRN). FRN is an ERP measured at fronto-central electrodes that is more negative after negative feedback or outcomes compared to positive feedback or outcomes. More specifically, this potential appears to be more negative when outcomes are worse than expected. In the present project, we want to study the FRN and fear of failure in a similar design, in sexually abused mothers and their children, and control mothers and their children. We will also determine attachment patterns between mothers and children, and the mother’s use of love withdrawal in response to task failure of her child, using observation techniques. Emotional availability of the mother towards the child and of the child towards the mother will be measured using the Emotional Availability Scales (Biringen, Robinson & Emde, 2000). We study sexually abused mothers because this is a relatively homogenous group in which fear of failure and rearing practices such as love withdrawal are expected to be high. Moreover, such characteristics and child maltreatment tend to be transmitted over generations (McGregor & Elliot, 2005).

Child neglect: Biobehavioural development of children growing up in residential settings

Attachment theory postulates that during the first years of life the child develops attachment relationships with one or several specific individuals, such as parents or caregivers, who interact with the child on a regular basis (Bowlby, 1982). This interaction, according to Bowlby (1998), when nurturing, predictable, and attuned to the infant’s or child’s attachment needs, facilitates healthy development and emotion regulation of the child within the “environment of evolutionary adaptiveness” or related developmental niches (Vorria et al. 2003). Conversely, institutional care still is common in developing countries and countries in transition due to suboptimal caregiver-child ratios, lack of educated staff, and high staff turnover usually confronts children with discontinuous and highly limited contacts with different caregivers who are not always sensitive to the individual needs of the child. Apparently, rearing in such circumstances may violate the conditions formulated by Bowlby and others to be necessary for a balanced attachment development, and therefore cannot provide the environmental input that will promote species-specific organization of attachment behaviors and attachment relationships. In a series of studies we focus on the attachment organization of institutionalized children and examine whether and how it is different from the attachment organization of non-institutionalized native children reared in regular families, in terms of antecedents and sequelae.
Several studies suggested that the early stress and deprivation usually experienced by institutionally reared children may affect the structure and functioning of the brain, which can lead to neurobiological changes responsible for long-term emotional, cognitive and behavioral deficits. In the current series of studies we examine biobehavioral functioning of the orphans through the collection of cortisol on regular days as well as in stressful situations. Although hyperreactivity of the cortisol response has been found in previously institutionalized children, it cannot be excluded that some institutionalized children may respond with a flat daytime pattern, indicating hypocortisolism which might be a reflection of repeated daily intermittent stress. Therefore we examine whether in natural as well as in stressful laboratory settings neurobiological differences exist in institutionally reared children in comparison to home reared children, and how these differences are related to their attachment status.
It would be ethical indefensible only to collect descriptive data and not at the same time prepare for an intervention that might enhance the quality of life and developmental prospects of this extremely deprived children. We hypothesize that improvement of the quality of caregiving through the enhancement of the caregiver’s sensitivity may improve the quality of attachment organization in children and produce better outcomes in other developmental domains in institutionally reared children. We plan to prepare VIPP-based intervention protocols for implementation and testing in various residential settings in countries like Ukraine, India and Zambia.