Biomedical subjects

Alan J Litrownik

Publications and source records attributed to Alan J Litrownik.

11 recordsLinked to original sources

PubMed2006

Effect of early childhood adversity on child health.

OBJECTIVE: To examine the effect of child abuse and other household dysfunction on child health outcomes. DESIGN: Data from the Longitudinal Studies of Child Abuse and Neglect collected through interviews and questionnaires administered when target children were 4 years old and 6 years old. SETTING: Children in the South, East, Midwest, Northwest, and Southwest United States. PARTICIPANTS: One thousand forty-one children at high risk for child abuse and neglect (3 cohorts derived primarily from among children recruited through social service mechanisms, 1 cohort recruited at birth from among high-risk infants, and 1 cohort recruited from a medical setting). MAIN OUTCOME MEASURES: (1) Association of 7 adverse exposures (3 categories of child abuse [physical abuse, sexual abuse, and psychological maltreatment] and 4 categories of household dysfunction [caregiver problem drinking, caregiver depression, caregiver treated violently, and criminal behavior in the household]) derived from data collected when the child was 4 years old. (2) Indexes of child physical health at age 6 years (caregiver overall assessment of child health and reports of illness requiring medical attention). RESULTS: Two thirds of the sample had experienced at least 1 adverse exposure. One adverse exposure almost doubled the risk of overall poor health (odds ratio, 1.89; 95% confidence interval, 1.02-3.48), and 4 adverse exposures or more almost tripled the risk of illness requiring medical attention (odds ratio, 2.83; 95% confidence interval, 1.10-7.31). CONCLUSION: Adverse environmental exposures, including child abuse and other household dysfunction, are associated with poor child health even at an early age, although our data do not support a dose-response relationship.

Alcoholism↗

PubMed2006

Reporting participants in research studies to Child Protective Services: limited risk to attrition.

This study examines the impact of Child Protective Services (CPS) reports made by research study staff on participant retention and discusses human subjects protocols that may minimize either the need to make such reports or the negative impact of reporting on participants and on participant retention. Among 1, 354 primary caregiver-child pairs in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) studies, a total of 15 were reported to CPS by study staff. Within this group, rates of study-generated reports and study participation subsequent to having been reported by researchers were examined. There was an overall retention rate of 93% across a minimum of three interview waves in this sample. Reporting research participants to CPS may have little impact on attrition.

Child↗

PubMed2005

Measuring the severity of child maltreatment.

OBJECTIVE: The purpose was to identify different operational definitions of maltreatment severity, and then to examine their predictive validity. METHOD: Children and their primary caregivers participating in a consortium of ongoing longitudinal studies were interviewed when they were approximately 4 and 8 years of age to assess behavior problems, and developmental and psychological functioning. Four different severity definitions were identified and applied to 519 children who were reported for alleged maltreatment between Birth and the Age 8 interview. A taxonomy for defining maltreatment characteristics (Barnett, Manly, & Cicchetti, 1993) was applied to Child Protective Service records to define severity as (a) Maximum Severity within each of five maltreatment types, (b) Overall Maximum Severity across the five types, (c) Total Severity or the sum of the maximum severity for each of five types, and (d) Mean Severity or the average severity for those types of maltreatment alleged, during each of two time periods-Birth to Age 4, and Age 4 to Age 8. RESULTS: Regression analyses that controlled for socio-demographic factors, early maltreatment (Birth to Age 4), prior functioning (Age 4), and site revealed that (a) all four severity definitions for maltreatment reports between Age 4 and Age 8 predicted Age 8 behavior problems, (b) Maximum Severity by Type and Mean Severity predicted adaptive functioning at Age 8, and (c) only Maximum Severity by Type was related to anger, at Age 8. Follow-up regression analyses indicated that only Maximum Severity by Type, specifically physical abuse, accounted for outcomes, beyond maltreatment occurrence versus non-occurrence. CONCLUSION: The results suggest that maltreatment severity definitions that preserve ratings within types of maltreatment may be the optimal approach to measure the severity of children's experiences.

Adaptation, Psychological↗

PubMed2005

Defining child neglect based on child protective services data.

OBJECTIVES: To compare neglect defined by Child Protective Services official codes with neglect defined by a review of CPS narrative data, and to examine the validity of the different neglect measures using children's functioning at age 8 years. METHODS: Data are from 740 children participating in a consortium of longitudinal studies on child abuse and neglect; 481 had at least one CPS report prior to age 8. CPS records were reviewed to ascertain both broad CPS types of neglect as well as specific subtypes of neglect using a modified version of the Maltreatment Classification System (MMCS). Frequencies of, and correlations among, the types and subtypes of neglect were examined. The validity of the neglect measures was evaluated by examining their relationships with children's functioning at age 8. RESULTS: The CPS neglect types and MMCS subtypes were moderately correlated, as were the MMCS subtypes of neglect. In general, neglect was only modestly associated with children's functioning at age 8 (r2=1-4%), with few differences between the CPS neglect types and the MMCS subtypes. There were significant associations with children's total and externalizing behavior problems, impaired socialization, and impaired daily living skills. Among the specific subtypes, neglect of children's medical needs was related to externalizing behavior problems, impaired socialization, and impaired daily living skills. Neglect of children's hygiene needs was related to impaired socialization. CONCLUSION: The moderate correlations among CPS and MMCS types and subtypes of neglect and their similar associations with children's functioning suggest that the considerable effort involved in coding neglect subtypes from CPS narrative data may yield limited incremental knowledge regarding the types of neglect children experience and their sequelae. However, the MMCS does offer useful descriptive information on the nature of neglect children experience, and may guide future research and practice on optimal ways to conceptualize neglect.

Child Abuse↗

PubMed2005

Defining maltreatment chronicity: are there differences in child outcomes?

OBJECTIVE: For nearly 25 years researchers have suggested that better taxonomic systems conceptualizing and reliably differentiating among different dimensions of maltreatment are required. This study examines the utility of three different characterizations of one dimension of maltreatment, chronicity, to predict child behavioral and emotional functioning in a sample of maltreated children. A secondary objective of the study is to examine additional parameters of maltreatment inherent in our definitions of chronicity: age at first report to CPS, extent and continuity of maltreatment. METHOD: The study consists of children reported for maltreatment (N=519) from the larger LONGSCAN study cohort. Lifetime maltreatment data were collected from CPS records and coded into two chronicity constructs: "developmental" and "calendar" definitions. Variables for age at first report, frequency, extent and continuity of maltreatment reports also were constructed. Hierarchical regression analyses were utilized to determine the extent to which the various chronicity constructs contributed to the prediction of child outcomes. RESULTS: The most salient definition of chronicity, in terms of its effects on child behavioral and emotional functioning, varied by outcome. The developmental definition was found to have the most balanced sensitivity across outcomes. Among other significant findings, extent and continuity of maltreatment contributed respectively to the prediction of behavior and emotional trauma symptoms. Early age at first report was a predictor of poor daily living skills. CONCLUSION: Chronicity is a complex construct. Findings indicate there are multiple parameters that make up the chronicity construct itself that may be important for understanding child outcomes.

Adaptation, Psychological↗

PubMed2005

Maltreatment's wake: the relationship of maltreatment dimensions to child outcomes.

OBJECTIVE: The aim of this exploratory study was to examine the extent to which, in combination, the best constructions of basic dimensions of maltreatment, identified in other papers from LONGSCAN, predict child outcomes. METHOD: Maltreatment records of a sample of 203 children were used to define dimensions of maltreatment related to Type, Severity, Chronicity, and Age at First Report. The definitions were based upon findings presented in other papers in this special issue. Children's behavioral and emotional functioning was examined at age 8 using standardized measures of problem behaviors, socialization and adaptation, and trauma symptomatology. Backward elimination regression was used to screen for interactions among the dimensions; regression models including dimensions and significant interactions were then run for each child outcome. Stratified partial correlations were utilized to explicate significant interactions. RESULTS: Individual maltreatment dimensions were found to have distinct effects on child functioning. Additionally, dimensions of maltreatment were interrelated and interacted in determining outcomes. Type of maltreatment (as indicated by the maximum severity rating of each type) was the most consistent predictor across outcomes, albeit different types predicted different outcomes. Various dimensional interactions were significant predictors of different outcomes. CONCLUSION: The results suggest that a comprehensive assessment of a child's maltreatment experience, including type and severity, when the maltreatment began and the pattern of maltreatment across the life span, is important to understanding the effects of maltreatment on children's growth and development.

Child Abuse↗

PubMed2005

Examination of a conceptual model of child neglect.

This study attempted to provide empirical support for conceptual definitions of child neglect. We identified 12 types of needs, conceptualizing neglect as occurring when children's basic needs are not adequately met. We examined measures administered to 377 children and caregivers at ages 4 and 6 years participating in longitudinal studies on child mal-treatment to identify potential indicators of these needs. Indicators were found for latent constructs, operationalizing three of the basic needs (emotional support and/or affection, protection from family conflict and/or violence, and from community violence). These latent constructs were used in a measurement model; this supported the conceptual definitions of neglect. A structural equation model then assessed whether the latent constructs were associated with child adjustment at age 8 years. Low level of perceived support from mother was associated with internalizing and externalizing behavior problems. Exposure to family conflict was also linked to these problems, and to social difficulties. Finally, children's sense of experiencing little early affection was associated with subsequent externalizing behavior and social problems. The approach of conceptualizing neglect in terms of unmet child needs, developing a measurement model to define latent neglect constructs, and relating these constructs to subsequent adjustment can build our understanding of neglect.

Affect↗

PubMed2004

The experience of foster care: relationship between foster parent disciplinary approaches and aggression in a sample of young foster children.

The relationship between disciplinary practices of 70 foster parents (kin and nonkin) and aggression in their 8-year-old foster children was examined. Aggressive behavior was assessed through child and foster parent reports, whereas disciplinary behavior was examined by asking foster parents how they would typically respond to five child misbehaviors. Kinship foster parents (64.8%) were significantly more likely than nonkinship foster parents (30.2%) to report that they would use harsh discipline (p < .01). No significant relationship was found between foster parent reports of child aggression and their reports of disciplinary behavior. However, foster parents who reported they would use harsher discipline were more likely to have children in their care who generated multiple aggressive solutions to social problems (odds ratio = 2.7, p < .01). The evidence suggesting that the disciplinary practices of foster parents may influence children's social aggression is discussed in relation to future research, policy, and interventions.

Aggression↗

PubMed2003

Some methodologic issues in analyzing data from a randomized adolescent tobacco and alcohol use prevention trial.

Three issues concerning the design and analysis of randomized behavioral intervention studies are illustrated and discussed within the framework of a tobacco and alcohol prevention trial among migrant Latino adolescents. The first issue arises when subjects are randomized in clusters rather than individually. Because subject observations cannot be assumed to be independent, information pertaining to the degree of clustering must be reported, and analyses must take the clustering into account. The second issue concerns the impact of compliance to the intervention and the importance of measuring compliance in the experimental and attention-control groups. A compliance analysis should control for participant contact with study personnel. Investigators must consider ways of constructing a compliance measure that is common to both conditions. Third, because outcomes are measured repeatedly over time, we illustrate the importance of assessing the impact of missing-data patterns on outcomes and the extent to which the patterns may modify the treatment effect.

Adolescent↗

PubMed2003

Going home: the complex effects of reunification on internalizing problems among children in foster care.

When children in fostercare are reunified with their families of origin they encounter changes that may influence their well-being in both positive and negative ways. We examined the effects of reunification among 218 children in foster care to test an integrative model of the effects of reunification using structural equation modeling. We hypothesized that reunification would exert indirect effects on subsequent child adjustment via changes in adverse life events, perceived social isolation, and mental health service utilization. Results indicated no direct effect of reunification on subsequent internalizing problems, but reunification was related to increased adverse life events that, in turn, were related to elevated symptoms. Second, reunification was negatively associated with mental health service use. Finally, reunification was associated with decreased child perceptions of social isolation. In summary, reunification with biological parents is associated with multiple environmental changes, with most but not all effects indicating negative consequences.

Adolescent↗

PubMed2002

Tobacco and alcohol use-prevention program for Hispanic migrant adolescents.

OBJECTIVE: Evaluate a community-based tobacco/alcohol use-prevention program group compared with an attention-control condition (first aid/home safety) group. METHODS: A total of 660 adolescents and 1 adult caregiver for each were recruited through the Migrant Education Program to participate in an 8-week intervention. Random assignment to the two groups occurred in 22 schools. Seventy 8-week intervention groups (37 tobacco/alcohol and 33 attention-control) were conducted. Assessments occurred at baseline, immediate post-intervention, and 1- and 2-year follow-ups. Susceptibility to smoking and alcohol as well as smoking and drinking over the past 30 days were the primary outcomes of interest. RESULTS: Following intervention, no between-group differences in smoking or drinking were significant. Thirty-day smoking started and remained at very low levels, with the highest group prevalence at any measurement period being 4.7% and the lowest 2.5%. Those considered susceptible to smoking dropped by nearly 40% in the attention-control group and by 50% in the intervention group from baseline to the final follow-up. (The overall reduction from post-test to final follow-up was statistically significant.) Less-acculturated children were less likely to report drinking in the past 30 days. CONCLUSIONS: The current intervention was not demonstrated to be effective in preventing cigarette or alcohol consumption. This perhaps is due to very low baseline levels of smoking and drinking in the migrant youth participants.

Adolescent↗