A cumulative ecological–transactional risk model of child maltreatment and behavioral outcomes: Reconceptualizing early maltreatment report as risk factor

The current analysis was designed to critically examine the tendency to focus on child maltreatment as a unique risk factor and test the resulting assumption of a direct causal relationship between early maltreatment and later behavioral problems. The variation seen in behavioral outcomes among children reported for maltreatment early in life led us to hypothesize that the cumulative level of risk facing children and their families can, at least in part, account for that variation in outcome. Participants were 242 mothers of predominantly at-risk newborn infants who were interviewed shortly after giving birth. The State Central Registry of Maltreatment was then reviewed over each child's first four years of life to assess for early maltreatment. Following the neonatal interviews, mothers completed the Child Behavior Checklist when their children were 4, 6, 8, 10 and 12 years-of-age. Although early maltreatment report does appear to be important to early child functioning, the cumulative level of risk more strongly predicts long-term clinical behavioral difficulty. High-risk children who were not reported for maltreatment by age 4 demonstrate greater behavioral problem trajectories than did low-risk children with a maltreatment report. Maltreatment itself may be best conceptualized as an important, but not singularly so, risk factor for later behavioral problems. In focusing directly on reported maltreatment, our child protective systems may be paying too little attention to what else is going wrong in the lives of children and targeting intervention efforts in the wrong direction. When it comes to early maltreatment our child protective policy and practice need to broaden their lenses to include greater emphasis on overall family functioning, stress and well-being. Early maltreatment, it seems, may be a symptom of more profound problems in the early environments of our most vulnerable children, rather than the problem itself.

► Cumulative risk more strongly predicts behavioral problems than early maltreatment.
► High-risk non-maltreated youth do worse than low-risk maltreated youth.
► Maltreatment provides a window into family capacity for coping with current risk.
► We need to look beyond maltreatment to overall family functioning and well-being.