This article reviews cognitive and behavioral treatment strategies that have been employed with parents who physically abuse their children. Using a developmental framework, a broadened view of abuse is presented that emphasizes targets for intervention that not only reduce aversive parental behavior but also increase behaviors that lead to more optimal child outcome. Interventions with maltreaters are then described, focusing on three periods of childhood -infancy, middle childhood, and adolescence. An argument is made for there being different goal parental behaviors during each of these periods, as well as unique child-based demands that act as obstacles to parents' successfully meeting these goals. Where behavioral treatments with abusive parents do not yet exist, treatments with similar parent populations are described. The article concludes with a discussion of the treatment issues facing the field in the future.
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References
1.
Ambrose, S. , Hazzard, A., & Haworth, J. (1980). Cognitive-behavioral parenting groups for abusive families. ChildAbuse and Neglect, 4, 119-125.
2.
Ammerman, R. T. (1989). Child abuse and neglect. In M. Hersen (Ed.), Innovations in child behavior therapy (pp. 353-394). New York: Springer.
3.
Ammerman, R. T. , Hersen, M., & Van Hasselt, V. B. (1988). Abuse and neglect in handicapped children: A critical review. Journal of Family Violence, 3, 53-72.
4.
Averill, J. R. (1983). Studies on anger and aggression: Implications for theories of emotion. American Psychologist, 38, 1145-1160.
5.
Azar, S. T. (1984). An evaluation of the effectiveness of cognitive behavioral versus insight oriented mothers groups with child maltreaters. Unpublished doctoral thesis, University of Rochester.
6.
Azar, S. T. (1986). A framework for understanding child maltreatment: An integration of cognitive behavioral and developmental perspectives. Canadian Journal of Behavioral Science, 18, 340-355.
7.
Azar, S. T. (1987, August). A transactional model of child abuse. Paper presented at the Annual meeting of the American Psychological Association, New York.
8.
Azar, S. T. (1988a). Methodological considerations in treatment outcome research in child maltreatment. In J. T. Hotaling, D. Finkelhor, J. T. Kirkpatrick, & M. Straus (Eds.), Coping with family violence. Research and policy perspectives. (pp. 288-298). Newbury Park, CA: Sage.
9.
Azar, S. T. (1988b, November). Unrealistic expectations and attributional processes: An examination of a cognitive behavioral model of child maltreatment. Paper presented at the Annual meeting of the Association for Advancement of Behavior Therapy, New York.
10.
Azar, S. T. (1989). Training parents of abused children. In C. E. Schaefer & J. M. Briesmeister (Eds.), Handbook of parent training: Parents as cotherapists for children's behavior problems (pp. 414-441). New York: John Wiley.
11.
Azar, S. T. , Barnes, K. T., & Twentyman, C. T. (1988). Developmental outcomes in abused children: Consequences of parental abuse or a more general breakdown in caregiver behavior?Behavior Therapist, 11, 27-32.
12.
Azar, S. T. , Fantuzzo, J., & Twentyman, C. T. (1984). An applied behavioral approach to child maltreatment: Back to basics. Advances in Behavior Research and Therapy, 6, 3-11.
13.
Azar, S. T. , Robinson, D. R., Hekimian, E., & Twentyman, C. T. (1984). Unrealistic expectations and problem solving ability in maltreating and comparison mothers. Journal of Consulting and Clinical Psychology, 52, 687-691.
14.
Azar, S. T. , & Rohrbeck, C. A. (1986). Child abuse and unrealistic expectations: Further validation of the Parent Opinion Questionnaire. Journal of Consulting and Clinical Psychology, 54, 867-868.
15.
Azar, S. T. , & Twentyman, C. T. (1984, November). An evaluation of the effectiveness of behaviorally versus insight oriented group treatments with maltreating mothers. Paper presented at the Annual meeting of the Association for Advancement of Behavior Therapy, Philadelphia.
16.
Azar, S. T. , & Wolfe, D. A. (1989). Child abuse and neglect. In E. J. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders (pp. 451-489), New York: Guilford.
17.
Barth, R. P. , Blythe, B. J., Schinke, S. P., Stevens, P., & Schilling, R. F. (1983). Self control training with maltreating parents. Child Welfare, 62, 313-323.
18.
Bee, H. L. , Disbrow, M. A., Johnson-Crowley, N., & Barnard, K. (1981, April). Parent-child interactions during teaching in abusing and non-abusing families. Paper presented at the Biannual convention of the Society for Research in Child Development, Boston.
19.
Brunk, M. , Henggeler, S. W., & Whelan, J. P. (1987). Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55, 171-178.
20.
Campbell, R. V. , O'Brien, S., Bickett, A. D., & Lutzker, J. R. (1983). In-home parent training of migraine headaches and marital counselling as an ecobehavioral approach to prevent child abuse. Journal of Behavior Therapy and Experimental Psychiatry, 14, 147-154.
21.
Carter, B. D. , Reed, R., & Reh, C. G. (1975). Mental health nursing interventions with child abusing and neglecting mothers. Journal of Public Nursing and Mental Health Services, 11-15.
22.
Clarke-Stewart, K. A. (1989). Infant day care. Maligned or malignant?American Psychologist, 44, 266-273.
23.
Conger, R. D. , Lahey, B. B., & Smith, S. S. (1981, July). An intervention program for child abuse: Modifying maternal depression and behavior. Paper presented at the Family Violence Research Conference, University of New Hampshire, Durham.
24.
Crittenden, P. M. (1982). Abusing, neglecting, problematic, and adequate dyads: Differentiating by patterns of interaction. Merrill-Palmer Quarterly, 27, 201-218.
25.
Crittenden, P. M. (1983). The effects of mandatory protective day care on mutual attachment in maltreating mother-infant dyads. ChildAbuse and Neglect, 3, 297-300.
26.
Dawson, B. , deArmas, A., McGrath, M. L., & Kelly, J. A. (1986) Cognitive problem-solving training to improve the child-care judgment of child neglectful parents. Journal of Family Violence, 1, 209-221.
27.
Delgado, A. E. , & Lutzker, J. R. (1985, November). Training parents to identify and report their children's illness. Paper presented at the Annual convention of the Association for Advancement of Behavior Therapy, Houston.
28.
Dietrich, K. N. , Starr, R. H., & Kaplan, M. G. (1980). Maternal stimulation and care of abused infants. In T. M. Field (Ed.), High risk infants and children (pp. 25-41). New York: Academic Press.
29.
DiGiuseppe, R. (1988). A cognitive-behavioral approach to the treatment of conduct disorder children and adolescents. In N. Epstein, S. E. Schlesinger, & W. Dryden (Eds.), Cognitive-behavioral therapy with families (pp. 183-214). New York: Brunner/Mazel.
30.
Dornbusch, S. M. , Carlsmith, J. M., Bushwall, S. J., Ritter, P. L., Leiderman, H., Hastorf, A. H., & Gross, R. T. (1985). Single parents, extended households, and the control of adolescents. Child Development, 56, 326-341.
31.
Egan, K. (1983). Stress management and child management with abusive parents. Journal of Clinical Child Psychology, 12, 292-299.
32.
Elmer, E. (1986). Outcome of residential treatment for abused and high risk infants. ChildAbuse and Neglect, 10, 351-360.
33.
Foreman, S. , & Seligman, L. (1983) Adolescent abuse. School Counselor, 31, 17-25.
34.
Fantuzzo, J. W. , Wray, L., Hall, R., Goins, C., & Azar, S. T. (1986). Parent and social skills training for mentally retarded parents identified as child maltreaters. American Journal of Mental Deficiency, 91, 135-140.
35.
Field, T. , Widmayer, S. M., Stringer, S., & Ignatoff, E. (1980). Teenage, lower class, black mothers and their preterm infants: An intervention and developmental follow-up. Child Development, 51, 426-436.
36.
Frodi, A. M. , & Lamb, M. E. (1980). Child abuser's responses to infant smiles and cries. Child Development, 51, 238-241.
37.
Gilbert, M. T. (1976). Behavioral approach to the treatment of child abuse. Nursing Times, 72, 140-143.
38.
Helfer, R. E. (1980). Retraining and relearning. In E. H. Kemp & R. E. Helfer (Eds.), The battered child (pp. 391-400). Chicago: University of Chicago Press.
39.
Herrenkohl, R. C. , Herrenkohl, E. C., & Egolf, B. P. (1983). Circumstances surrounding the occurrence of child maltreatment. Journal of Consulting and Clinical Psychology, 51, 424-43 1.
40.
Isaacs, C. D. (1982). Treatment of child abuse: A review of the behavioral interventions. Journal of Applied BehavioralAnalysis, 15, 273-294.
41.
Justice, B. , & Justice, R. (1978). Evaluating outcome of group therapy for abusing parents. Corrective and Social Psychiatry and Journal of Behavioral Technology, 24, 45-49.
42.
Kaufman, J. , & Zigler, E. (1987). Do abused children become abusive parents?American Journal of Orthopsychiatry, 57, 186-192.
43.
Kifer, R. E. , Lewis, M. A., Green, D. R., & Phillips, E. L. (1974). Training predelinquent youths and their parents to negotiate conflict situations. Journal ofApplied BehavioralAnalysis, 7, 357-364.
44.
Larrance, D. T. , & Twentyman, C. T. (1983). Maternal attributions in child abuse. Journal of Abnormal Psychology, 92, 449-457.
45.
Lutzker, J. R. , & Rice, J. M. (1984). Project 12-Ways: Measuring outcome of a large in-home service for treatment and prevention of child abuse and neglect. Child Abuse and Neglect, 8, 519-524.
46.
Lutzker, S. Z. , Lutzker, J. R., Braunling-McMorrow, D., & Eddleman, J. (1987). Prompting to increase mother-baby stimulation with single mothers. Journal of Child and Adolescent Psychotherapy, 4, 3-12.
47.
Miller, S. (1988). Parent's beliefs about children's cognitive development. Child Development, 59, 259-285.
48.
Novaco, R. W. (1975). Anger control: The development and evaluation of an experimental treatment. Lexington, MA: Lexington Books.
49.
Olds, D. L. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65-78.
50.
Pagelow, M. (1989). The incidence and prevalence of criminal abuse of other family members. In L. Ohlin & M. Tonry (Eds.), Family violence (pp. 263-314). Chicago: University of Chicago Press.
51.
Plotkin, R. (1983) Cognitive mediation in disciplinary action among mothers who have abused or neglected their children: Dispositional and environmentalfactors. Unpublished doctoral dissertation, University of Rochester.
52.
Reid, J. B. , Kavenaugh, K., & Baldwin, D. V. (1987). Abusive parents' perceptions of child problem behavior: An example of parental bias. Journal of Abnormal Psychology, 15, 457-466.
53.
Rohrbeck, C. A. , & Twentyman, C. T. (1986). A multimodal assessment of impulsiveness in abusing, neglectful, and normal mothers and their preschool children. Journal of Consulting and Clinical Psychology, 54, 231-236.
54.
Rueger, D. B. , & Liberman, R. P. (1984). Behavioral family therapy for delinquent substance abusing adolescents. Journal of Drug Issues, 14, 403-418.
55.
Russell, C. S. (1974). Transition to parenthood. Journal of Marriage and the Family, 36, 294-302.
56.
Salzinger, S. , Kaplan, S., & Artemyeff, C. (1983). Mothers' personal social network and child maltreatment. Journal of Abnormal Psychology, 92, 68-72.
57.
Sanders, R. W. (1978). Systematic desensitization in the treatment of child abuse. American Journal of Psychiatry, 135, 483-484.
58.
Sandford, D. A. , & Tustin, R. D. (1974). Behavioral treatment of parental assault on a child. New Zealand Psychologist, 2, 76-82.
59.
Sarber, R. E. , Halasz, M. M., Messmer, M. C., Bickett, A. D., & Lutzker, J. R. (1983). Teaching menu planning and grocery shopping skills to a mentally retarded mother. Mental Retardation, 21, 101-106.
60.
Schellenbach, C. J. , & Guemey, L. F. (1987). Identification of adolescent abuse and future intervention. Journal ofAdolescence, 10, 1-12.
61.
Schmitt, B. D. (1987). Seven deadly sins of childhood: Advising parents about difficult developmental phases. Child Abuse and Neglect, 11, 421-432.
62.
Szykula, S. A. , & Fleischman, M. J. (1985). Reducing out-of-home placement of abused children: Two controlled studies. Child Abuse and Neglect, 9, 277-284.
63.
Tertinger, D. A. , Greene, B. F., & Lutzker, J. R. (1984). Home safety: Development and validation of one component of an ecobehavioral treatment program for abused and neglected children. Journal ofApplied BehaviorAnalysis, 17, 150-174.
64.
Thorne, G. L. , Tharp, R. G., & Wetzel, R. J. (1967). Behavior modification techniques: New tools for probation officers. Federal Probation, 31, 21-27.
65.
Wilkie, C. F. , & Ames, E. W. (1986). The relationship of infant cries to parental stress in the transition to parenthood. Journal of Marriage and the Family, 48, 545-550.
66.
Wolfe, D. A. , Sandler, J., & Kaufman, K. (1981). A competency based parent training program for abusive parents. Journal of Consulting and Clinical Psychology, 49, 633-640.
67.
Wolfe, D. A. , Edwards, B., Manion, I., & Koverola, C. (1988). Early intervention for parents at risk of child abuse and neglect: A preliminary investigation. Journal of Consulting and Clinical Psychology, 56, 40-47.
68.
Wolfe, D. A. , Kaufman, D., Aragona, D., & Sandler, J. (1981). The child management program for abusive parents. Winter Park, FL: Anna Publishing.
69.
Wolfe, D. A. , St. Lawrence, J., Graves, K., Brehony, K., Bradlyn, D., & Kelly, J. (1982). Intensive behavioral parent training for a child abusive mother. Behavior Therapy, 13, 438-451.
70.
Wood-Shuman, S. , & Cone, J. D. (1986). Differences in abusive, at-risk for abuse, and control mothers' descriptions of normal child behavior. Child Abuse and Neglect, 10, 397-405.
