Individual Cognitive Behavioral Treatment and Family Therapy for Physically Abused Children and their Offending Parents: A Comparison of Clinical Outcomes

Abstract

Few studies have evaluated short-term psychosocial treatments with physically abused school-aged children and their offending parents or families. This study compares the treatment outcomes of 55 cases that were randomly assigned to individual child and parent cognitive behavioral therapy (CBT) or family therapy (FT) with those who received routine community services (RCS). Measures of child, parent, and family dysfunction and adjustment were collected from both participants and supplemented with official social service records to evaluate the efficacy of treatment through 1-year follow-up. Compared with RCS, CBT and FT were associated with improvements in child-to-parent violence and child externalizing behavior, parental distress and abuse risk, and family conflict and cohesion. All three conditions reported several improvements across time. One parent participant each in CBT and FT and three in RCS were found to have engaged in another incident of physical maltreatment after treatment had begun. No differences between CBT and FT were observed on consumer satisfaction or maltreatment risk ratings at termination. The findings of this evaluation provide additional support for the continued development and evaluation of individual and family treatments involving child victims of physical abuse.

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References

Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington: University of Vermont, Department of Psychiatry.

Achenbach, T. M. , & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: University Associates in Psychiatry.

Alexander, J. , & Parsons, B. (1982). Functional family therapy. Monterey, CA: Brooks/Cole.

Anderson, C. M. , & Reiss, D. (1983). Approaches to psycho-educational family therapy. International Journal of Family Psychiatry, 3, 501-517.

Arnold, D. S. , O'Leary, S. G. , Wolff, L. S. , & Acker, M. M. (1993). The parenting scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137-144.

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.

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.

Azar, S. T. , & Siegel, B. R. (1990). Behavioral treatment of child abuse: A developmental perspective. Behavior Modification, 14, 279-300.

Barnett, D. , & Manly, J.T.C.D. (1993). Defining child maltreatment: The interface between policy and research. In D. Cicchetti & S. L. Toth (Eds.), Child abuse, child development, and social policy (pp. 7-74). Norwood, NJ: Ablex.

10.

Beck, A. T. , Ward, C. H. , Mendelson, M. , Mock, J. , & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.

11.

Belsky, J. (1993). Etiology of child maltreatment: A developmental-ecological analysis. Psychological Bulletin, 114, 413-434.

12.

Beutler, L. E. (1993). Designing outcome studies: Treatment of adult victims of child sexual abuse. Journal of Interpersonal Violence, 8, 402-414.

13.

Bierman, K. , & McCauley, E. (1987). Children's descriptions of their peers' interactions: Useful information for clinical child assessment. Journal of Clinical Psychology, 16, 9-18.

14.

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.

15.

Bugental, D. B. , Mantyla, S. M. , & Lewis, J. (1989). Parental attributions as moderates of affective communication to children at risk for physical abuse. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 254-259). New York: Cambridge University Press.

16.

Chambers, W. J. , Puig-Antich, J. , Hirsch, M. , Paez, P. , Ambrosini, P. J. , Tabrizi, M. A. , & Davies, M. (1985). The assessment of affective disorders in children and adolescents by semistructured interview. Archives of General Psychiatry, 42, 696-702.

17.

Culp, R. E. , Little, V. , Letts, D. , & Lawrence, H. (1991). Maltreated children's self-concept: Effects of a comprehensive treatment program. American Journal of Orthopsychiatry, 61, 114-121.

18.

Dale, P. , & Davies, M. (1985). A model of intervention in child-abusing families: A wider systems view. Child Abuse & Neglect, 9, 449-455.

19.

Daro, D. (1993). Child maltreatment research: Implications for program design. In D. Cicchetti & S. L. Toth (Eds.), Child abuse, child development, and social policy (pp. 331-367). Norwood, NJ: Ablex.

20.

Davis, S. , & Fantuzzo, J. W. (1989). The effects of adult and peer social initiations on social behavior of withdrawn and aggressive maltreated preschool children. Journal of Family Violence, 4, 227-248.

21.

Deblinger, E. (1995). Cognitive behavioral interventions for treating PTSD in sexually abused children. In NCCAN grantee status report (Grant #90CA1416). Washington, DC: DHHS.

22.

Derogatis, L. , & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13, 595-605.

23.

Egan, K. (1983). Stress management with abusive parents. Journal of Clinical Child Psychology, 12, 292-299.

24.

Epstein, N. B. , Baldwin, L. M. , & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Martial and Family Therapy, 9, 171-180.

25.

Fantuzzo, J. W. , Jurecic, L. , Stovall, A. , Hightower, A. D. , & Goins, C. (1988). Effects of adult and peer social initiations on the social behavior of withdrawn, maltreated preschool children. Journal of Consulting and Clinical Psychology, 56, 34-39.

26.

Feindler, E. L. , & Ecton, R. B. (1986). Adolescent anger control: Cognitive-behavioral techniques. New York: Pergamon.

27.

Finkelhor, D. , & Berliner, L. (1995). Research on the treatment of sexually abused children: A review and recommendations. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1408-1423.

28.

Fleischman, M. , Horne, A. , & Arthur, J. (1983). Troubled families: A treatment program. Champaign, IL: Research Press.

29.

Frankel, F. , & Weiner, H. (1990). The Child Conflict Index: Factor analysis, reliability, and validity for clinic-referred and nonreferred children. Journal of Clinical Child Psychology, 19, 239-248.

30.

Gibbons, R. , Hedeker, D. , Elkin, I. , Waternaux, H. , Kraemer, C. , Greenhouse, J. , Shea, T. , Imber, S. , Sotsky, S. , & Watkins, J. (1993). Some conceptual and statistical issues in analysis of longitudinal psychiatric data. Archives of General Psychiatry, 50, 739-750.

31.

Hazzard, A. , Christensen, A. , & Margolin, G. (1983). Children's perceptions of parental behaviors. Journal of Abnormal Child Psychology, 11, 49-59.

32.

Kazdin, A. E. , Rodgers, A. , Colbus, D. , & Siegel, T. (1987). Children's Hostility Inventory: Measurement of aggression and hostility in psychiatric inpatient children. Journal of Clinical Child Psychology, 16, 320-328.

33.

Kolko, D. J. (1992). Characteristics of child victims of physical violence: Research findings and clinical implications. Journal of Interpersonal Violence, 7, 244-276.

34.

Kolko, D. J. (1995). Multimodal partial/day treatment of child antisocial behavior: Description and multilevel program evaluation. Continuum: Developments in Ambulatory Health Care, 2, 3-24.

35.

Kolko, D. J. (1996a). Child physical abuse. In J. Briere , L. Berliner , J. A. Bulkley , C. Jenny , & T. Reid (Eds.), The APSAC handbook on child maltreatment (pp. 21-50). Thousand Oaks, CA: Sage.

36.

Kolko, D. J. (1996b). Clinical monitoring of treatment course in child physical abuse: Child and parent reports. Child Abuse & Neglect, 20, 23-43.

37.

Kolko, D. J. , Kazdin, A. E. , & Day, B. T. (1996). Children's perspectives in the assessment of family violence: Psychometric characteristics and comparison to parent reports. Child Maltreatment, 1(2), 156-167.

38.

Kovacs, M. (1981). Rating scales to assess depression in school-age children. Acta Paedopsychiatrica, 46, 305-315.

39.

Lutzker, J. R. (1990). Project 12-Ways: Treating child abuse and neglect from an ecobehavioral perspective. In R. F. Dangel & R. F. Polster (Eds.), Parent training: Foundations of research and practice (pp. 260-291). New York: Guilford.

40.

Malinosky-Rummell, R. , & Hansen, D. J. (1993). Long-term consequences of child physical abuse. Psychological Bulletin, 114, 68-79.

41.

Mannarino, A. P. , & Cohen, J. A. (1990). Treating the abused child. In R. T. Ammerman & M. Hersen (Eds.), Children at risk: An evaluation of factors contributing to child abuse and neglect (pp. 249-266). New York: Plenum.

42.

Mannarino, A. , Cohen, J. , & Berman, S. R. (1994). The Children's Attributions and Perceptions Scale: A new measure of sexual abuse-related factors. Journal of Child Psychology, 23, 204-211.

43.

Milner, J. S. (1986). The Child Abuse Potential Inventory: Manual (2nd ed.). Webster, NC: Psytec.

44.

Milner, J. S. , & Chilamkurti, C. (1991). Physical child abuse perpetrator characteristics: A review of the literature. Journal of Interpersonal Violence, 6, 345-366.

45.

Moos, R. H. , Insel, P. M. , & Humphrey, B. (1974). Family work and group environment scales. Palo Alto, CA: Consulting Psychologists Press.

46.

National Academy of Sciences . (1993). Understanding child abuse and neglect. Washington, DC: National Academy Press.

47.

Nicol, A. R. , Smith, J. , Kay, B. , Hall, D. , Barlow, J. , & Williams, B. (1988). A focused casework approach to the treatment of child abuse: A controlled comparison. Journal of Child Psychology and Psychiatry, 29, 703-711.

48.

Oates, R. K. , & Bross, D. C. (1995). What have we learned about treating child physical abuse? A literature review of the last decade. Child Abuse & Neglect, 19, 463-473.

49.

Robin, A. L. , & Foster, S. L. (1989). Negotiating parent/adolescent conflict: A behavioral-family systems approach. New York: Guilford.

50.

Szykula, S. A. , & Fleischman, M. J. (1985). Reducing out-of-home replacements of abused children: Two controlled field studies. Child Abuse & Neglect, 9, 277-283.

51.

Stouthamer-Loeber, M. , & Loeber, R. (1985). Child rearing practices—Pilot version. Unpublished instrument, Pittsburgh Youth Study, University of Pittsburgh, Western Psychiatric Institute and Clinic.

52.

Straus, M. A. (1990). Measuring intrafamily conflict and violence: The Conflicts Tactics (CT) Scales. In M. A. Straus & R. J. Gelles (Eds.), Physical violence in American families: Risk factors and adaptations to violence in 8,145 families (pp. 29-47). New Brunswick, NJ: Transaction Books.

53.

Szapocznik, J. , & Kurtines, W. (1989). Breakthroughs in family treatment. New York: Springer.

54.

Toth, S. L. , & Cicchetti, D. (1993). Child maltreatment: Where do we go from here in our treatment of victims? In D. Cicchetti & S. L. Toth (Eds.), Child abuse, child development, and social policy (pp. 399-437). Norwood, NJ: Aplex.

55.

Walker, C. E. , Bonner, B. L. , & Kaufman, K. L. (1988). The physically and sexually abused child: Evaluation and treatment. New York: Pergamon.

56.

Weisz, J. R. , Weiss, B. , Han, S. S. , Granger, D. A. , & Morton, T. (1995). Effects of psychotherapy with children and adolescents revised: A meta-analysis of treatment outcome studies. Psychological Bulletin, 117, 450-468.

57.

Whiteman, M. , Fanshel, D. , & Grundy, J. F. (1987, November-December). Cognitive-behavioral interventions aimed at anger of parents at risk of child abuse. Social Work, pp. 469-474.

58.

Willett, J. B. , Ayoub, C. C. , & Robinson, D. (1991). Using growth modeling to examine systematic differences in growth: An example of change in the functioning of families at risk of maladaptive parenting, child abuse, or neglect. Journal of Consulting and Clinical Psychology, 59, 38-47.

59.

Wilson, S. K. , Cameron, S. , Jaffe, P. , & Wolfe, D. (1986). Manual for a group program for children exposed to wife abuse. Unpublished manual.

60.

Wolfe, D. A. (1994). The role of intervention and treatment services in the prevention of child abuse and neglect. In G. B. Melton & F. D. Barry (Eds.), Protecting children from child abuse and neglect: Foundations for a new national strategy (pp. 224-303). New York: Guilford.

61.

Wolfe, D. A. , Edwards, B. , Manion, I. , & Koverola, C. (1988). Early intervention for parents at risk for child abuse and neglect: A preliminary report. Journal of Consulting & Clinical Psychology, 56, 40-47.

62.

Wolfe, D. A. , Sandler, J. , & Kaufman, K. (1981). A competency based parent-training program for child abusers. Journal of Consulting and Clinical Psychology, 49, 633-640.

63.

Wolfe, D. A. , & Wekerle, C. (1993). Treatment strategies for child physical abuse and neglect: A critical progress report. Clinical Psychology Review, 13, 473-500.