ORIGINAL ARTICLE

Maternal Perceptions of Temperament Among Infantsand Toddlers Investigated for Maltreatment: Implicationsfor Services Need and Referral

Cecilia Casanueva & Jenifer Goldman-Fraser &

Heather Ringeisen & Cindy Lederman & Lynne Katz &

Joy D. Osofsky

Published online: 26 May 2010# Springer Science+Business Media, LLC 2010

Abstract Infants and young children reported for maltreat-ment are a particularly vulnerable population. Many ofthese young children are maltreated by their own mothers.A mother’s description of her infant’s temperament caninform researchers’, practitioners’, and policy makers’understanding of the relational problems between themother and her young child and thereby sharpen the focusof intervention and treatment programs. We examinematernal perception of infants’ temperament, using datafrom the National Survey of Child and Adolescent Well-Being. The sample consisted of 1,001 biological mothers ofchildren aged birth to 23 months and investigated for childmaltreatment. About a fifth of the sample reported that formore than half the time their infants or toddlers were crying

or upset and were difficult to soothe or calm. During theaverage day, about 40% of infants or toddlers were reportedlyfussy and irritable half the time or longer. The most negativeinfant behaviors were consistently reported by 13.6% of themothers. In multivariate analyses, variables significantlyassociated with the mother’s perception of difficult tempera-ment were physical victimization by an intimate partner andthe mother’s own childhood history of abuse and neglect.Knowledge about mothers’ perceptions of difficult tempera-ment and about predictors of these perceptions can helpidentify mother-child dyads in need of dyadic-psychotherapyand domestic violence interventions, which can help heal themother-child relationship and restore the capacity for mutualjoy and protection of the child well-being.

Keywords Child maltreatment .Maternal perceptions .

Infants’ temperament . NSCAW

Infants and young children are disproportionately at risk formaltreatment. The most recent report on child maltreatmentin the United States found that in 2006, 3.6 million childrenwere subjects of investigation by child protective services(Administration for Children and Families 2008). Childrenyounger than 4 years of age represented 31% of allmaltreated children, with infants younger than 1 year oldexperiencing the highest victimization rate (24.4 perthousand children), followed by children 1 to 3 years old(14.2 per 1,000 children in the same age group; Adminis-tration for Children and Families, 2008).

The developmental-ecological model (Sameroff and Fiese2000) suggests that child maltreatment results from multiplefactors, including caregiver characteristics (Barnett et al.1997), family functioning (Edleson 1999; World HealthOrganization 2002), child characteristics (National ResearchCouncil 1993; Sullivan and Knutson 2000), and environ-

C. Casanueva (*)RTI International,3040 Cornwallis Rd., PO Box 12194,Research Triangle Park, NC 27709-194, USAe-mail: ccasanueva@rti.org

J. Goldman-Fraser :H. RingeisenRTI International,Research Triangle Park, NC, USA

C. LedermanJuvenile Court, Miami-Dade, Eleventh Judicial Circuit,Miami, FL, USA

L. KatzUniversity of Miami,Coral Gables, FL, USA

J. D. OsofskyDepartments of Pediatrics and Psychiatry,Louisiana State University Health Sciences Center,1542 Tulane Avenue, 2nd floor,New Orleans, LA 70112, USA

J Fam Viol (2010) 25:557–574DOI 10.1007/s10896-010-9316-6

mental factors such as poverty and lack of social support(Kotch et al. 1997, 1999; Lieberman et al. 2005; Sameroffand Fiese 2000). Most cases of substantiated child maltreat-ment (58%) are perpetrated by the mother (Administrationfor Children and Families 2002, 2008). While the researchon maternal risk factors associated with child maltreatmenthas primarily focused on poverty and substance abuse, fewstudies have investigated infant temperament among childrenreported for maltreatment to the child welfare system (CWS).To address this gap in the literature, we report findings froma nationally representative sample of infants who weresubjects of child maltreatment investigations, ascertainingwhether this particularly vulnerable population of youngchildren faces heightened risk for negative maternal percep-tions of difficult temperament. We also explore correlatesof negative maternal perceptions of child temperament.This analysis informs an understanding of the relation-ship between maternal perceptions of infant’s difficulttemperament and key contributing factors that, takentogether, represent risk to the mother-child relationshipand areas to target in intervention and treatment.

Child Temperament

Temperament can be defined as “constitutionally-basedindividual differences in emotional, motor, and attentionalreactivity and self-regulation” that are consistent acrossdifferent situations and stable over time (Rothbart and Bates1998). Researchers have generally conceptualized childtemperament in terms of one or more of the following keydimensions: withdrawal and distress to new situations(adaptability); irritable/distress; positive affect (e.g., smiling,laughter, manageability); activity level; attention span/persis-tence; and predictability/rhythmicity (Rothbart and Bates1998). In infants and young children, temperament is typicallymeasured using caregiver reports (most often mothers),along with naturalistic or structured laboratory observations(Rothbart and Bates 1998). Because the caregiver’s perspec-tive reflects experience with the child over time and acrossmany contexts, it is considered a crucial window ontemperament. However, researchers in this area also recognizethat mothers’ perceptions of their children’s temperament areshaped as heavily by maternal psychological, demographic,and other factors as by the child’s objective behavior.

Indeed, researchers in child temperament have longrecognized that the notion of difficult temperament is a socialconstruct with both subjective and objective components(Bates 1980). Although behavior differences intrinsic in thechild reflect an objective component, studies on therelationship between maternal and independent ratings ofinfant temperament consistently have found only a modestconvergence (Hubert et al. 1982).

The precise pathway of effect is complex and multiplydetermined, and, therefore, not yet fully understood.Researchers do, however, agree that maternal perceptionsof infant and child behavior interact with the child’stemperament to result in compromised mother-child inter-action (Belsky 1984), which, in turn, can lead to subsequentdevelopmental problems (Sameroff and Fiese 2000). Thisinteractional effect helps explain why researchers havefound a young child’s “difficult” temperament, particularlyin terms of negative emotionality and mood, increases therisk for child abuse and neglect (Black et al. 2001;Dubowitz and King 1995; Harrington et al. 1998; Lutzker1998; Myers et al. 2002; Pianta et al. 1989). For example,in a study based on a sample of 121 urban, low-incomemothers with a child younger than 30 months old, maternalreports of more difficult child temperament were found topredict child neglect (Harrington et al. 1998). Moreover,difficult temperament early in the child’s life has also beenfound to predict behavior problems in later childhood(Crockenberg and Acredolo 1983; Hane et al. 2006;Mangelsdorf et al. 1990; Vandenboom and Hoeksma1994), including internalizing and externalizing behaviorsand psychiatric disorders in adolescence (Keenan et al.1998; Lee and Bates 1985; Teerikangas et al. 1998).

Factors that Influence Maternal Perceptionof Child Temperament

Maternal Characteristics Numerous studies have foundmaternal mental health and psychological characteristicsto be associated with mothers’ classifications of theirinfants as “difficult” or “easy.” A study of infants 4 to6 months old reported that mothers who were more anxiousand had lower self-esteem were more likely to perceive theirinfants as difficult than less anxious mothers with higher self-esteem (Vaughn et al. 1987). In other research using atemperament scale created by the authors, maternal anxietyand depression were found to predict toddlers’ difficultnessat 2 years of age (Daniels et al. 1984). As measured withvarious temperament scales, both predictive and concurrentpositive relationships have been shown in other studiesexamining the relationship between maternal depression andinfant difficultness (Cutrona and Troutman 1986; Foremanand Henshaw 2002; Hopkins et al. 1987; Pesonen et al.2004; Ventura and Stevenson 1986). Substance abuse bymothers consistently has been associated with negativeperceptions and unrealistic expectations of child behavior(Spieker et al. 2001), impaired parenting (Ammerman et al.1999; Mayes 1995), and exposure of children to abuse,neglect, and multiple episodes of separation (Mayes 1995).

Aside from mental health problems, other harmful lifeexperiences of the mother can influence her perception and

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treatment of her infant. As described by Lieberman and VanHorn (2008) in their work with maltreated infants andtoddlers, “The parents do not see their infants as uniqueindividuals but as transference objects with whom theyreenact their painful childhood experiences, alternating theroles of victim and victimizer. Parents caught in thesereenactments are trapped in entrenched conflicts with theirbabies and young children, loving then consciously, butunconsciously engaged with then in a painful repetition oftheir past that places the child in danger either from theparent or from others” (p.59). Many studies report that amother’s history of having been maltreated during child-hood increases her risk for perceiving characteristics of theabuser in her child, for poor parenting, and for perpetrationof maltreatment (Barnett et al. 1997; Black et al. 2001;Coohey 2004; Lieberman 2007; Lieberman and Van Horn2008). Mothers’ young age has been associated withinappropriate developmental expectations and distortedperceptions, which are associated with harsh parenting(Straus et al. 1998) and maltreatment reports (Connelly andStraus 1992; Cox et al. 2003; Sedlack and Broadhurst1996). Perceptions of child temperament and behavior mayvary by cultural background, as well, with some race/ethnicity groups being more strict and demanding of theirchildren or perceiving normative behaviors like crying assigns of having a “spoiled” child (Bradley et al. 2001).

Intimate-Partner Violence Among the many family-levelcharacteristics influencing mothers’ perceptions of infantand child temperament, a main risk factor is being a victimof intimate-partner violence (IPV; Lieberman and Van Horn2008). Because of the compromised mental health ofwomen victims of IPV, some researchers have askedwhether IPV impairs women’s parenting skills and theirperception of their child (Holden and Ritchie 1991;Levendosky and Graham-Bermann 2000, 2001; Wolfe etal. 1985). Similarly, researchers have asked whetherdomestic violence may affect a mother’s interactions withher children by impeding her emotional and psychologicalavailability, her responsiveness to the child’s needs, andpositive childrearing practices (Cummings 1998; Holdenand Ritchie 1991; McCloskey et al. 1995; Osofsky 1998).Some studies have not shown an adverse effect of IPV onverbal and physical aggression, increased parenting stress,and use of harsh discipline (Ehrensaft et al. 2003;Levendosky et al. 2003; Sullivan et al. 2000; Van Hornand Lieberman 2002). Other studies addressing IPV havefound that, compared with nonvictimized women, victimizedwomen reported more parenting-related stress (Holden andRitchie 1991), less warmth in the mother-child relationship(Levendosky and Graham-Bermann 2000; McCloskey et al.1995), and more conflict with their children (Holden andRitchie 1991).

Child Characteristics Many child characteristics have beenshown to influence the mother-child relationship. Some, likethe child’s age or gender, trigger normative patterns ofparental behavior. By contrast, characteristics that makeparenting difficult (e.g., special health needs, disabilities,irritability, negative emotionality, sensory processing andattention abnormalities) are often related to negative percep-tion of the child and poorer-quality parenting (Barnard andSolchany 2002; Gelles 1997). Unfortunately, mothers wholive in poverty and chaotic circumstances are more likely tohave children with greater health care needs, children withother indications of disregulation, and children whosedevelopment is compromised because of inadequate prenatalcare and birth complications (Bradley and Corwyn 2002).

Environmental Characteristics Several environmental fac-tors are recognized as contributing to child maltreatment,including poverty, unemployment, social isolation, and lackof social support (Cadzow et al. 1999; Chase-Lansdale andPittman 2002; Edleson et al. 2003; Golding 1999; Kotch etal. 1997). Economic hardship critically influences parentalperceptions. The stress of poverty has a negative, generaleffect on how life and children are perceived, withfinancially poor parents using less effective parentingstrategies than nonpoor parents (Bradley et al. 2001;Brooks-Gunn et al. 1995; Klebanov et al. 1994).

Test Variables and Hypothesis

The goal of this study is to gain a better understanding of theproblems and negative behaviors that mothers ascribe to theirinfants and toddlers reported for maltreatment and the areasthat should be the focus of treatment programs that have thegoal of repairing the mother/child relationship. Our mainhypothesis is that negative perceptions of young children’stemperament among mothers reported for maltreatment willbe associated with the mother’s current and past harmfulexperiences with significant others (Lieberman and VanHorn 2008). Although we expect that daily stressors (e.g.,poverty, lack of social support) will be associated withnegative maternal perception of the child’s temperament, weexpect that the mother’s experience as a victim of violencewill be the predominant factor associated with negativeperceptions of the child’s difficult temperament.

This study addresses maternal perceptions of infanttemperament, using the first nationally representative dataset of children investigated for maltreatment by the CWS.We explore the possible associations of maternal percep-tions of infant temperament with the child’s characteristics,the mother’s characteristics, the case investigation charac-teristics, and the caseworker’s risk assessment of the

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mother. Our analysis of correlates of maternal perceptionincludes case investigation information and the case-worker’s risk assessment because previous studies havereported that the main predictors of service receipt formaltreated children are case investigation characteristics,including substantiation of allegations, level of harm to thechild, and severity of future risk of maltreatment asestimated by the investigative caseworker (Casanueva etal. 2008; Walter R. McDonald and Associates 2003). Thisemphasis on risk assessment in service referrals may causecaseworkers to overlook other important factors indicatingpotential service need. These factors include the caregiver’sperception of her infant’s temperament, which may indicateparenting deficits and a troubled parent-child relationship.We examined the following factors that could increase theinfant’s risk of being perceived by the mother as difficult:the infant’s fair-to-poor health, the mother’s mental healthproblems, the mother’s IPV victimization, the mother’salleged perpetration of the reported maltreatment, a caseclassification of high harm or severe risk of harm to thechild, and the caseworker’s report of the mother’s ownhistory of childhood abuse and neglect, the mother’s poorparenting, and the mother’s lack of social support.

Method

We base our analyses on data from the National Survey ofChild and Adolescent Well-Being (NSCAW), which fea-tures the first nationally representative sample of childreninvestigated for child maltreatment. NSCAW is a nationallongitudinal study of the well-being of 5,501 children aged14 or younger who had contact with the CWS during a 15-month period starting October 1999. To be eligible for thesample, children had to enter child welfare services throughan investigation of child abuse or neglect by childprotective services. Because of statistical power require-ments for key categories of cases, the sample designrequired oversampling of open cases, infants, and sexualabuse cases. Baseline data were collected approximately4 months after the completion of the index CWS maltreat-ment investigation. The response rate at baseline was64.2%.

The NSCAW sample design involved a stratified two-stage sample with the primary sampling units being countychild welfare agencies. The secondary sampling units werechildren selected from lists of closed investigations orassessments from the sampled agencies. The sample wassubdivided into nine strata—one each for eight key statesand a ninth stratum for 28 other states. The nine stratacombined to produce national estimates. Analysis weightswere constructed in stages corresponding to the stages ofthe sample design. Selection of a child was the product of

two probabilities: selection of the primary sampling unitand selection of a child, given the child’s county ofresidence. Weights were further adjusted to account forsmall deviations from the original plan, which occurredduring sampling, and for nonresponse. Additional informa-tion about the NSCAW methodology has been publishedelsewhere (NSCAW Research Group 2002, 2003).

Participants

This analysis focuses on biological mothers of childrenfrom birth to 23 months at baseline who were involved inchild maltreatment investigations and were part of theNSCAW child protective services sample. A total of 1,006biological mothers were living with their child at baseline.Fewer than 1% (5 cases) had missing data on temperament,leaving an analysis study sample of 1,001.

Procedure

Field representatives received 12 days of intensive trainingwith special emphasis on the practice and administration ofchild assessment instruments. Field representatives con-tacted caregivers and asked permission to interview themabout the selected child and to assess the child directly bymeans of standardized measures. Interviews with thechildren’s caregivers were conducted in English (96%) orSpanish at the children’ homes, by means of computer-assisted personal interviewing. Caregivers received anhonorarium of approximately $40 for their participation ineach interview. NSCAW also conducted 1-hour computer-assisted personal interviewing sessions with the CWScaseworkers, who were instructed to consult the case recordas needed during the interview. The data analyzed herewere drawn from mothers’ interviews and assessments, aswell as caseworkers interviews.

All study methods, including protocols for recruitingparticipants and obtaining informed consent, were reviewedand approved by an institutional review board at RTIInternational (the contracted organization for the NSCAWfield work) and the Office of Management and Budget.Relevant state and local agency institutional review boardsalso reviewed and approved the study protocols.

Measures

NSCAW was supervised by a panel of national experts todetermine the list of instruments and tests used at eachwave of data collection. Whenever possible, standardizedinstruments with national norms were chosen, or instru-ments or questions that had been used in previous studieswith large and diverse national samples of children andfamilies.

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Sociodemographics Mothers were asked about their child’sgender, their child’s age, and their own race/ethnicity, levelof education, marital status, family income, and householdnumber of adults and children. Family income and numberof adults and children in the household were used todetermine poverty level by the U.S. Census Bureau guide-lines (Dalaker 2001).

Child Health Caregivers were asked to provide an overallrating of child health (i.e., excellent, very good, good, fair,or poor) by answering a question from the Child HealthQuestionnaire (Landgraf et al. 1996). For the currentanalysis, child health was coded as a dichotomous variable(i.e., good = excellent, very good, or good health; poor =fair or poor health).

Maternal Depression Maternal major depression wasassessed with the screening scales of the World HealthOrganization Composite International Diagnostic InterviewShort-Form (CIDI-SF; Kessler et al. 1998). Mothers wereasked if during the previous 12 months there was a timewhen they felt sad, blue, or depressed for 2 consecutiveweeks or longer. If the answer was “Yes” or “I was onmedication/anti-depressant,” then a series of questionsfollowed regarding the 2-week period when these feelingswere worst. For the diagnosis of major depression, theCIDI-SF follows the guidelines of the Diagnostic andStatistical Manual of Mental Disorders, which characterizesa major depressive episode as “a period of at least 2 weeksduring which there is either depressed mood or the loss ofinterest or pleasure in nearly all activities” (AmericanPsychiatric Association 1994, p. 320). Classification accu-racy of the CIDI-SF as compared with the CIDI rangesfrom 93% to 98% in relation to psychiatric standards(Kessler et al. 1998). For the CIDI-SF, to meet the probablediagnostic requirement for the 12-month prevalence ofmajor depression, the respondent has to report three ormore symptoms of depression (e.g., loss of interest in usualactivities, tiredness, changes in weight, trouble sleeping orexcessive sleeping, difficulty concentrating, feelings of lowself-worth, thoughts about death) and respond affirmativelyin at least one of the following areas: (1) experiencing 2 ormore weeks of dysphoric mood, (2) experiencing 2 or moreweeks of anhedonia (lack of enjoyment of any activity), or(3) using medication for depression.

Intimate-Partner Violence The physical violence subscaleof the Conflict Tactics Scales (Straus 1979) was used toassess caregivers’ experiences with IPV. Caregivers wereasked about their experiences of nine physically violent actsfrom a partner (e.g., throwing something; pushing, grab-bing, or shoving). Women were classified as being currentvictims of IPV if they reported experiencing one or more of

these acts during the 12 months prior to interview. If all actsof IPV occurred more than 12 months beforehand but notmore recently, then women were classified as past victimsof IPV. Women who reported that they did not experienceany of the nine acts of violence were classified asnonvictims.

The associations found between IPV, on the one hand,and maternal perception of the child’s temperament, on theother, were of similar magnitude and direction for avariable with categories that accounted for recency of IPV(current, past, none). Because of the similarity of magni-tude and direction between past IPV and no IPV, we reportresults for a dichotomous variable (current IPV versus NoIPV or only past IPV). Cronbach’s alpha coefficient for theConflict Tactics Scales ranged from .75 to .92.

Maltreatment Characteristics NSCAW used the LimitedMaltreatment Classification System (L-MCS; Barnett et al.1993) to capture information about the reported maltreat-ment. Caseworkers were provided with a card withexamples of each type of maltreatment. The most serioustype of maltreatment was assessed by asking the case-workers in the baseline interview, “Of the types of abuse orneglect that were reported, please tell me the type that youfelt was the most serious (physical maltreatment, sexualmaltreatment, emotional maltreatment, physical neglect[failure to provide], neglect [lack of supervision], abandon-ment, moral/legal maltreatment, educational maltreatment,exploitation, and other).” Because of the limited number ofcases in some maltreatment categories, a variable wascreated with the following categories: (1) physical mal-treatment, (2) physical neglect [failure to provide], (3)neglect [lack of supervision], and (4) other (includingsexual maltreatment, emotional maltreatment, abandon-ment, moral/legal maltreatment, educational maltreatment,exploitation, and other).

Alleged Perpetrator For the main six types of childmaltreatment (sexual abuse, physical abuse, physicalneglect, supervisory neglect, moral/legal maltreatment,and educational maltreatment) caseworkers were asked,“Who was reported to be responsible for this abuse?”Caseworkers could select as many responses options asthey wanted from 19 possibilities, including father, mother,stepmother, stepfather, sibling, other relatives, neighbor,friend, stranger, and other. If among the alleged perpetra-tors the caseworker identified the biological mother, thecase was counted as maternal alleged perpetration (even ifother perpetrators were also identified). If the mother wasnot identified as one of the perpetrators or if no informationwas available about the alleged perpetrator, the case wasclassified as a no for the mother’s being the allegedperpetrator.

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Level of Harm and Severity of Risk Caseworkers alsocompleted 4-point Likert-scale items (none, mild, moderate,severe) about the degree of harm the child experienced andthe degree of risk the child faced, by answering the followingquestions: “Regardless of the outcome of the investigation,how would you describe the level of harm to [FILLCHILD]?” and “Regardless of the outcome of the investiga-tion, how would you describe the level of severity of risk?”

Substantiation Children were classified as having a substan-tiated maltreatment case on the basis of caseworkers’responses to the following question: “What was the outcomeof the investigation: (1) substantiated, (2) indicated, (3)neither substantiated or indicated,[nor] unfounded or ruledout, (4) high risk, (5) medium risk, (6) low risk.” In so-calledthree-tier states, indicated is a classification option thatmeans some evidence of maltreatment was found, but notenough officially to substantiate allegations (DePanfilis andSalus 2003). In this study, for 21.3% of children the outcomeof the investigation was substantiated, slightly lower thanthe percentage (28%) reported for 2000 in the National ChildAbuse and Neglect Data System (NCANDS), which includeschildren placed in foster care as a result of maltreatment(Administration for Children and Families 2002). Followingthe criteria used for the annual national reports on ChildMaltreatment, based on NCANDS (Administration forChildren and Families 2002), only when caseworkers chosesubstantiated did we classify children’s cases as such. Allother cases were classified as unsubstantiated.

Caseworker’s Report on Caregiver’s Problems NSCAWuses risk assessment questions from the risk assessmenttools used in child protective services in Michigan, NewYork, Washington, Illinois, and Colorado. These toolscollect information regarding the main caregiver. Questionsinclude: “At the time of the investigation was there activealcohol abuse by primary caregiver? Was there active drugabuse by primary caregiver? Did caregiver have any seriousmental health or emotional problem? Was there a history ofabuse and neglect of caregiver? Was there low socialsupport? Was there high stress on the family?” All responseoptions were yes/no.

Maternal Perception of Infant Temperament The childtemperament scales used in NSCAW were developed for usein the National Longitudinal Survey of Youth and were basedon Rothbart’s Infant Behavior Questionnaire (Rothbart andDerryberry 1984), Campos and Kagan’s compliance scale,and other items from Campos (Campos et al. 1983). Theinternal reliability and the cross-sectional and longitudinalcontinuity of factor structures have been reported to besatisfactory (Baydar 1995). Similarly, the analysis ofstability, and validity of the instrument based on the NLSY

showed that the structure of concurrent and predictivecorrelation with other assessments followed the patternsexpected on a conceptual basis (Baydar 1995). Atbaseline, mothers whose infants were younger than24 months were asked to report how often their infantexhibited specific behaviors (e.g., “During the day, howoften does [CHILD] get fussy and irritable?” “How often doyou have trouble soothing [CHILD] when he/she is tired orupset?”).

Thematernal scale, HowMy Infant UsuallyActs, addressesthe activity, predictability, fearfulness, positive affect, andcrying/fussiness’ of infants younger than a year old. How MyToddler Usually Acts addresses the fearfulness, positive affect,and crying/fussiness of 1-year-olds. The behavioral tendenciesof the children were rated by the mother on a 5-point scale,ranging from almost never (value of 1) to almost always(value of 5). The scores of the various scales were computedby summing the individual items in the scale whereappropriate and dividing by the number of items answered(summed scores required a minimum of 75% of items thatdid not have missing data). Some items are recoded inreverse (e.g., positive affect) before summing so that higherscores always represent more difficult behavior. In this study,we present results for the Total difficult temperament scale,which includes all subscales of the instrument. The reliability(cronbach alpha) of the difficult temperament scale was .63for the difficult temperament of children younger than a yearold and .61 for children aged 1 year. The difficulttemperament variable had a normal distribution, with mean,median, and mode equal to 2.01 (SE=0.04), ranging from 1to 3.8 (skewness = .49; kurtosis=−.011).

Analyses

All analyses were conducted with weighted data, using theSUDAAN statistical package version 9.0.1 to take intoaccount NSCAW’s complex sampling design (RTI Interna-tional 2002). All percentages were adjusted (weighted) forsampling probabilities; listed sample sizes have not beenadjusted (i.e., are unweighted). Analyses were to examinedifferences in temperament perceptions as a function ofchild, maternal, and maltreatment history characteristics. Totest for the statistical significance of the differences onmeans by child, mother, and maltreatment characteristics,we used t tests adapted for complex samples. Multiplelinear regression analyses modeled the mother’s perceptionof difficult infant temperament (a continuous variable basedon the difficult temperament scale). First, four partial linearregression models were used: one for child characteristics,one for maternal characteristics, one for CWS investigationvariables, and one for the caseworkers risk assessmentvariables. The models for CWS investigation and case-

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workers risk assessment variables were not statisticallysignificant. Variables from the child and maternalcharacteristics that were significant in the block modeland bivariate analyses, as well as some variables thatprevious research has identified as relevant controlvariables, were used in the final model, for which wereport results. In order to provide an indicator of themagnitude of differences in temperament scores amongsub-group, Cohen effect size index d (Cohen 1988) areprovided. Standard diagnostic procedures were conductedfor all regression models to preempt problems withmulticollinearity and heterocedasticity.

Bivariate analyses (chi-square tests) were used to deter-mine associations among predictor variables. This analysis ispresented in Table 1. Toddlers (19 to 23 months of age) weremore likely to have mothers in the 20–29 age range than inthe 14–19 range (p<.01), and were more likely to bereported for failure to supervise than for failure to providecompared to children less than 19 months of age (p<.05).Infants 13 to 18 months of age were more likely than otherchildren to be classified by caseworkers as not having beenharmed (p=.01). Mothers of the youngest infants were morelikely than older mothers to be identified as drug users bycaseworkers (p<.001). Children in poor health were morelikely than children in good health to have an unmarriedmother (p<.001) and to live in poverty (p<.5).

Regarding mothers characteristics, older mothers (30 ormore years old) were more likely than mothers less than30 years old to have a high school education ormore (p<.001),be married (p<.01), and to be identified as alcohol users(p<.05) and drug users by caseworkers (p<.01). Blackmothers were more likely than Latino mothers to beidentified as drug users by caseworkers (p<.05), while whitemothers were more likely than all other mothers to beidentified by caseworkers as having high stress (p<.05).Mothers who had a high school education or more were morelikely to be married (p<.05), while mothers who had lessthan a high school education were more likely to have ahistory of child abuse and neglect (p=.001). Non-marriedmothers were more likely than married mothers to live inpoverty (p<.05) and to be identified as having poor parentingskills by caseworkers (p<.05). Mothers living in povertycompared to those not living in poverty were more likely tobe identified as having high stress by caseworkers (p<.05).Mothers who were a current victim of IPV were more likelythan non-current victims to have a child classified asbeing at moderate or severe risk by caseworkers (p<.05)and to be identified as having low social support by case-workers (p<.05). Mothers with major depression scores in theclinical range were more likely than non-depressed mothersto be identified by caseworkers as having mental healthproblems (p<.05), having a history of child abuse and neglect(p<.05) and having high stress (p<.05).

Analysis of associations among predictors variableswith the CWS investigation variables show that higherlevels of harm reported by the caseworkers wereassociated with higher estimates of risk (p<.001),substantiation of the case (p<.001), mothers use of alcohol(p<.01), mothers use of drugs (p=.001), and mothersmental health problems (p<.05). Similarly, caseworkersestimates of higher levels of risk for children wasassociated with substantiation of the case (p<.001), mothersuse of alcohol (p<.01), mothers use of drugs (p<.01),mothers mental health problems (p<.01), mother’s poorparenting skills (p<.01), and mothers having high stress(p<.05). Substantiation of the case was also associatedwith mothers use of drugs (p<.001), mother’s poorparenting skills (p<.01), and mothers having low socialsupport (p<.05).

Several of the risk assessment variables based oninformation provided by caseworkers were associatedamong them. Reports of caseworkers of mother’s alcoholuse were associated with drug use (p<.01) and poorparenting skills (p<.01). Mother’s having mental healthproblems was associated with poor parenting skills (p<.01),history of child abuse and neglect (p<.01), and low socialsupport (p<.05). Low social support was associated withmothers’ mental health problems (p<.05), and poorparenting skills (p<.01).

The sociodemographic characteristics of the sample arepresented in Table 2. Slightly more than half of infants weremale. Only a small percentage of infants were between zeroand 6 months (15.7%), with the majority being 7 to12 months (27.3%), 13 to 18 months (31.7%), and 19 to23 months (25.3%). Most of the children were in goodhealth, and only 1.0% (10 children) were born prematurely.Generally, mothers were young. A quarter of mothers wereteenagers, and 60.3% were between 20 and 29 years old.More than half were White, and about a fifth were Black.About two thirds had a high school education or more.Most were unmarried, and more than half were living at orbelow the federal poverty level. More than a third (37.1%)were current victims of physical IPV; about a quarter wereclinically depressed.

Among the CWS investigations of child maltreatmentallegations, the main type of reported maltreatment wasneglect (lack of supervision, 33.2%; failure to provide forthe child, 28.0%), followed by physical abuse (22.0%).More than half (58.6%) of mothers were reported bycaseworkers to be the alleged perpetrator of maltreatment.For about half of children, caseworkers considered that noharm had occurred to the child, but they classified twothirds as being at risk for maltreatment. About a fifth of theCWS investigations were substantiated. Among themothers’ risk factors, as identified by caseworkers, highstress was reported among half of mothers, poor

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Tab

le1

Associatio

nsbetweenchild

,biolog

ical

mother,case

investigation,

andrisk

assessmentcharacteristicsof

infantsandtodd

lers

inthechild

welfare

system

12

34

56

78

910

1112

1314

1516

1718

1920

2122

23

Child

1.Gender

X

2.Age

nsX

3.Health

nsns

X

4.Low

birthw.

nsns

nsX

Mother

5.Age

ns.004

nsns

X

6.Race

nsns

nsns

nsX

7.Edu

catio

nns

nsns

ns<.001

nsX

8.MaritalStatus

nsns

<.001

ns.005

ns.020

X

9.Pov

erty

nsns

.025

nsns

nsns

.001

X

10.IPV

nsns

nsns

nsns

nsns

nsX

11.Depression

X

CWSInvestigation

12.Maltreat.

ns.038

nsns

nsns

nsns

nsns

nsX

13.MotherPerpetr.

nsns

nsns

nsns

nsns

nsns

nsns

X

14.Harm

ns.010

nsns

nsns

nsns

nsns

nsns

nsX

15.Risk

nsns

nsns

nsns

nsns

ns.016

nsns

ns<.001

X

16.Sub

stantiated

nsns

nsns

nsns

nsns

nsns

nsns

ns<.001

<.001

X

RiskAssessm

ent

17.Alcoh

olns

nsns

ns.039

nsns

nsns

nsns

nsns

.008

.003

nsX

18.Drugs

ns<.001

nsns

.006

.024

nsns

nsns

nsns

ns.001

.005

.001

.003

X

19.MentalHealth

nsns

nsns

nsns

nsns

nsns

.046

nsns

.045

.008

nsns

nsX

20.Poo

rParentin

gns

nsns

nsns

nsns

.029

nsns

nsns

nsns

.002

.002

.003

.005

.004

X

21.History

CAN

nsns

nsns

nsns

.008

nsns

ns.042

nsns

nsns

nsns

ns.007

.012

X

22.HighStress

nsns

nsns

ns.014

nsns

.035

ns.036

nsns

ns.019

nsns

nsns

ns.002

X

23.Low

SocialSup

nsns

nsns

nsns

nsns

ns.044

nsns

nsns

ns.047

nsns

.017

.003

<.001

<.001

X

pvalueof

Chi

Squ

aretests

NSno

tsign

ificant

564 J Fam Viol (2010) 25:557–574

Table 2 Mean difficult-temperament scores by child, biological mother, case investigation, and risk assessment characteristics of infants andtoddlers in the child welfare system

N % (SE) Temperament mean (SE) p value

Total 1001 100 2.01 (.04)

Child characteristics

Gender NS

Male 550 53.5 (4.3) 1.97 (.04)

Female 451 46.5 (4.3) 2.06 (.07)

Age

0 to 6 months 304 15.7 (1.8) 1.94 (.06)

7 to 12 months 368 27.3 (2.7) 1.96 (.03)

13 to 18 months 245 31.7 (4.1) 2.15 (.07) <.05

19 to 23 months 84 25.3 (4.0) 1.93 (.11)

Health

Excellent/very good/good 934 95.7 (.9) 1.99 (.04)

Fair/poor 63 4.3 (.9) 2.47 (.17) <.01

Low birthweight/prematurity

Yes 10 1.0 (.5) 1.77 (.09) <.05

No 991 99.0 (.5) 2.0 (.04)

Mother characteristics

Age

14 to 19 years old 206 24.8 (2.8) 2.16 (.08) <.01

20 to 29 years old 575 60.3 (3.2) 1.99 (.06)

30 or more 219 14.9 (1.7) 1.87 (.04)

Race/ethnicity

White 502 55.6 (4.6) 1.92 (.04)

Black 284 21.7 (3.7) 2.29 (.10) <.05

Hispanic 147 13.2 (2.8) 1.95 (.11)

Other 68 9.5 (2.3) 2.01 (.09)

Education

Less than high school 440 38.7 (2.9) 2.15 (.05) <.01

High school or more 560 61.3 (2.9) 1.93 (.06)

Marital Status

Married 213 24.5 (3.2) 1.88 (.05)

Not married 788 75.5 (3.2) 2.05 (.05) <.01

Poverty

At or below 100% federal poverty level 537 55.0 (4.4) 2.07 (.06) .059

Over 100% federal poverty level 367 45.0 (0.1) 1.93 (.05)

Current victim of intimate partner violence

Yes 370 37.1 (3.1) 2.12 (.06) <.05

No 621 62.9 (3.1) 1.95 (.05)

Depression

Yes 276 25.4 (2.6) 2.14 (.08) .064

No 722 74.7 (2.6) 1.97 (.05)

CWS investigation

Main type of maltreatment NS

Physical 173 22.0 (3.1) 1.98 (.13)

Physical neglect (failure to provide) 310 28.0 (4.4) 1.95 (.03)

Neglect (lack of supervision) 276 33.2 (4.3) 1.99 (.05)

Other 163 16.7 (3.4) 2.11 (.14)

J Fam Viol (2010) 25:557–574 565

parenting skills was reported for 29.0%, and a history ofabuse and neglect was reported for a quarter of mothers.

Results

The infants’ temperament descriptors provided by mothersare presented in Table 3 for each item of the temperament

scales. About half of infants zero to 11 months old weredescribed as active half the time or more in that theysquirmed or waved their arms during feeding time andmoved around the crib while sleeping. Most infants weredescribed as predictable in terms of sleeping, waking, andbeing hungry at regular times each day. Although more thanhalf of infants and toddlers (12 to 23 months) rarelydemonstrated fear of strangers, unfamiliar dogs and cats, or

Table 2 (continued)

N % (SE) Temperament mean (SE) p value

Mother alleged perpetrator

Yes 564 58.6 (4.6) 1.95 (.04)

No/no information 437 41.4 (4.6) 2.10 (.07) .056

Level of harm NS

None 356 48.6 (4.7) 2.00 (.06)

Mild 264 26.2 (3.4) 2.00 (.07)

Moderate 229 19.5 (3.5) 2.00 (.08)

Severe 90 5.8 (1.2) 1.96 (.09)

Severity of risk NS

None 162 33.4 (5.2) 2.00 (.07)

Mild 267 33.9 (4.3) 2.02 (.10)

Moderate 267 23.4 (2.8) 2.05 (.06)

Severe 123 9.3 (1.3) 2.05 (.06)

Substantiation NS

Yes 335 21.3 (2.6) 2.00 (.05)

No 594 78.7 (2.6) 2.00 (.05)

Caseworker risk assessment

Alcohol abuse NS

Yes 89 7.1 (1.4) 2.00 (.09)

No 798 92.9 (1.4) 2.00 (.04)

Drug abuse NS

Yes 195 9.6 (1.5) 2.00 (.06)

No 694 90.4 (1.5) 2.00 (.05)

Mental health or emotional problems NS

Yes 137 15.4 (3.3) 2.07 (.07)

No 764 84.6 (3.3) 1.99 (.05)

Poor parenting skills NS

Yes 362 29.0 (3.9) 2.06 (.10)

No 592 71.0 (3.9) 1.98 (.04)

History of abuse and neglect

Yes 249 24.0 (3.1) 2.20 (.08) <.01

No 565 76.0 (3.1) 1.95 (.05)

Low social support NS

Yes 288 20.9 (2.3) 2.10 (.06)

No 621 79.1 (2.3) 1.97 (.05)

High stress NS

Yes 552 49.3 (4.0) 2.00 (.05)

No 365 50.7 (4.0) 2.00 (.05)

All percentages are weighted; Ns are unweighted

NS not significant

566 J Fam Viol (2010) 25:557–574

Table 3 Temperament items by child’ age as reported by biological mothers of infants and toddlers in the Child Welfare System

Items children 0 to 11months N Never Less than half the time Half the time More than half the time Almost always% (SE) % (SE) % (SE) % (SE) % (SE)

Activity Level

During feeding, how often does child squirmor kick?

606 36.9 (3.5) 19.1 (2.6) 17.1 (2.7) 6.9 (1.7) 20.1 (2.6)

During feeding, how often does child wavearms?

604 19.7 (3.3) 17.8 (2.0) 20.1 (2.8) 11.4 (4.3) 31.0 (3.0)

During sleeping, how often does child movearound the crib?

606 24.3 (4.5) 27.8 (3.4) 18.6 (2.2) 6.2 (1.3) 23.1 (2.6)

Predictability

Some children get sleepy about the same timeeach evening, give or take 15 minutes, howoften does child do this?

604 7.1 (1.4) 5.0 (1.1) 10.4 (1.9) 10.3 (2.0) 67.2 (2.9)

Some children get hungry about the sametime each evening, give or take 15 minutes,how often does child do this?

598 4.3 (1.0) 6.7 (1.4) 9.8 (1.9) 11.5 (2.1) 67.7 (3.7)

When child wakes up in the morning, howoften is he/she in the same mood?

604 3.2 (1.4) 3.6 (1.0) 9.0 (1.5) 8.4 (1.7) 75.9 (2.7)

Fearfulness

When child sees a stranger, how often doeshe/she turn away or cry as if afraid?

602 53.3 (4.0) 14.5 (2.4) 8.2 (1.8) 5.7 (1.6) 18.3 (4.0)

When child sees an unfamiliar dog or cat,how often does he/she turn away or cry as ifafraid?

538 74.7 (4.0) 4.6 (1.4) 4.8 (1.9) 6.5 (4.8) 9.5 (2.1)

When you leave the room and leave the childalone, how often does he/she become upset?

599 20.6 (3.1) 17.7 (4.0) 17.8 (2.6) 6.4 (1.7) 37.6 (2.9)

When you take child to the doctor, dentist, ornurse, how often does he/she turn away orcry as if afraid?

601 57.8 (2.8) 11.8 (2.1) 11.5 (2.2) 1.7 (0.5) 17.2 (4.2)

Positive affect

When you play with child, how often does he/she smile or laugh?

608 0 0.3 (0.3) 1.7 (0.7) 6.4 (1.6) 91.6 (1.8)

When child plays on own, how often does he/she smile or laugh?

598 3.2 (1.4) 4.2 (1.3) 18.7 (2.4) 18.7 (3.8) 55.2 (4.7)

When child is in the bath, how often does he/she smile or laugh?

607 6.8 (1.6) 6.2 (1.6) 13.4 (1.9) 5.7 (1.2) 67.9 (3.0)

Crying/fussiness

When child hears an unexpected loud sound,how often does he/she cry or become upset?

602 43.4 (5.3) 17.4 (3.1) 15.1 (2.7) 6.6 (1.4) 17.5 (3.1)

How often do you have trouble soothing orcalming child when he/she is crying orupset?

608 57.3 (4.3) 25.0 (3.0) 11.2 (2.2) 1.5 (0.6) 5.0 (1.3)

During the day how often does child get fussyand irritable?

608 12.8 (2.2) 47.8 (4.0) 30.7 (3.2) 7.6 (1.9) 1.2 (0.7)

In general compared with most babies, howoften does child cry and fuss?

605 43.7 (3.8) 39.1 (3.5) 11.6 (1.9) 4.7 (1.5) 1.0 (0.7)

Items children 12 to 23 months

Fearfulness

When child sees a stranger, how often doeshe/she turn away or cry as if afraid?

392 42.7 (6.9) 15.1 (4.7) 15.5 (3.0) 7.4 (3.3) 19.4 (4.0)

When child sees an unfamiliar dog or cat,how often does he/she turn away or cry as ifafraid?

385 61.7 (5.9) 13.7 (4.0) 12.1 (3.1) 1.8 (0.8) 10.5 (2.0)

When you leave the room and leave the childalone, how often does he/she become upset?

391 27.8 (5.4) 12.2 (3.5) 21.2 (5.1) 10.0 (3.7) 28.8 (4.4)

When you take child to the doctor, dentist, ornurse, how often does he/she turn away orcry as if afraid?

393 44.9 (4.7) 18.5 (4.5) 12.8 (2.8) 2.8 (1.3) 21.0 (4.7)

Positive affect

When you play with child, how often does he/she smile or laugh?

396 0.1 (0.1) 0.6 (0.5) 0.2 (0.2) 4.4 (1.6) 94.7 (1.6)

J Fam Viol (2010) 25:557–574 567

doctors and nurses, 61.8% of infants and 60.0% of toddlersbecame upset half the time or more when the mother leftthem alone in a room. Almost all the mothers reported thattheir infants and toddlers expressed positive affect (smiling,laughing) most of the time when playing with their mother,at bath time, or when playing alone.

In terms of crying and fussiness, about 40% of infantsand toddlers cried or became upset half the time or morewhen they heard a loud sound. About a fifth of thesample reported that for more than half the time theirinfants or toddlers were crying or upset and weredifficult to soothe or calm. During the average day,about 40% of infants or toddlers were reportedly fussyand irritable half the time or longer. When asked to thinkof their children in comparison with other babies ortoddlers in terms of how often they cried and fussed,17.3% of mothers of infants and 25.9% of mothers oftoddlers reported that their own children cried or fussedhalf the time or more. When all items related to crying,irritability, and fussiness were considered simultaneously,13.6% of infants were reported as being more difficultacross all the temperament items half the time or more.

Bivariate analysis showed a number of variablesassociated with the mother’s perception of difficulttemperament (Table 2). Among the child’s characteristics,children aged 13 to 18 months were assigned higher meandifficult temperament scores by their mothers thanchildren zero to 12 months and children 19 to 23 months(mean of 2.15 compared with 1.93 to 1.96 among other-aged children, p<.05 for all comparisons). Children in fairor poor health had significantly higher mean difficulttemperament scores than children in good health (mean of2.47 compared with 1.99, p<.01). Among the few childrenborn with low birth weight, their mean difficult tempera-

ment score was lower (they were reported as being lessdifficult) than all other children (mean of 1.77 comparedwith 2.0, p<.05).

Mothers’ background characteristics yielded somedifferences. Children of teenage mothers were morelikely than children of mothers aged 20 years or olderto have a higher mean score for difficult temperament(mean of 2.16 compared with 1.99 among mothers 20 to29 and 1.87 among mothers 30 or older, all comparisonsp<.01). Children of Black mothers had a higher meandifficult-temperament score than all other race/ethnicities(mean of 2.29 compared with 1.92 among White mothers,1.95 among Hispanic mothers, and 2.01 among others, allcomparisons p<.05). Children of mothers with less than ahigh school education had higher mean difficult-temperamentscores than children of mothers with high school or more(mean of 2.15 compared with 1.93, p<.01). Children ofunmarried mothers had higher mean difficult-temperamentscores than children of married mothers (mean of 2.05compared with 1.88, p<.01). Children of mothers who werecurrent victims of physical IPV had higher mean difficult-temperament scores than children of nonvictim mothers(mean of 2.12 compared with 1.95, p<.05).

Bivariate analysis of variables associated with theCWS investigation showed that main type of maltreat-ment, level of harm, severity of risk, and substantiationof allegations, all as reported by the caseworker, werenot significantly associated with the mothers’ perceptionof difficult temperament. Of borderline significance wasthe mother’s being the alleged perpetrator of maltreat-ment, but the association was in the unexpected direc-tion: Children of mothers identified as allegedperpetrators had lower mean difficult-temperament scoresthan mothers not identified as perpetrators (mean of 1.95

Table 3 (continued)

Items children 0 to 11months N Never Less than half the time Half the time More than half the time Almost always% (SE) % (SE) % (SE) % (SE) % (SE)

When child plays alone, how often does he/she smile or laugh?

390 3.2 (1.7) 5.2 (3.3) 17.4 (3.2) 14.0 (2.9) 60.2 (4.7)

When child is in the bath, how often does he/she smile or laugh?

397 0.9 (0.3) 1.4 (1.0) 12.1 (4.4) 8.8 (3.3) 76.9 (5.4)

Crying/fussiness

When child hears an unexpected loud sound,how often does he/she cry or become upset?

395 41.7 (4.8) 17.5 (5.3) 18.6 (3.8) 4.3 (1.5) 17.9 (4.1)

How often do you have trouble soothing orcalming child when he/she is crying orupset?

397 41.6 (5.2) 40.5 (4.9) 11.4 (3.0) 4.5 (2.0) 2.0 (0.7)

During the average day how often does childget fussy and irritable?

395 5.7 (1.7) 54.7 (5.5) 28.7 (5.3) 9.3 (2.8) 1.6 (0.7)

In general compared with most toddlers, howoften does child cry and fuss?

396 31.5 (4.8) 42.6 (4.6) 20.5 (4.9) 3.7 (2.2) 1.7 (0.6)

All percentages are weighted; Ns are unweighted

568 J Fam Viol (2010) 25:557–574

compared with 2.10, p=.0563). Among the variablesanalyzed from the caseworker’s risk assessment, onlyone was associated with the mother’s perception ofdifficult temperament: Children of mothers identified as

having a history of being abused or neglected had a highermean difficult-temperament score than mothers not soidentified (mean of 2.20 compared with 1.95, p<.01).

Multivariate analyses are reported in Table 4. Again,mother’s race/ethnicity, mother’s being a victim of IPV, andthe mother’s childhood history of abuse and neglect weresignificantly associated with the mother’s perception ofdifficult temperament. Black mothers were more likelyto perceive their child as having difficult temperamentthan White, Hispanic, and “other” mothers (comparedwith Black mothers, White mothers B=−0.38, SE=0.11,p<.001; Hispanic mothers B=−0.36, SE=0.16, p<.05;other mothers B=−0.38, SE=0.13, p<.01). Mothers whowere victims of IPV at the time of the interview weremore likely to perceive their child as having a difficulttemperament than mothers who were not (current victimsof IPV B=0.13, SE=0.06, p<.05). Mothers with a historyof childhood abuse or neglect were more likely toperceive their child as having a difficult temperamentthan mothers who were not identified by caseworkers ashaving such history (mothers with a history of abuse orneglect B=0.14, SE=0.6, p<.05).

Effect sizes, Cohen effect size index d (Cohen 1988),were also estimated for those variables that showedstatistically significant differences among categories in themultivariate model. Comparisons across race/ethnicitycategories showed less than small effect sizes, indicating alack of clinical relevance for this finding. Only twocomparisons reached a small effect size: being a victim ofIPV and having a history of child abuse and neglect.

Discussion

This study is the first to describe infant temperament in anationally representative sample of biological mothers ofchildren investigated by the CWS for maltreatment. In thishigh-risk population, 13.6% of mothers reported consis-tently negative descriptions of their infant’s temperament.The prevalence of infants with difficult temperament in ourstudy sample is 36% higher than that found in the generalpopulation of infants and toddlers (estimated across studiesat approximately 10% based on maternal report; Bates1980; Daniels et al. 1984). The increased prevalence ofdifficult temperament in our sample may be associated withIPV, either through the child’s direct exposure or vianegative alterations in the mothers’ perceptions andbehaviors towards her child due to her own exposure.

In terms of the first pathway (child’s direct exposure toIPV), previous research indicates that preschool and school-aged children exhibit symptoms of trauma related toexposure to IPV (Graham-Bermann and Levendosky1998; Kilpatrick et al. 1997; Levendosky et al. 2002). For

Table 4 Multiple regression analysis of the difficult-temperamenttotal scores

Characteristic B SE B p

Child Age .065

0 to 6 months −0.10 0.13

7 to 12 months −0.06 0.12

13 to 18 months 0.09 0.12

19 to 23 months ref. ref.

Child Health .105

Excellent/very good/good ref. ref.

Fair/poor 0.30 0.19

Mother’s Age .585

14 to 19 years old 0.07 0.08

20 to 29 years old −0.01 0.07

30 or more ref. ref.

Mothers Race/Ethnicity .008

Black ref. ref.

Whitea −0.38 0.11 .001

Hispanicb −0.36 0.16 .024

Otherc −0.38 0.13 .004

Mother’s Education .075

Less than High School 0.14 .08

High school or more ref. ref.

Mother’s Marital Status .788

Married ref. ref.

Not married 0.02 0.09

Current victim of intimate partner violence .047

Yesd 0.13 0.06

No ref. ref.

Depression .147

Yes 0.13 0.09

No ref. ref.

Mother’s history of abuse and neglect .024

Yese 0.14 0.06

No ref. ref.

Final model: N=801, r2 : .22; Wald F: 4.02; p<.001a Effect size (mean difference on Temperament scores between White andBlack): .13b Effect size (mean difference on Temperament scores between Hispanicand Black): .11c Effect size (mean difference on Temperament scores between Other andBlack): .11d Effect size (mean difference on Temperament scores between currentvictim of IPV and non-current victim): .15e Effect size (mean difference on Temperament scores between motherswith childhood history of abuse and neglect and mothers without history ofabuse and neglect): .20

J Fam Viol (2010) 25:557–574 569

infants, the symptoms of exposure to IPV include eatingand sleeping problems, lack of normal responsiveness toadults, irritability, hyperarousal, fear, aggression, and highrates of crying and screaming (Bogat et al. 2006;Cummings et al. 1981; Dejonghe et al. 2005). Amongtoddlers, symptoms of exposure to IPV include emotionalblunting (less responsiveness, less pleasure and interest inplay activities) and extreme negative states (tantrums,unstoppable crying, and inconsolable sobs; Kaufman andHenrich 2000). Any of these symptoms can be directlyreflected in the types of descriptors used in the tempera-ment scale of this study, producing an abnormally highscore that should be interpreted clinically instead of as anindicator of difficult temperament per se.

The finding also raises concern that, for a subset ofmothers in our sample, perceptions of the child may benegatively biased due to their own exposure to IPV.Research suggests that a woman who experiences traumaand abuse may project her experience onto her child,assigning negative, aggressive attributes to the child’sbehavior (Lieberman 2007; Lieberman and Van Horn2005, 2008). In this scenario, perceptions of an infant’stemperament would be influenced by the mother’s projec-ting onto her child the negative characteristics of her abuseror, because the child is the offspring of a physically abusiveman, interpreting developmentally appropriate behaviors inhis child as signs of difficult temperament. Whether thechild is, objectively speaking, traumatized by IPV, orwhether the mother’s perceptions of the child are negativelyinfluenced by the IPV, a mother in this situation likelyneeds help to prevent future maltreatment of her child.Moreover, both mother and child require help to resolveany trauma symptoms manifest in the infant.

A related important finding was the association betweenthe mother’s perception of infant temperament as difficultand the mother’s history of having been abused orneglected herself. Many of the clinical features associatedwith mothers’ exposure to IPV also apply to mothers’previous exposure to abuse and trauma during childhood.These features include the projection of characteristics ofthe abuser onto the child, a psychological response that canbias a mother’s perception of her child’s temperament andundermine her parenting capacity as a result of theemotionally damaging experience of being raised by anabusive parent (Barnett et al. 1997; Lieberman 2007;Lieberman and Van Horn 2008).

This study found no association between maternaldepression and the mother’s negative perception of herinfant’s temperament. Although bivariate analysis showedan association of borderline significance, multivariateanalysis failed to confirm an association. Although depressionhas been related to the quality of maternal caregiving andmaternal perception of difficult temperament in many

previous studies (Daniels et al. 1984; Foreman and Henshaw2002; Pesonen et al. 2004; Vaughn et al. 1987), it is possiblethat maternal depression is not as central as the mother’sexperience of abuse and trauma experience. Moreover,maternal depression, to the extent that it does influenceperception of the infant, may be a secondary conse-quence of this abuse. Similarly, fair or poor infant healthand caseworkers’ reporting poor parenting and low socialsupport did not increase the infant’s risk of beingperceived as difficult in multivariate analysis. None ofthe case maltreatment variables that could be associatedwith the mother’s negative perception of her infant’stemperament were associated.

Several limitations to this study warrant mention.This study used mothers’ responses to assess riskfactors such as depression and IPV, which were subjectto various forms of recall and response biases. Suchbiases are especially likely because of the stressfulnature of the events (which may affect memory) andthe sensitive nature of the topics. Additionally, theassessment of IPV was limited to physical violence anddid not include emotional and sexual abuse, which theliterature finds are also associated with maternalperceptions of child behavior. The study would havebenefited from the use of all scales of the ConflictTactics Scales and from additional sources of informa-tion regarding history, type, and amount of IPVexposure. It should also be noted that the measuresobtained through the interviews with caseworkersprovided only general information about maternal riskfactors. Finally, without an external observation of thechild to evaluate temperament, it is not possible toascertain how much maternal perceptions in the studypopulation were negatively biased.

Implications

The CWS and the judicial system are in a critical positionto help infants and mothers with a history of abuse andneglect, many of whom continue to be abused by anintimate partner. It is important to develop mechanisms bywhich such mothers and their young children can beidentified as being in acute need of services. Despite theCWS’s and the judicial system’s important roles inallocating services, the CWS maltreatment investigationcharacteristics that have been associated with receipt ofservices did not in our current study predict more negativematernal ratings of infant temperament. In other words,traditional CWS risk assessment or basic case character-istics like substantiation or alleged perpetrator did notappear to be sensitive to maternal perceptions of difficulttemperament, an important feature of early relationalproblems. Consequently, systems relying on case investi-

570 J Fam Viol (2010) 25:557–574

gation characteristics to determine provision of servicesare overlooking many mothers and children struggling ina negative or complicated relationship. Mothers incontact with the CWS face psychological obstacles thatinterfere with their capacity to protect and heal therelationship with their child, yet they likely will receiveno services.

Taken together, the study findings support emergingintervention models that include evidence-based child-parent psychotherapy (CPP) for families with a history ofchild maltreatment in contact with the CWS. A pioneeringexample can be seen in the Miami Child Well-Being CourtModel (Juvenile Court, Miami-Dade Eleventh JudicialCircuit). In this model juvenile court, the judge has formeda multidisciplinary partnership with clinical experts ininfant mental health, referring adjudicated dependentsunder the age of three and their mothers for intensiveevaluation and treatment at the University of Miami’sLinda Ray Intervention Center. To ensure best practiceof parent-child psychotherapy in the context of court-ordered treatment, treating therapists participate in anongoing learning collaborative led by an expert ontrauma in early childhood and infant mental healthintervention with very young children (Lederman andOsofsky 2004; Lederman et al. 2001; Malik et al. 2002).The clinical services foster a positive attachment betweenmother and child by helping the mother adjust herperception of her child and learn skills for nurturing andcaring for her child. A critical component of this clinicalwork is raising the mother’s awareness of her ownunhealed wounds from childhood or intimate partnerviolence and how these unresolved issues determinesher perception of the child, putting her at risk of childmaltreatment (Carter et al. 1991; Lieberman 2007;Lieberman et al. 2006; Lieberman et al. 2005; Liebermanet al. 2000). More research yielding data on evidence-based programs or practices that address mother-infantattachment and the developing early caregiver relation-ship are needed to inform the work of the CWS, courts,and clinicians working with maltreated young childrenand their mothers.

As the first of its kind that relies on a nationalprobability sample representative of families referred tothe CWS and that systematically examines variablesassociated with mothers’ perceptions of infant’s difficulttemperament, our current study has important implicationsfor effective referral decision making. By using standard-ized measures with well-established psychometric proper-ties to assess IPV, as well as mothers’ histories of childhoodmaltreatment, in relation to mothers’ perceptions of infanttemperament, this research deepens our understanding ofthe dysfunctional aspects of the mother-child relationship inthis particularly vulnerable population.

Our current findings identify a subgroup of mothers andchildren involved in the CWS for whom negative maternalperceptions may interact with key corollary risk factors(e.g., IPV, history of childhood abuse or neglect) to placethe mother-child relationship at heightened risk. Weargue that early identification and referral to evidence-based psychotherapeutic mother-child intervention is acrucial mean for promoting caregiving and healing theeffects of maltreatment. With appropriate early interven-tion, mothers can gain pivotal insights about theirchildren’s needs and behaviors, and their capacity formutual joy and protection of the child can be restored.

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