1

1
The Current
The Current Status
Status of
of
Etiological Theories
Etiological Theories in
in
Intrafamilial Child
Intrafamilial Child
Maltreatment
Maltreatment
SANDRA T.
SANDRA T. AZAR, TANIA Y.
AZAR, TANIA Y. POVILAITIS,
POVILAITIS,
ALLISON F.
ALLISON F. LAURETTI,
LAURETTI,
and CHRISTINA
and CHRISTINA L.L. POUQUETTE
POUQUETTE

Child
Child maltreatment
maltreatment is is aa major social problem
major social problem affecting over aa million
affecting over million children
children andand
their
their families each year
families each year (National
(National Center
Center on Child Abuse
on Child and Neglect,
Abuse and 1992). Ef-
Neglect, 1992). Ef-
fective
fective treatment
treatment development
development for for both
both perpetrators
perpetrators andand victims
victims ofof this
this problem
problem
rests
rests on
on the
the availability
availability ofof well-articulated
well-articulated and validated theories
and validated theories ofof etiology.
etiology. Such
Such
theories
theories allow for empirical
allow for documentation of
empirical documentation causal factors
of causal factors and ultimately, more
and ultimately, more
precisely
precisely targeted
targeted interventions.
interventions. The The goal
goal of
of this
this chapter
chapter is
is to
to assess
assess progress
progress inin
the
the development
development of etiological models
of etiological models of of intrafamilial
intrafamilial child
child maltreatment.
maltreatment. The The
chapter
chapter begins with aa historical
begins with overview of
historical overview of the forces that
the forces that operated
operated to to slow
slow the-
the-
ory
ory building in early
building in early phases
phases of of this
this field
field and
and ones that are now more fostering
ones that are now more fostering of of
theory
theory development.
development. We We then
then examine
examine thethe foundations of current theories
foundations of current theories about about
each form of
each form child maltreatment,
of child maltreatment, highlighting
highlighting the the definitions and assumptions
definitions and assumptions
that
that models have adopted
models have adopted and and the
the basic
basic dimensions
dimensions on on which
which they differ. The
they differ. The
chapter
chapter ends with aa preliminary
ends with attempt to
preliminary attempt integrate current
to integrate theorizing into
current theorizing into aa
meta-model
meta -model that would be
that would useful in
be useful in treatment
treatment development.
development.

SANDRA
SANDRA T.T. AZAR, TANIA Y.
AZAR, TANIA Y. POVILAITIS,
POVILAmS, ALIlSON
ALUSON F. F. LAURETTI,
LAURETTI, andand CHRISTINA
CHRISTINA L. L.
POUQUETIE
POUQUETIE •• Frances
Frances L.
L. Hiatt
Hiatt School
School of
of Psychology,
Psychology. Clark University, Worcester.
Clark University. Worcester, Massachusetts
Massachusetts
01610.
01610.
Handbook
Handbook of
of Child Abuse Research
Child Abuse and 'freatment.
Research and 'Ireatment, edited by Lutzker.
edited by Lutzker. Plenum
Plenum Press,
Press. New
New York,
York, 1998.
1998.

33
44 T. AZAR
SANDRA T. aI.,
AZAR et al

FORCES INFLUENCING
FORCES INFLUENCING MODEL
MODEL DEVELOPMENT
DEVELOPMENT

Society's initial outrage

Society's initial outrage at at the
the identification
identification of child abuse
of child abuse asas aa social
social problem
problem
impelled
impelled itit to take legal
to take legal actions
actions to to protect children, but
protect children, but this
this emotional atmosphere
emotional atmosphere
did
did not
not encourage
encourage careful
careful scientific inquiry into
scientific inquiry into the
the etiology
etiology ofof the problem [Azar,
the problem (Azar,
Fantuzzo, &
Fantuzzo, Twentyman, 1984;
& Twentyman, 1984; Gelles, 1983). Treatment
Gelles, 1983). Treatment took took precedence
precedence over over de-
de-
fining the
fining the disorder
disorder and searching for
and searching for causes,
causes, limiting
limiting thethe knowledge
knowledge base base from
from
which
which model
model building could take
building could place. The
take place. The epistemologies
epistemologies and emphases of
and emphases of the
the
disciplines
disciplines that
that dominated
dominated the the field early in
field early its history
in its (law, medicine,
history (law, medicine, and psy-
and psy-
chodynamic
chodynamic psychiatry)
psychiatry) also slowed the
also slowed the development
development of an empirical
of an knowledge
empirical knowledge
base
base upon which to
upon which to build theory.
build theory.
In the
In the late 1970s, such
late 1970s, professionals as
such professionals as social
social learning theorists, sociologists,
learning theorists, sociologists,
and
and developmental psychologists began to enter the field, bringing strong empi-
developmental psychologists began to enter the field, bringing strong empi-
rical traditions
rical traditions andand rich
rich theoretical
theoretical backgrounds
backgrounds to bear on
to bear on the problem. Unfor-
the problem. Unfor-
tunately,
tunately, aa lack
lack of research funding
of research funding hampered
hampered their
their efforts.
efforts. InIn addition,
addition, manymany
methodological
methodological issues from earlier
issues from decades remained
earlier decades remained unresolved
unresolved Ie.g.,(e.g., the
the lack
lack of
of
operational
operational definitions; Azar, 1988;
definitions; Azar, 1988; Plotkin,
Plotkin, Azar, Twentyman, &
Azar, Twentyman, Perri, 1981).
& Perri, 1981).
Consequently, growth in
Consequently, growth in the
the field's
field's knowledge
knowledge base
base was slow.
was slow.
Recently,
Recently, however,
however, thethe picture
picture hashas begun
begun to to change. The number
change . The number of mal-
of mal-
treated
treated children
children hashas startled
startled society,
society, and
and preliminary solutions have
preliminary solutions have proven
proven to be
to be
ineffective
ineffective (e.g.,
(e.g., foster care, legal
foster care, legal sanctions).
sanctions). Federal
Federal task forces have
task forces called for
have called for
more
more careful
careful theory-guided research (National
theory-guided research (National Research
Research Council, 1993; The
Council, 1993; The U.S.
U.S.

Definitions
Definitions
Assumptions
Assumptions
-Defect
-Defect
-Deficit
-Deficit
-Disruption
-Disruption
-Mismatch between typical
-Mismatch between typical modes
modes of of responding
responding and
and that which is
that which more appropriate
is more or effective
appropriate or effective
in
in aa given situation
given situation
Levels
Levels of
of analysis
analysis
-Biological
-Biological
-Personality-emotional
-Personality-emotional
-Experiential-learning
-Experiential-learning
-Societal-cultural
-Societal-cultural
Complexity
Complexity
-Single
-Single factor models
factor models
-Lists
-Lists ofof factors
factors
-Integrated models
-Integrated models
Model
Model form
form (modified
(modified version
version of of Handlon,
Handlon, 1960;
1960; Wiener
Wiener & & Cromer,
Cromer, 1967)
1967)
-Modell:
-Modell: AbuseAbuse isis aa class
class with
with aa single
single member,
member. this member having
this member having aa single
single cause.
cause.
-Model
-Model 2: Abuse is
2: Abuse is aa class
class with
with aa single
single member.
member. having multiple factors
having multiple factors constituting
constituting the
the
radical cause.
radical cause.
-Model
-Model 3: 3: Abuse
Abuse isis aa class
class with
with several
several members.
members. allall members having the
members having same single
the same single cause.
cause.
-Model
-Model 4: 4: Abuse
Abuse isis aa class
class with
with several members. each
several members. having aa single
each having single oror multiple
multiple causes
causes that
that
are not
are not necessarily
necessarily unique
unique to that member.
to that member.
-Model 5: Abuse is a class with several members. each member having a single unique cause.
-Model
-Model 6: 6: Conditional statements in
Conditional statements ordered series
in ordered series predicting
predicting points
points in the development
in the development ofof
disorder.

Figure 1.
Figure 1. Dimensions on which
Dimensions on models differ.
which models differ.
 ETIOLOGICAL THEORIES
ETIOLOGICAL THEORIES IN
IN INTRAFAMILIAL
INTRAFAMILIAL CHILD
CIDLD MALTREATMENT
MALTREATMENT 55

Advisory Board
Advisory Board on
on Child
Child Abuse
Abuse and
and Neglect
Neglect;; 1993). Although growth
1993). Although growth has
has been
been
slow, enough
slow, enough data
data have
have accumulated
accumulated inin at
at least
least two
two ofof the
the areas
areas (physical
(physical and
and sex-
sex-
ual abuse)
ual abuse) toto contribute
contribute to
to more
more sophisticated
sophisticated model
model development.
development.
Over time,
Over time, theories
theories of
of maltreatment
maltreatment have
have shifted
shifted from
from single
single cause
cause models
models
(e.g., stress)
(e.g., stress) to
to more
more recent
recent integrated
integrated perspectives
perspectives (e.g.,
(e.g., cognitive-behavioral
cognitive-behavioral per-
per-
spectives, social-ecological
spectives, social-ecological frameworks).
frameworks). These
These newer
newer approaches
approaches hold the most
hold the most
promise for
promise for intervention
intervention development.
development. Data in the
Data in the areas
areas ofof neglect
neglect and
and emotional
emotional
maltreatment, however,
maltreatment, however, have
have continued
continued to
to lag
lag behind.
behind. Our
Our discussion
discussion of
of theory
theory in
in
these two
these two forms
forms of
of maltreatment
maltreatment will,
will, therefore,
therefore, bebe more
more limited.
limited.

DIMENSIONS ON
DIMENSIONS ON WHICH
WHICH MODELS
MODELS VARY
VARY

Models of
Models of intrafamilial
intrafamilial child
child maltreatment
maltreatment vary
vary onon aa number
number of of dimensions,
dimensions,
including definition
including definition of the behavior
of the behavior inin question,
question, assumptions
assumptions regarding
regarding its
its ori-
ori-
gins, level
gins, level of
of identification
identification ofits
of its determinants
determinants (e.g.,
(e.g., intra-individual,
intra-individual, social
social group,
group,
culture), complexity
culture), complexity (single
(single cause
cause versus
versus multiple
multiple causes),
causes), andand form
form of
of ante-
ante-
cedent-consequence relationships
cedent-eonsequence relationships (Azar,
(Azar, 1991; Figure 1).
1991; Figure When developing
1). When developing frame-
frame-
works, theorists implicitly
works, theorists implicitly or
or explicitly
explicitly make
make decisions
decisions on on all
all five
five dimensions.
dimensions. InIn
this section,
this each form
section, each form ofof maltreatment
maltreatment will
will be
be considered
considered separately,
separately, examining
examining
these dimensions and
these dimensions and assessing
assessing progress.
progress.

PHYSICAL CHILD
PHYSICAL ABUSE!1
CHILD ABUSE

Definitions
Definitions
Perhaps
Perhaps thethe most
most important
important factor
factor inin determining
determining aa model's
model's direction
direction is is how
how
it defines
it defines the phenomenon in
the phenomenon question. For
in question. For example, some models
example, some models begin
begin with
with the
the
premise
premise thatthat physical
physical child
child abuse
abuse isis an
an aggressive
aggressive act
act and,
and, thus,
thus, can
can be
be explained
explained
by
by existing
existing models
models of of aggression
aggression (e.g.,
(e.g., mediational
mediational models,
models, Bandura,
Bandura, 1983;1983; frus-
frus-
tration-aggression
tration-aggression models, Miller, 1941).
models , Miller, 1941). Others
Others see
see the
the context
context in in which
which it it oc-
oc-
curs,
curs, the
the family,
family, asas having
having special
special meaning
meaning and,and, therefore,
therefore, invoke processes in
invoke processes in
social
social groups
groups and
and families (e.g. general
families (e.g. general social systems theory,
social systems Straus, 1973).
theory, Straus, 1973). Such
Such
conceptualizations
conceptualizations have resulted in
have resulted in explanatory
explanatory models
models that that often
often combine
combine all all
forms
forms of of family
family violence.
violence.
Some
Some models
models havehave moved
moved away
away fromfrom aggression
aggression as as an
an organizing
organizing construct
construct
and
and classified
classified physical
physical abuse
abuse within
within broader
broader categories
categories (e.g.,
(e.g. , conflict
conflict strategies,
strategies, useuse
of
of power).
power). For
For example,
example , resource
resource theory
theory (Goode, 1971) sees
(Goode, 1971) sees violence
violence asas aa resource
resource
for
for obtaining
obtaining dominance,
dominance, aa resource
resource that
that is
is used
used only
only when
when others
others are
are lacking.
lacking.
Moving
Moving even
even further
further from
from aa narrow
narrow focus
focus on
on aggression
aggression are are theories
theories that
that view
view
physical
physical abuse
abuse asas one
one ofof many
many possible
possible interpersonal
interpersonal behaviors,
behaviors, some some of which fa-
of which fa-
cilitate
cilitate transactions
transactions (e.g.,
(e.g., produce
produce good
good child
child outcome)
outcome) andand others
others ofof which
which do do not.
not.
Such
Such models
models attempt
attempt to to delineate
delineate whywhy oneone behavior
behavior isis chosen
chosen overover another
another (e.g.,
(e.g.,
differential
differential modeling
modeling experiences,
experiences, attributional
attributional biases).
biases). For instance, in
For instance, in some
some re- re-
cent
cent models,
models, abuse
abuse isis at
at one
one end
end of
of aa continuum
continuum of of normal
normal parenting
parenting withwith the
the other
other

tI This
This section
section relies
relies heavily
heavily upon
upon Azar
Azar (1991).
(1991).
6 SANDRA T.
SANDRA T. AZAR et aI.
AZAR et

end
end being
being optimal parenting (Azar,
optimal parenting (Azar, 1986,
1986, 1989; Wolfe, 1987).
1989; Wolfe, Here, abuse
1987). Here, abuse is viewed
is viewed
as part of
as part of aa constellation
constellation ofof parental
parental behaviors
behaviors that
that negatively
negatively affect
affect child
child outcome.
outcome.
Developmentally
Developmentally based,based, these models are
these models are intrinsically models of
intrinsically models of parenting ade-
parenting ade-
quacy. This view
quacy. This view will form the
will form the core
core of the meta-model
of the meta-model that will be
that will outlined later
be outlined later in
in
this chapter.
this chapter.
Other
Other theorists, while conceiving
theorists, while conceiving of of physical abuse as
physical abuse part of
as part of aa constellation
constellation
of
of aberrant parenting behavior,
aberrant parenting behavior, seesee itit as
as discontinuous
discontinuous withwith "normal"
"normal" parenting.
parenting.
Physical
Physical punishment
punishment is is not viewed as
not viewed as on
on the
the same
same continuum
continuum with abuse, and
with abuse, and the
the
processes leading to abuse are seen as more trauma-based than those
processes leading to abuse are seen as more trauma-based than those posited in the posited in the
continuum
continuum view view (e.g., disturbed attachment;
(e.g., disturbed attachment; Carlson,
Carlson, Cicchetti, Barnett, &
Cicchetti, Barnett, Braun-
& Braun-
wald, 1989).
wald, 1989).
The definition
The definition ofof physical
physical child
child abuse sets the
abuse sets the stage
stage for
for the other aspects
the other aspects of of aa
model.
model. Because definitions of
Because definitions all forms
of all forms ofof maltreatment
maltreatment have
have not
not been given much
been given much
attention,
attention, research has focused
research has focused on on narrowly defined cases
narrowly defined cases (i.e.,
(i.e., identified
identified fami-
fami-
lies),
lies), limiting
limiting the
the nature
nature ofof the
the models
models produced.
produced.

Assumptions
Assumptions
Along
Along withwith classifying
classifying physical child abuse,
physical child abuse, theories make assumptions
theories make assumptions about about
its origins that
its origins further determine
that further determine theory
theory development
development (Wiener(Wiener & & Cromer, 1967).
Cromer, 1967).
First,
First, there
there cancan be
be anan assumption
assumption of defect [i.e.,
of defect (Le., some
some malfunction
malfunction such such that
that the
the in-
in-
dividual [parent, child
dividual [parent, child or or both]
both] cannot benefit from
cannot benefit from his or her
his or her experiences).
experiences). Im- Im-
pairment is
pairment is thought
thought to to be
be permanent
permanent or or of
of such
such aa deeply based nature
deeply based nature that it would
that it would
be
be highly
highly resistant
resistant to to treatment
treatment (e.g.,
(e.g., neurological
neurological defects,
defects, Elliot, arousal
1988; arousal
Elliot, 1988;
problems,
problems, Vasta, 1982; mental
Vasta, 1982; retardation, Schilling,
mental retardation, Schilling, Schinke, Blythe, &
Schinke, Blythe, Barth,
& Barth,
1982). Typically,
1982). Typically, defect
defect models
models do do not
not provide avenues for
provide avenues treatment development
for treatment development
and have not
and have had much
not had much empirical support. Consequently,
empirical support. Consequently, such such models
models have
have not not
held
held much
much appeal
appeal for professionals, except
for professionals, except perhaps
perhaps in in some
some legal contexts (e.g.,
legal contexts (e.g.,
termination
termination of of parental rights). They
parental rights). They do do have popular appeal
have popular appeal in in that
that society
society may may
prefer
prefer toto distance
distance itself
itself from all maltreating
from all maltreating parents
parents by by seeing
seeing them
them as defective.
as defective.
The second
The second assumption
assumption possible
possible is is that physical abuse
that physical abuse isis linked
linked toto some
some de- de-
ficiency-the
ficiency-the absence absence of of some
some function-that
function-that is is amenable
amenable to to change. Models of
change. Models of
this sort became
this sort became prevalent
prevalent when social learning
when social learning theorists entered the
theorists entered field. Such
the field. Such
aa perspective
perspective is implicit in
is implicit in education-based
education-based social social work
work responses
responses to abuse and
to abuse and in in
recent
recent behavioral interventions aimed
behavioral interventions aimed at skill deficits.
at skill deficits.
The
The third
third possible assumption is
possible assumption is that involves aa disruption.
abuse involves
that abuse disruption. That That is,is,
some external
some external factor interferes with
factor interferes with appropriate
appropriate parental
parental functioning.
functioning. Such Such views
views
arrived with
arrived with thethe movement
movement of of social
social psychologists
psychologists and and sociologists
sociologists intointo the field.
the field.
In models
In models withwith this assumption, individual
this assumption, individual or or culture-based stressors are
culture-based stressors posited
are posited
as
as causal
causal (Garbarino,
(Garbarino, 1976). Interventions are
1976). Interventions are then
then aimed
aimed at reducing such
at reducing such stress
stress
(e.g.,
(e.g., day
day care,
care, economic subsidies).
economic subsidies).
The last
The last possible
possible assumption
assumption attributes disorder to
attributes disorder to differences
differences or mismatches
or mismatches
between typical modes
between typical modes of of responding
responding and and that
that which
which is is more
more appropriate
appropriate or ef-
or ef-
fective
fective in given situation
in aa given situation (e.g., an overreliance
(e.g., an overreliance on on coercive transactions to
coercive transactions elicit
to elicit
child
child compliance,
compliance, Wolfe, Wolfe, 1987). The emphasis
1987). The emphasis is is on
on transactional
transactional problems
problems (re- (re-
sponse-environment fit).
sponse-environment This assumption
fit). This assumption placesplaces the
the problem
problem in in aa transaction,
transaction, not not
an
an individual. Models emphasizing
individual. Models emphasizing societalsocietal validation
validation of violence as
of violence as aa response
response to to
conflict
conflict or or those
those positing
positing aa mismatch
mismatch between
between the the needs
needs of families and
of families and soci-
soci-
ETIOLOGICAL THEORIES IN
ETIOLOGICAL THEORlES IN INTRAFAMILIAL
INTRAFAMllJAL CHILD MALTREATMENT
CHILD MALTREATMENT 7

etal/culture based supports

etal/culture based supports would
would fit
fit here
here Ie.g.,
(e.g., Levinson,
Levinson, 1988; Steinmetz &
1988; Steinmetz &
Straus,
Straus, 1974). Interventions would
1974). Interventions would require
require broad
broad social
social changes that may
changes that pose aa
may pose
threat
threat to
to strongly held social
strongly held social values.
values.
Recently, models of
Recently, models of physical
physical child
child abuse have begun
abuse have begun to
to combine assumptions
combine assumptions
(Cicchetti
(Cicchetti && Rizley,
Rizley, 1981; Wolfe, 1987).
1981; Wolfe, is not
It is
1987). It not clear
clear whether this approach
whether this approach will
will
be
be useful.
useful.

Levels of
Levels of Analysis
Analysis
Models
Models differ
differ as
as to where they
to where they direct the search
direct the search for
for causal mechanisms-in bi-
causal mechanisms-in bi-
ological,
ological, personality-emotional,
personality-emotional, experiential-learning,
experiential-learning, and and societal-eulturallev-
societal-cultural lev-
els
els of
of analysis. Early theories
analysis. Early focused on
theories focused on variables within the
variables within the individual.
individual. More
More
recent
recent transactional views have
transactional views have attempted
attempted to integrate multiple
to integrate levels of
multiple levels of analysis.
analysis.
For
For example, Belsky'S model
example, Belsky's model (1980) suggests causes
(1980) suggests causes in multiple ecological
in multiple sys-
ecological sys-
tems : what
tems: what parents
parents bring
bring to
to parenthood (e.g., preparation),
parenthood (e.g., factors in
preparation), factors in the
the family's
family'S
immediate
immediate context (e.g., child
context (e.g., care needs),
child care needs), factors
factors in
in larger social settings
larger social settings (e.g.,
(e.g.,
work) , and culture based values/beliefs. Variables within each system interact
work),
with
with variables in other
variables in systems to
other systems produce specific
to produce specific family
family transactions. The model
transactions. The model
does not, however, specify whether disturbances in only one system or in more
than one
than one are
are required for abuse
required for abuse toto occur;
occur; this
this lowers
lowers its usefulness for
its usefulness for treatment
treatment
development.

Complexity
Complexity
Over
Over time in all
time in all fields,
fields, the complexity of
the complexity of models
models evolves.
evolves. As
As noted earlier, in-
noted earlier, in-
tegration
tegration has
has begun
begun to occur in
to occur theories of
in theories of physical abuse. These
physical abuse. These efforts, however,
efforts, however,
are in
are in their
their earliest stages and
earliest stages typically are
and typically are merely lists of
merely lists of the
the components
components of sin-
of sin-
gle-factor theories with
gle-factor theories with little attempt to
little attempt specify contingent
to specify relationships among
contingent relationships among
factors
factors oror prioritize their contribution
prioritize their contribution to to etiology. In some
etiology. In some cases,
cases, too
too many
many com-
com-
ponents are posited to result in testable models (Gelles (Gelles & 1979). Some the
& Straus, 1979). the--
orists
orists have
have argued that integration
argued that integration may
may notnot be
be possible
possible and others have
and others have suggested
suggested
that
that mid-level
mid-level theories, moderate in
theories, moderate in complexity,
complexity, maymay have the greatest
have the greatest ultimate
ultimate
utility (Gelles, 1983).
utility (Gelles, 1983).

Model
Model Form
Form
The final
The final dimension
dimension on on which
which models
models differ
differ is
is inin their
their structure (i.e., the
structure (i.e., the
form
form ofof antecedent-consequence relationship posited).
antecedent-consequence relationship posited). Using
Using aa formal
formal analysis
analysis
framework delineated by Handlon (1960), (1960), progress and conceptual problems hin-
dering
dering model
model development
development can be seen.
can be seen. In
In applying
applying this framework, more
this framework, basic
more basic
problems
problems quickly
quickly become apparent (Figure
become apparent (Figure 1). First,, elaborate
1). First theories are
elaborate theories are still
still
rare, and thus,
rare, and thus, what
what wewe call
call theories
theories and
and how
how wewe group
group themthem may
may bebe open
open toto
question.
question. Indeed,
Indeed, many would not
many would not meet
meet strict
strict criteria
criteria for
for being
being deemed theories
deemed theories
(e.g.,
(e.g., operational definitions of
operational definitions of components, testable hypotheses)
components, testable hypotheses).. Second,
Second, be-be-
cause
cause all
all forms of maltreatment
forms of maltreatment involve
involve transactions
transactions rather than one
rather than individual's
one individual's
behavior, simple
behavior, linear relationships
simple linear might not
relationships might not be the most
be the appropriate explana-
most appropriate explana-
tory
tory format.
format. Wiener and Cromer's
Wiener and Cromer's (1967) addition of
(1967) addition of type
type 66 models
models toto Handlon's
Handlon's
framework may ultimately prove prove to be more appropriate. Here, abuse would be
88 SANDRA T.
SANDRA T. AZAR
AZAR et aI.
et al.

seen as
seen as the
the end
end point
point of of aa transactional
transactional process process (see(see Wolfe,
Wolfe, 19871987 forfor an example).
an example).
Third,
Third, most models of
most models of physical
physical child child abuseabuse view
view it it as
as aa class
class with
with aa single
single mem-
mem-
ber
ber or
or combine
combine it it with other forms
with other forms of of family violence, limiting
family violence, limiting attempts
attempts at at mod-
mod-
els 33 to
els to 5.5.
Until
Until the the last
last decade
decade or or so,
so, it
it was
was typetype 11 models
models thatthat dominated
dominated the the field
field ("If A, A,
then X"). Here,
then X"). Here, eacheach casecase of of physical
physical child child abuse
abuse is seen as
is seen as equivalent
equivalent to to every
every
other case and
other case having its
and having origin in
its origin in aa single
single factor, something about
factor, something about the perpetrator,
the perpetrator,
the
the victim,
victim, or or the context in
the context in which
which they they interact.
interact. Early
Early type
type 11 models
models were were typically
typically
"borrowed" from
"borrowed" from other
other areas
areas (e.g.,
(e.g., behavioral
behavioral modelsmodels of of family
family [Patterson
[Patterson & & Reid,
Reid,
1967]). With
1967]). With more data, models
more data, specific to
models specific to physical
physical child
child abuse
abuse havehave emerged.
emerged.
Perpetrator models
Perpetrator models are are the
the most
most common
common type type 11 model.
model. In In the
the extreme,
extreme, these
these
models posited that child maltreaters were psychotic
models posited that child maltreaters were psychotic or suffered from personal- or suffered from personal-
ity
ity disorders,
disorders, with with factors
factors in the perpetrator's
in the perpetrator's early early history being crucial
history being (e.g., aa
crucial (e.g.,
lack of empathic caregiving; Steele, 1980).
lack of empathic caregiving; Steele, Their underlying
1980). Their constructs (e.g.,
underlying constructs (e.g., dis-
dis-
rupted
rupted identification
identification processes),
processes), however,
however, have have not been amenable
not been amenable to to empirical
empirical
validation,
validation, and specific diagnoses
and specific diagnoses have have not not differentiated maltreaters. The
differentiated maltreaters. The idea
idea of of
negative
negative early parental role
early parental role models,
models, however,however. has has been
been retained
retained in in more recent
more recent
frameworks.
frameworks.
Until
Until recently,
recently, amongamong the the least
least adequately
adequately developed
developed of of the perpetrator theo-
the perpetrator theo-
ries have been
ries have been biological
biological approaches.
approaches. These These efforts have included
efforts have included earlyearly attempts
attempts
at
at ethological
ethological models models [e.g..(e.g., "critical period" attachment
"critical period" attachment views, Klaus &
views, Klaus & Kennell,
Kennell,
1976) and
1976) recent explanations
and recent explanations of of physical
physical abuseabuse involving
involving nonspecific neurologi-
nonspecific neurologi-
cal
cal problems
problems (Elliot, 1988) and
(Elliot, 1988) physiological reactivity
and physiological reactivity (Frodi
(Frodi & & Lamb, 1980). Al-
Lamb, 1980). Al-
though
though the the biological
biological bases bases of of these disturbances have
these disturbances have not been documented,
not been documented,
these
these ideas
ideas have been retained
have been retained in in more behavioral form
more behavioral form in in recent
recent frameworks
frameworks (e.g., (e.g.,
"conditioned arousal,"
"conditioned arousal," behavioral
behavioral system system viewsviews of attachment). Sociobiological
of attachment). Sociobiological
concepts,
concepts, such such as as inclusive
inclusive fitness,
fitness, have also been
have also been invoked,
invoked, although
although theythey do do bet-
bet-
ter
ter at
at explaining
explaining abuse abuse where
where aa stepparent
stepparent is is involved
involved (Burgess
(Burgess & & Draper, 1989;
Draper, 1989;
Daly
Daly & & Wilson,
Wilson, 1981).1981).
In
In the
the last few years,
last few years, perpetrator
perpetrator theories theories havehave become
become more sophisticated.
more sophisticated.
For
For example,
example, Azar Azar (1986, 1989) has
(1986, 1989) has suggested
suggested parental social-cognitive distur-
parental social-cognitive distur-
bances (e.g., disturbed
bances [e.g., disturbed schemaschema involving children, problem-solving
involving children, problem-solving deficits) deficits) are are
present
present in perpetrators that
in perpetrators that result
result in in negative
negative interpretations
interpretations of of child behavior.
child behavior.
These, ultimately, lead
These, ultimately, lead to to abusive transactions and
abusive transactions and to to an
an environment
environment that that doesdoes
not support children's
not support overall development.
children's overall development. Along Along the the same
same lines.
lines, Newberger
Newberger and and
Cook
Cook (1983) have explained abuse using a developmental
(1983) have explained abuse using a developmental model of "parental model of "parental
awareness,"
awareness," where where less sophisticated levels
less sophisticated levels ofof perspective-taking
perspective-taking ability ability and
and con-con-
ceptions of
ceptions of children
children are conducive to
are conducive maladaptive parenting.
to maladaptive parenting. Research
Research focusing
focusing
on
on parent
parent and and child
child disturbances
disturbances in in emotion
emotion recognition
recognition and and expression
expression (Camras,
(Camras,
et
et al.,
al., 1990)
1990) is is also
also promising
promising and and may.may, ultimately,
ultimately, result
result in in fine-tuned
fine-tuned emotion-
emotion-
based
based theory.
theory. Perpetrator theories that
Perpetrator theories that areare well specified and
well specified and validated
validated may may prove
prove
very
very useful
useful for treatment development.
for treatment development.
In
In addition
addition to to aa focus
focus on on perpetrators,
perpetrators, studies studies have
have attempted
attempted to identify char-
to identify char-
acteristics of
acteristics abused children
of abused children that either produce
that either produce abuseabuse directly
directly or or hasten
hasten an an abu-
abu-
sive cycle
sive cycle in in aa "vulnerable"
"vulnerable" parent. parent. For For example,
example, such such children
children may may begin
begin life life
with
with characteristics
characteristics which which make make themthem seem seem more
more aversive
aversive (e.g., handicaps, diffi-
(e.g., handicaps, diffi-
cult
cult temperament;
temperament; Belsky, Belsky, 1980; Parke &
1980; Parke & Collmer,
Collmer, 1975),
1975), or or through
through modeling
modeling or or
reinforcement processes,
reinforcement processes, "difficult"
"difficult" child child behavior
behavior may may occur,
occur, maintaining
maintaining an an
ETIOLOGICAL THEORIES IN
ETIOLOGICAL THEORIES INTRAFAMILIAL CHILD
IN INTRAFAMILIAL ClllLD MALTREATMENT
MALTREATMENT 99

abusive
abusive pattern
pattern (Azar, Wolfe, 1987).
1989; Wolfe,
(Azar, 1989; 1987). NoNo single
single child
child factor, however, distin-
factor, however, distin-
guishes physically abused children, and prospective work suggests that any dif-
ferences
ferences observed
observed are are more
more likely
likely toto have
have resulted from the
resulted from the abuse
abuse itself than to
itself than to be
be
causal
causal (Pianta,
(Pianta, Egeland,
Egeland, & Erickson, 1989).
& Erickson, 1989). Overall,
Overall, child-based
child-based theories
theories have met
have met
with
with great
great resistance.
resistance. TheyThey areare seen
seen asas "blaming
"blaming the the victim." However, transac-
victim." However, transac-
tional views of children's development (where both participants playa part in out-
comes)
comes) are dominant in
are dominant in developmental literature. Thus,
developmental literature. Thus, aa model
model without
without aa child
child
component may be less useful, although such elements might be relegated to a
lower
lower priority than parental
priority than parental or contextual ones.
or contextual ones.
In the
In the final kind of
final kind type 11 model,
oftype model, environmental
environmental factors
factors are seen as
are seen impinging
as impinging
on
on families' general ability
families' general ability toto function,
function, or or to function in
to function certain ways.
in certain ways. In In the ex-
the ex-
treme, such
treme, models would
such models would argue
argue that any parent,
that any given the
parent, given right circumstances,
the right circumstances,
could
could bebe physically
physically abusive. For example,
abusive . For example, associations
associations havehave been
been found
found between
between
abuse and
abuse and both stress (Egeland
both stress Breitenbucher, &
(Egeland Breitenbucher, Rosenberg, 1980)
& Rosenberg, 1980) and and lack
lack of so-
of so-
cial support (Salzinger,
cial support (Salzinger, Kaplan,
Kaplan, & & Artemyeff, 1983), although
Artemyeff, 1983), although it is not
it is clear why
not clear why
only some
only some parents experiencing these
parents experiencing these conditions become aggressive.
conditions become aggressive. OtherOther mod-
mod-
els view as causal society's validation of the use of violence (Gelles 1983; 1983; Gelles & &
Straus, 1979).
1979). Again, most most parents do not engage in physical child abuse; there-
fore, societal values
fore, societal values alone
alone cannot
cannot account
account forfor abuse.
abuse.
In summary, no
In summary, single factor
no single factor appears
appears to account for
to account for significant
significant amounts
amounts of of
physical abuse. These
physical abuse. These early views, however,
early views, however, stimulated research and
stimulated research many of
and many of
their
their components
components have have been
been incorporated
incorporated in in more recent type
more recent models, which
type 22 models, which
posit
posit multiple routes to
multiple routes to the
the development
development of of physically abusive behavior.
physically abusive behavior. At At first,
first,
these
these newer models were
newer models were merely lists of
merely lists the single
of the single factors
factors posited
posited in in the early the-
the early the-
ories,
ories, without
without providing
providing any any organizing
organizing links
links between
between them.them. More
More recent attempts
recent attempts
have provided
have provided global organizing frameworks
global organizing frameworks or or have
have eveneven posited staged pro-
posited staged pro-
cesses.
cesses. AnAn example
example is Belsky'S (1980)
is Belsky's ecological framework
(1980) ecological framework described
described earlier.
earlier. An-
An-
other
other is that of
is that of Azar
Azar and
and Twentyman
Twentyman (1986),
(1986), who
who outlined
outlined five five areas
areas of of parental
parental
skill
skill deficit
deficit that increase abuse
that increase abuse risk:
risk: parenting
parenting skills
skills (e.g.,too
(e.g., too narrow
narrow aa repertoire),
repertoire),
cognitive
cognitive dysfunctions
dysfunctions (e.g.,
(e.g., unrealistic expectations regarding
unrealistic expectations children), and
regarding children), im-
and im-
pulse
pulse control, stress management,
control, stress management, and and social skills problems.
social skills problems. Over Over time, these
time, these
deficits result in
deficits result in aa four-stage
four-stage sequence
sequence of of responses
responses leading
leading to an abusive
to an abusive incident
incident
(Figure
(Figure 2; 2; Azar, 1989).
Azar, 1989).
Other
Other type models provide
type 22 models provide global contingent factors
global contingent (Le., "if
factors [i.e., "if high
high levels
levels of
of AA
and low levels of B, then X"). Cicchetti and Rizley's (1981)
X"). For example, Cicchetti (1981) transac-
tional model posits that risk involves both transient and enduring factors that may
be potentiating (increase
be potentiating (increase risk) or compensatory
risk) or compensatory (buffering
(buffering or protective in
or protective in nature).
nature).
When potentiating factors are more frequent than buffering ones, abuse is likely.
When

Stage
Stage 1: The parent
1: The holds unrealistic
parent holds unrealistic standards
standards regarding
regarding what are appropriate
what are appropriate behaviors in
behaviors in
children.
children.
Stage 2:
Stage They encounter
2: They encounter aa child behavior that
child behavior that fails
fails to meet their
to meet their standards.
standards.
Stage 3:
Stage The parent
3: The parent misattribtues
misattribtues negative intent to
negative intent to the
the behavior and does
behavior and does not
not question
question her
her
interpretations or blames
interpretations or blames herself
herself when
when herher interventions
interventions dodo not
not change the child's
change the child's
response.
response.
Stage 4:
Stage 4: The
The parent overreacts perhaps
parent overreacts perhaps after making some
after making some poorly
poorly skilled
skilled effort
effort to
to change the child's
change the child's
behavior, and punishes
behavior, and punishes the
the child
child excessively.
excessively.

Figure Physical abuse:

2. Physical
Figure 2. abuse: A
A four-stage
four-stage process
process..
10 SANDRA T.
SANDRA T. AZAR et aI.
AZAR et al.

This
This model
model nicely
nicely emphasizes
emphasizes risk over time
risk over time and links potential
and links potential causal
causal elements
elements to to
child outcome.
outcome . Unfortunately, it does not prioritize prioritize the factors it specifies.
Wolfe's transitional model
(1987) transitional
Wolfe's (1987) model also also explicitly includes time.
explicitly includes Initially, this
time . Initially, this
model
model described
described an an escalation
escalation theory,
theory, whereby
whereby the the abusive
abusive parent
parent over-relies
over-relies on on
coercion
coercion to to elicit child compliance
elicit child compliance (Wolfe,(Wolfe, Kaufman, Aragona, &
Kaufman, Aragona, Sandler, 1981).
& Sandler, 1981).
Although
Although such such strategies
strategies are are effective
effective at at first,
first, children eventually habituate
children eventually habituate to to
them and
them and increasingly higher levels
increasingly higher levels of of coercion
coercion are are required
required to to produce
produce an an impact,
impact,
culminating in physical abuse. In a recent reformulation, Wolfe (1987) (1987) provides
three stages in
three stages in the
the development
development of of these
these abusive
abusive patterns
patterns andand the
the destabilizing
destabilizing
and
and compensatory
compensatory factors that might
factors that might facilitate
facilitate oror inhibit
inhibit movement
movement through them.
through them.
(This reformulation in some ways foreshadows a type
(This reformulation in some ways foreshadows a type 6 model.) Although similar 6 model.) Although similar
to Cicchetti and
to Cicchetti Rizley's (1981)
and Rizley's model, this
(1981) model, this one
one isis more
more firmly based in
firmly based in social
social
learning theory and,
learning theory therefore,, aa deficiency
and, therefore assumption is
deficiency assumption made throughout.
is made throughout.
As noted
As earlier, the
noted earlier, the development
development of models beyond
of models beyond typetype 2 is is more
more limited.
limited.
Most require differentiated views of physical child abuse. While there were some
early efforts in
early efforts this direction
in this direction (e.g., Merrill, 1962),
(e.g., Merrill, 1962), the typologies produced
the typologies produced were were
not
not empirically validated. A more recent attempt at classifying physical child
abuse
abuse is is that
that of of Gelles and Straus
Gelles and (1979) who
Straus (1979) posit two
who posit two defining dimensions:: ex-
defining dimensions ex-
pressive/instrumental and
pressive/instrumental legitimacy/illegitimacy. Expressive
and legitimacy/illegitimacy. violence is
Expressive violence is physical
physical
abuse that serves to reduce perpetrators' tension level, whereas instrumental instrumental vio- vio-
lence
lence involves
involves violent
violent actsacts intended
intended to to produce
produce aa response
response in in others (e.g., disci-
others Ie.g., disci-
pline
pline that becomes excessive).
that becomes Legitimacy involves
excessive). Legitimacy involves aa continuum
continuum in in the
the use
use ofof
physical
physical forceforce in situations where
in situations where it it is
is approved
approved or required by
or required society. The
by society. The re-
re-
sulting four-cell
sulting four-cell taxonomy
taxonomy may may ultimately
ultimately proveprove useful
useful toto developing
developing models models thatthat
differentiate
differentiate between
between typestypes ofof physical
physical abuse.
abuse.
Based on
Based actual observations
on actual observations of abusive parent-child
of abusive interaction patterns,
parent-child interaction patterns ,
Oldershaw,
Oldershaw, Walters,
Walters, and Hall (1989)
and Hall posited aa typology
(1989) posited typology withwith three subgroups: Hos-
three subgroups: Hos-
tile,
tile, Emotionally
Emotionally Distant,Distant, andand Intrusive.
Intrusive. This This empirically defined typology
empirically defined typology couldcould
serve
serve as
as aa foundation
foundation for for more
more complex
complex theories.
theories.
A third alternative has been suggested by Azar and Siegel (1990). (1990). They argue
that
that abuse
abuse that emerges in
that emerges in different
different developmental
developmental periods periods (e.g.,
(e.g., in
in infancy versus
infancy versus
adolescence,
adolescence, or or across more than
across more one period)
than one period) maymay have
have different
different antecedents
antecedents and, and,
thus,
thus, may
may require
require different models.. Using
different models tasks required
Using tasks required of parents in
of parents in each period
each period
of
of childhood,
childhood, they they outlined
outlined potential
potential causal
causal factors that either
factors that either cut
cut across
across devel-
devel-
opmental
opmental phasesphases or or vary with children's
vary with children's needs.
needs. ForFor example,
example, they posit unrealis-
they posit unrealis-
regarding children's behavior that may playa causal role across
tic expectations regarding
development,
development, and behavioral skills
and behavioral skills that
that may
may be be important
important in in one phase, but
one phase, but not
not in
in
others (e.g.,
others (e.g., verbal
verbal negotiation skills with
negotiation skills with teens).
teens). This
This framework
framework will will form
form thethe
core for the meta-model that that will be described later.

INTRAFAMILIAL SEXUAL ABUSE

Although sexual contact

Although sexual contact between
between children and adult
children and adult family
family members has al-
members has al-
ways been
ways taboo in
been aa taboo most cultures,
in most cultures, the study of
the study of the
the causes
causes of sexual abuse
of sexual abuse is
is aa
much
much younger field than
younger field that of
than that of physical
physical abuse
abuse.. At
At the same time,
the same perhaps be-
time, perhaps be-
cause of
cause of this
this taboo and aa bias
taboo and bias toward
toward seeing
seeing the victims of
the victims of this
this form
form of abuse as
of abuse as
more psychologically damaged (Vitulano, Lewis, Doran, Nordhaus, & & Adnopoz,
ETIOLOGICAL THEORIES IN
IN INTRAFAMILIAL CHILD
cmLD MALTREATMENT 11
11

1986), research
1986), in this
research in this area
area has progressed more
has progressed more rapidly.
rapidly. Current
Current frameworks for
frameworks for
understanding
understanding etiology, however, are
etiology, however. still somewhat
are still somewhat simplistic.
simplistic. These
These frameworks
frameworks
are
are usually lists of
usually lists of single factors that
single factors that differentiate perpetrators of
differentiate perpetrators of incest.
incest. The
The
narrowness
narrowness of the samples
of the samples studied
studied (e.g.,
(e.g., fathers/stepfathers,
fathers/stepfathers, incarcerated perpetra-
incarcerated perpetra-
tors)
tors) may
may also
also limit the generalization
limit the generalization of the models
of the models produced
produced (Williams
(Williams && Finkel-
Finkel-
hor, 1990).
hor, 1990).

Definitions
Definitions
A
A common
common definition
definition of sexual abuse
of sexual abuse has been sexual
has been sexual exploitation involving
exploitation involving
physical
physical contact between aa child
contact between and another
child and another person
person (Cohen
(Cohen & & Mannarino, 1993).
Mannarino, 1993).
Exploitation implies an
Exploitation implies an inequality
inequality ofof power between the
power between child and
the child and the abuser on
the abuser on
the
the basis
basis ofof age, physical size,
age, physical size, and/or
and/or the
the nature
nature of the emotional
of the emotional relationship.
relationship.
Physical
Physical contact
contact includes anal, genital,
includes anal, genital, oral, or breast
oral, or breast contact.
contact. AsAs with
with physical
physical
abuse, models of
abuse, models of incest
incest either have separated
either have separated it it from other forms
from other forms ofof child abuse
child abuse
and
and other
other sexual
sexual offenses
offenses (e.g.,
(e.g., rape)
rape) or, at the
or, at the other
other extreme,
extreme, have combined it
have combined it
with
with these
these other
other disturbances. Attempts have
disturbances. Attempts have also
also been made to
been made to explain
explain parent
parent
(stepparent) incest separately
(stepparent) incest separately from
from sexual
sexual offenses within the
offenses within the family carried out
family carried out
by other family members (e.g., siblings). Finally, including exploitation
by other family members (e.g., siblings). Finally, including exploitation as a defin- as a defin-
ing quality
ing quality has also directed
has also some theorizing
directed some theorizing to to the
the realm
realm ofof power
power and
and its
its misuse
misuse
both
both within
within andand outside
outside the family and
the family directed it
and directed it away
away from the sexual
from the sexual nature
nature of
of
the
the act.
act.

Assumptions
Assumptions
In examining
In examining thethe four
four types
types ofof assumptions inherent in
assumptions inherent in models
models of incest, pat-
of incest, pat-
terns
terns similar
similar toto the
the early stages of
early stages of model
model development
development in in physical abuse can
physical abuse can be de-
be de-
tected.
tected. TheThe major
major portion
portion of work to
of work date has
to date has emphasized
emphasized defects
defects or or deficits
deficits
within
within thethe perpetrator. One defect-based
perpetrator. One defect-based model
model describes
describes deviant
deviant sexual
sexual arousal
arousal
and
and interests
interests gained through conditioning
gained through conditioning and social learning
and social learning (Laws
(Laws & Marshall,
& Marshall,
1990). Neuropsychological correlates of
Neuropsychological correlates violence and
of violence and aggression,
aggression, in in general, and
general, and
of
of sex offending, in
sex offending, particular, have
in particular, also been
have also been found.
found. The The biological
biological bases
bases for
for such
such
models
models are supported primarily
are supported primarily byby inappropriate
inappropriate sexual sexual behavior shown in
behavior shown in indi-
indi-
viduals suffering from
viduals suffering central nervous
from central nervous system
system degeneration,
degeneration, as as in
in Alzheimer's
Alzheimer's dis-
dis-
ease
ease oror brain injuries (Golden,
brain injuries (Golden, Jackson, Peterson-Rohne, &
Jackson, Peterson-Rohne, & Gontkovsky,
Gontkovsky, 1996).1996).
However,
However, psychopathology models, another
psychopathology models, another form
form of of defect models, have
defect models, have not
not been
been
supported;
supported; the majority of
the majority incestuous fathers
of incestuous fathers dodo not
not manifest severe psychiatric
manifest severe psychiatric
problems
problems (Williams
(Williams & & Finkelhor, Despite limited
1990). Despite
Finkelhor, 1990). limited evidence,
evidence, defect
defect models
models
remain
remain popular
popular because society would
because society would prefer
prefer toto see
see perpetrators
perpetrators as as untreatable
untreatable
and have them
and have them locked
locked away
away asas criminals.
criminals.
Deficiency
Deficiency models
models have also been
have also been postulated.
postulated. For For example,
example, perpetrators
perpetrators have
have
been described as having empathy deficits and problems in emotional
been described as having empathy deficits and problems in emotional recognition recognition
skills,
skills , freeing
freeing them
them to engage in
to engage in behavior harmful to
behavior harmful to children (Marshall, Hudson,
children (Marshall, Hudson,
Jones,
Jones, & & Fernandez, 1995; Monto,
Fernandez, 1995; Zgourides, Wilson,
Monto, Zgourides, Wilson, & & Harris,
Harris, 1994). Cognitive
1994). Cognitive
disturbances
disturbances regarding
regarding the meaning of
the meaning of their
their behavior
behavior havehave also been identified
also been identified inin
offenders,
offenders, which
which may
may also free them
also free them to act. For
to act. For example, child molesters
example, child molesters perceive
perceive
more
more benefits
benefits toto children
children from
from sexual
sexual contact,
contact, greater
greater complicity
complicity on on the child's
the child's
part,
part, and less responsibility
and less responsibility onon the adult's part,
the adult's part, all
all of
of which
which may playa facilitating
may playa facilitating
12
12 SANDRA T.
SANDRA T. AZAR et aI.
AZAR et al.

role
role in
in child molesting (Abel
child molesting (Abel & Rouleau, 1995;
& Rouleau, Stermac &
1995; Stermac Segal, 1989).
& Segal, Deficits
1989). Deficits
in social skills (Stermac Segal, & & Gillis, 1990) and in establishing intimacy in in
adult
adult relationships
relationships have have alsoalso been
been found;
found; these
these may
may lead
lead to high levels
to high levels of
of emo-
emo-
tional
tional loneliness (Marshall, 1989;
loneliness (Marshall, Seidman, Marshall,
1989; Seidman, Marshall, Hudson,
Hudson, & Robertson,
& Robertson,
1994). Although each
1994). Although each of of these individual factors
these individual has some
factors has some validity
validity standing alone,
standing alone,
some
some combination
combination may may provide
provide aa moremore comprehensive
comprehensive picture of of the origins
origins of
sexual
sexual abuse.
abuse.
Disruption models of sexual sexual abuse have been less prevalent. Unlike physical
abuse, sexual abuse occurs across all social classes, suggesting that that environmental
stress does not playas strong a role as it may in neglect
stress does not playas strong a role as it may in neglect or emotional abuse. or emotional abuse. Hau-
Hau-
gaard
gaard (1988), however, refers
(1988), however, refers to
to aa chaos explanation where
chaos explanation where riskrisk for
for sexual abuse
sexual abuse
may occur when there is a lack of external regulation in a community, such as in
postwar disorganization. Generally, the sociopolitical atmosphere surrounding
sexual abuse (the need to see perpetrators as disturbed) may prevent implicating
external factors. One
external factors. One exception
exception is is exploring
exploring the the effects
effects ofof alcohol
alcohol consumption,
consumption,
which
which maymay be viewed as
be viewed as more
more within perpetrators' control
within perpetrators' control (Koss
(Koss & Gaines, 1993).
& Gaines, 1993).
Models
Models that that focus
focus on missocialization processes
on missocialization processes maymay be be examples
examples of "mis-
of "mis-
match"
match" models
models in in this area. Finkelhor
this area. Finkelhor (1984) suggests that
(1984) suggests that abuse should be
abuse should be de-
de-
scribed as a problem within masculine socialization, with men learning to focus
on
on sex
sex as
as part
part of
of their gender identities
identities and and to
to see younger and smaller persons as as
their
their appropriate
appropriate sexual partners. partners. In In addition, he he notes
notes that our culture
culture teaches us us
that
that children
children and and females are less less powerful and the the risk
risk of
of sexual abuse may in-
crease
crease ifif this
this view
view isis internalized
internalized too too strongly.
strongly. Thus,
Thus, in the extreme,
in the extreme, whatwhat society
society
may
may teach some men
teach some men is is aa "mismatch"
"mismatch" with what would
with what would be more appropriate-the
be more appropriate-the
avoidance
avoidance of of using children for
using children sexual gratification.
for sexual gratification. Supporting
Supporting such such views
views is
is in-
in-
teresting
teresting social psychological research
social psychological research indicating
indicating that
that males havehave a greater
greater ten-
dency
dency than
than females
females to interpret
interpret friendliness
friendliness on on the part
part of members of of the
the opposite
opposite
sex as
as indicative
indicative of sexual attraction (Abbey, 1987). In
1982, 1987).
(Abbey, 1982, In addition to to missocial-
missocial-
ization, alcohol consumption
ization, alcohol consumption may may increase
increase disinhibition
disinhibition and and misattributions
misattributions in in
individuals
individuals proneprone to sexual aggression (Crowe (Crowe & & George,
George, 1989). Such findings pro-
1989). Such
vide the beginnings for more integrative theories using multiple assumptions. assumptions.

Levels
Levels of
of Analysis
Analysis
Biological (e.g., neuropsychological
Biological (e.g., neuropsychological problems),
problems), personality-emotional (e.g.,
personality-emotional (e.g.,
lack of empathy), experiential-learning (e.g.,(e.g., transmission of sex offending in boys
through
through modeling),
modeling), and societal-cultural factors (e.g., societal values) have have all
been
been given
given attention
attention inin theories
theories in
in this area and
this area and have
have been
been examined
examined at each level
at each level
of
of analysis:
analysis: intra-individual, social group,
intra-individual, social group, and
and cultural group. For
cultural group. For example,
example, when
when
misuse
misuse ofof power
power is considered the
is considered the defining element of
defining element of sexual
sexual abuse,
abuse, models
models have
have
focused on power relationships either within the family, between genders, or
within
within the larger society
the larger society (Finkelhor,
(Finkelhor, 1981; Solomon, 1992).
1981; Solomon, 1992).

Complexity
As
As with physical abuse,
with physical sexual abuse
abuse, sexual models have
abuse models have evolved to embody
evolved to embody aa range
range
of
of complexity.
complexity. Early on,
on, descriptive models
models identifying single factors
factors that
that differ-
differ-
entiated
entiated sexual
sexual abusers
abusers from
from nonabusers were common. When aa variety
variety of factors
 ETIOLOGICAL THEORIES IN
ETIOLOGICAL THEORIES IN INTRAFAMILIAL
INTRAFAMILIAL CmLD
CmLD MALTREATMENT
MALTREATMENT 13
13

were
were identified
identified (Le., social isolation,
(i.e., social lack of
isolation, lack of empathy, history of
empathy, history of abuse),
abuse), models
models
combining
combining these factors began
these factors began to
to appear. Although these
appear. Although these continue to dominate
continue to dominate the
the
field,
field, few
few attempts to integrate
attempts to them have
integrate them have been
been made.
made. Examples
Examples of of each
each will
will be
be
provided below.
provided below.

Model
Model Form
Form
Almost
Almost all all models
models of of etiology
etiology for this form
for this form of of maltreatment
maltreatment are type 11 frame-
are type frame-
works. Sexual
works. Sexual abuse
abuse is seen as
is seen as having
having its its origin
origin in in aa single
single factor,
factor, typically
typically within
within
perpetrators.
perpetrators. In In his review, Haugaard
his review, Haugaard (1988) groups models
(1988) groups into four
models into four general
general cate- cate-
gories:
gories: individual
individual deviance
deviance explanations
explanations (defect-deficiency
(defect-deficiency models), models), chaotic
chaotic ex- ex-
planations
planations (Le., models citing
(i.e., models citing aa lacklack of of external
external regulation,
regulation, aa disruption
disruption view), view),
feminist
feminist perspectives (focusing on
perspectives (focusing on inequality
inequality of of the sexes), and
the sexes), the functional
and the functional ex- ex-
planation,
planation, where incest serves
where incest serves aa purpose
purpose within within the the context
context in in which
which it it occurs
occurs
(e.g., acting as
(e.g., acting as aa compensatory
compensatory factor factor if if aa couple
couple is is having
having marital problems).
marital problems).
Intergenerational transmission has
Intergenerational transmission has also
also been
been posited.
posited. It seems that
It seems prior
that prior
abuse
abuse oror mistreatment
mistreatment may may place
place aa victim
victim at at greater
greater riskrisk for
for perpetrating
perpetrating sexual sexual
offenses
offenses (Renshaw,
(Renshaw, 1994). 1994). RyanRyan (1989) suggests past
(1989) suggests past victims
victims may offend to
may offend to gain
gain
some sense of
some sense of personal control lost
personal control lost as as aa result
result of of their own abuse.
their own abuse. Insecure
Insecure at- at-
tachment
tachment has has also
also been
been posited
posited as as the
the mechanism
mechanism whereby whereby the experience of
the experience of
abuse
abuse translates
translates intointo perpetration (Alexander, 1992),
perpetration (Alexander, 1992), and and may
may be be aa precursor
precursor of of
intimacy deficits
intimacy noted by
deficits noted by Marshall
Marshall (1989).(1989). SuchSuch deficits
deficits inin tum
tum may may leadlead to ag-
to ag-
gression and
gression and a tendency to pursue sexual contacts to find intimacy, even with in-
a tendency to pursue sexual contacts to find intimacy, even with in-
appropriate partners.
appropriate partners.
Sociobiological perspectives
Sociobiological perspectives have have alsoalso been
been posited. Higher rates
posited. Higher rates of incest
of incest
have
have been found for
been found for nonbiological
nonbiological fathers fathers and and for biological fathers
for biological fathers who who did did not not
participate
participate in in crucial
crucial early socialization and
early socialization nurturing activities,
and nurturing such as
activities, such as diaper-
diaper-
ing
ing and
and feeding
feeding (Daly
(Daly & & Wilson, 1985; Parker
Wilson, 1985; Parker & & Parker, 1986).
Parker, 1986).
Single-factor models
Single-factor models focusing
focusing on on children
children have have not not developed
developed in in this area. In
this area. In
the
the past,
past, psychoanalytic perspectives hinted
psychoanalytic perspectives hinted that victims may
that victims may contribute
contribute to to their
their
abuse
abuse by by being seductive (Diamond,
being seductive (Diamond, 1989). 1989). Few Few researchers
researchers todaytoday focusfocus on on thethe
personality
personality characteristics
characteristics of of victims,
victims, although
although behavioral characteristics of
behavioral characteristics of vic-
vic-
tims
tims may place them
may place them at at risk. For example,
risk. For exploration of
example, exploration of factors that make
factors that make aa childchild
vulnerable,
vulnerable, more more accessible,
accessible, and and lessless able
able to prevent abuse
to prevent abuse or or to
to report
report it it (e.g.,
(e.g.,
handicapped
handicapped children)
children) has has continued.
continued.
Overall,
Overall, no single factor
no single factor seems
seems acceptable
acceptable as as an
an explanation
explanation for for the etiology of
the etiology of
sexual abuse.
sexual Consequently, listlike
abuse. Consequently, frameworks (type
listlike frameworks (type 22 models)
models) have have appeared.
appeared.
Finkelhor's
Finkelhor's (1984) sociological model
(1984) sociological model describes
describes four preconditions essential
four preconditions essential to to the
the
occurrence
occurrence of sexual abuse
of sexual abuse (although
(although they they may may not playa causal
not playa role): (1)
causal role): (1) motiva-
motiva-
tion
tion to
to sexually
sexually abuse
abuse aa child
child (e.g.,
(e.g., emotional
emotional needs needs,, sexual
sexual arousal
arousal by by children);
children);
(2) weakened
(2) weakened internal inhibitions that
internal inhibitions would normally
that would normally prevent such abuse;
prevent such abuse; (3) few
(3) few
external
external barriers
barriers to to abuse (Le., easy
abuse [i.e., easy assessibility
assessibility to locations where
to locations where the the offense
offense
could
could occur);
occur) ; and
and (4) the perpetrator's
(4) the perpetrator's ability ability to to overcome
overcome the the resistance
resistance of of thethe
child.
child. While
While each
each may contribute to
may contribute to abuse,
abuse, thisthis framework
framework does not prioritize
does not prioritize them.
them.
A
A few
few early attempts to
early attempts to define
define types
types of of incest
incest perpetrators
perpetrators were were made.
made. For For ex- ex-
ample,
ample, Rist
Rist (1979) identified three
(1979) identified three types
types ofincestuous
of incestuous fathers:fathers: the
the socially
socially isolated
isolated
man who
man who isis highly
highly dependent
dependent on on his family for
his family for interpersonal relationships, the
interpersonal relationships, the fa- fa-
ther
ther who
who has
has aa psychopathic
psychopathic personality
personality and and is is indiscriminate
indiscriminate in in choosing
choosing sexualsexual
14
14 SANDRA T.
SANDRA T. AZAR et aI.
AZAR et

partners,
partners, andand thethe father
father who
who has has pedophilic tendencies and
pedophilic tendencies and is
is sexually
sexually involved
involved
with several children,
with several including his
children, including his daughter.
daughter. ThisThis emphasis
emphasis on on patterns
patterns of of-
of of-
fending has formed the basis for later empirically based higher-level models. models .
Hall and Hirschmann (1991, 1992), for example, have attempted to integrate
(1991, 1992),
factors found in the literature into a model of all forms of sexual aggression against
both
both adults
adults andand children. Their quadripartite
children. Their quadripartite modelmodel emphasizes
emphasizes the presence of
the presence of
deviant
deviant patterns
patterns of sexual arousal
of sexual arousal,, aa level
level ofof cognitive distortion great
cognitive distortion great enough
enough to to
counteract
counteract environmentally
environmentally based based information,
information, deviant
deviant appraisal
appraisal patterns,
patterns, andand
loss of affective control, all of which combine to increase risk
loss of affective control, all of which combine to increase risk for sexual aggres- for sexual aggres-
sion.
sion. When
When the affect is
the affect is depression,
depression, the target of
the target of the sexual aggression
the sexual aggression is likely to
is likely to
be
be aa child, whereas when
child, whereas when it is anger,
it is anger, it
it is
is more often an
more often an adult. Personality factors
adult. Personality factors
are seen as
are seen as further mediating risk.
further mediating risk.
Marshall
Marshall and Barbaree (1990)
and Barbaree have also
(1990) have made an
also made attempt to
an attempt to integrate
integrate empiri-
empiri-
cal
cal findings. Their model
findings. Their model posits
posits biological,
biological, early
early experiential
experiential (e.g.,
(e.g., poor
poor attach-
attach-
ment), sociocultural, and
ment), sociocultural, transitory situational
and transitory situational factors
factors that
that combine
combine to explain
to explain
cases
cases where
where both both sexual
sexual abuse
abuse andand aggression
aggression occur.
occur.
Recent
Recent theorizing
theorizing hashas emphasized
emphasized aa person-by-environment
person-by-environment transactional
transactional
model. Holman and Stokols (1994) (1994) cite the role of sociocultural and physical en-
vironmental factors in
vironmental factors in moderating
moderating the the occurrence
occurrence and and long-term consequences of
long-term consequences of
sexual abuse.
sexual abuse. Although
Although they
they areare similar
similar to to Marshall
Marshall and Barbaree in
and Barbaree in their
their articu-
articu-
lation
lation of
of important factors, they
important factors, they organize
organize these factors within
these factors within phases:
phases: pre-abuse,
pre-abuse,
abuse,
abuse, and
and post-abuse. Thus,, their
post-abuse. Thus their framework
framework has has relevance both to
relevance both to the occurrence
the occurrence
of abuse and
of abuse and to to potential outcomes in
potential outcomes in the
the child. The framework
child. The framework alsoalso adds greater
adds greater
emphasis
emphasis to physical and
to physical and macrolevel
macrolevel factors
factors (e.g.,
(e.g., the residential environment
the residential environment of of
the
the child,
child, neighborhood,
neighborhood, and and community).
community).
As
As can
can be seen in
be seen in our discussion, the
our discussion, the field is beginning
field is beginning to to move
move away from
away from
single-factor frameworks
single-factor frameworks to more unified
to more versions. This
unified versions. This movement
movement has has been facil-
been facil-
itated
itated by
by aa stronger empirical data
stronger empirical data base
base where
where single
single factors
factors are validated and
are validated and
combined
combined to produce more
to produce more complex
complex models
models for testing.. This
for testing This kind
kind of progress has
of progress has
yet
yet to occur in
to occur development of
in development theories of
of theories neglect and
of neglect and emotional
emotional abuse.
abuse.

NEGLECT
NEGLECf

The diversity
The of behaviors
diversity of that are
behaviors that are labeled neglectful has
labeled neglectful has made
made model build-
model build-
ing
ing particularly
particularly difficult
difficult (Figure
(Figure 3;3; Zuravin, 1991). Neglect
Zuravin, 1991). has received
Neglect has received less
less re-
re-
search attention than the other forms of maltreatment discussed
search attention than the other forms of maltreatment discussed thus far. Unlike thus far. Unlike
children suffering from
children suffering physical and
from physical sexual abuse
and sexual abuse,, neglected children are
neglected children are often
often
seen
seen byby the nursing and
the nursing and social
social work
work professions,
professions, both
both ofof which
which have
have only re-
only re-
cently
cently developed research traditions.
developed research traditions. In In addition,
addition, inin many
many cases, neglect is
cases, neglect is
linked
linked to poverty; this
to poverty; fact adds
this fact adds aa sociopolitical
sociopolitical element that may
element that may be
be less
less palat-
palat-
able
able to
to aa scientific
scientific community
community that that attempts
attempts toto be apolitical. Neglect
be apolitical. may also
Neglect may also be
be
thought of
thought of as
as the
the least
least "compelling"
"compelling" type type ofof child
child maltreatment
maltreatment and and may not
may not
arouse
arouse asas high
high aa level of societal
level of societal outrage
outrage as as do
do other
other forms
forms [e.g.,
(e.g., sexual
sexual abuse). In
abuse). In
addition, it
addition, it involves behaviors that
involves behaviors that tend
tend toto be
be viewed
viewed as chronic, with
as chronic, with perpetra-
perpetra-
tors
tors viewed
viewed as as more dispositionally disturbed.
more dispositionally disturbed. Intervention
Intervention may,
may, therefore,
therefore, bebe
viewed as more futile than with other types of child maltreatment and, thus,
model building may be seen as less important. Complicating theory development
ETIOLOGICAL THEORIESIN
THEORIES IN INTRAFAMILIAL CHILD MALTREATMENT 15
15

Refusal
Refusal toto provide
provide physical
physical health
health care
care
Delay in
Delay in providing
providing physical health care
phys ical health care
Refusal
Refusal toto provide
provide mental
mental health
health care
care
Delay in
Delay providing mental
in providing health care
mental health care
Supervisory neglect
Supervisory neglect
Custody refusall
Custody refusa
Custody-related neglect
Custody-related neglect
Abandonment/desertion
Abandonmentldesertion
Failure to
Failure provide aa permanent
to provide permanent home
home
Personal hygiene
Personal hygiene neglect
neglect
Housing
Housing hazards
hazards
Housing sanitation
Housing sanitation
Nutritional neglect
Nutritional neglect
Educational neglect
Educational neglect

Figure 3. Subtypes
Figure 3. Subtypes of
of neglect (Zuravin, 1991).
neglect (Zuravin, 1991).

further
further isis the
the difficulty
difficulty posed
posed byby measuring
measuring acts acts of omission (e.g.,
of omission (e.g., failing
failing to
to pro-
pro-
vide
vide medical
medical care), which is
care), which is more difficult than
more difficult than assessing observable and
assessing observable and quan-
quan-
tifiable
tifiable acts
acts ofof commission.
commission.
In devising
In devising perpetrator models, the
perpetrator models, the question
question of who is
of who labeled the
is labeled neglector is
the neglector is
open
open to to debate. Mothers are
debate. Mothers are typically
typically thethe ones
ones soso labeled, even if
labeled, even if aa father
father or an-
or an-
other
other caretaker
caretaker is present.
is present.
The
The nature
nature of of neglect
neglect also depends on
also depends on the
the child's
child's developmental
developmental level. level. Be-
Be-
haviors that
haviors that might
might be neglectful of
be neglectful of an
an infant
infant may
may notnot be neglectful of
be neglectful of an
an adoles-
adoles-
cent. The
cent. The issue of how
issue of chronically the
how chronically parental omission
the parental needs to
omission needs to occur
occur before
before itit
is considered neglectful has also not been adequately addressed. The etiology of
chronic neglect may be quite different from neglect that occurs in response to a
parental
parental stress (e.g., in
stress (e.g., response to
in response to aa recent
recent job
job loss).
loss). Finally,
Finally, the
the relevance
relevance of of in-
in-
tent in defining
tent in defining neglect,
neglect, andand how this might
how this might bebe determined
determined has not received
has not received muchmuch
attention.
attention. Wolock
Wolock and Horowitz (1977)
and Horowitz (1977) in in their
their definition
definition ofof housing sanitation
housing sanitation
problems
problems (e.g., spoiled food,
(e.g., spoiled food, dirty
dirty dishes),
dishes), for
for instance, require that
instance, require that they
they bebe parent
parent
induced
induced in in order
order toto be
be considered neglect.
considered neglect.
The lack
The of theory
lack of theory in in this
this area
area is striking,, given
is striking given that neglected children
that neglected typi-
children typi-
cally
cally outnumber
outnumber those those who have encountered
who have encountered the the other
other forms
forms of maltreatment. In-
of maltreatment. In-
cidence rates in one study (Sedlak, 1990) 1990) were 14.6 1,000 children compared
14.6 per 1,000
4 .9 per 1,000
to 4.9 1,000 for physical abuse and 2.1 1,000 for sexual abuse. There are no
2.1 per 1,000
estimated rates for emotional maltreatment of children, although if substantiated
cases
cases are
are examined,
examined, it it accounts
accounts forfor only
only 6% 6% oror less
less of cases compared
of cases compared to 45% for
to 45% for
neglect
neglect (National Center on
(National Center on Child Abuse and
Child Abuse and Neglect, Furthermore, in
1992). Furthermore,
Neglect, 1992). in the
the
long
long run,
run, neglect
neglect may may have the most
have the most far-reaching implications for
far-reaching implications children's so-
for children's so-
cial,
cial, emotional,
emotional, and and physical
physical outcomes.
outcomes.

Definitions
Definitions
As noted above, models may vary with the subtype of neglect being ad-
dressed.
dressed. Neglect of health
Neglect of health care and hygiene
care and hygiene may result from
may result from basic
basic knowledge
knowledge
deficits in
deficits parents (e.g.,
in parents how to
(e.g.,how take aa child's
to take temperature), whereas
child's temperature), whereas abandonment
abandonment
could originate in
could originate in aa myriad
myriad of other factors
of other besides lack
factors besides lack of knowledge (e.g.,
of knowledge sub-
(e.g., sub-
stance abuse,
stance severe psychopathology).
abuse , severe psychopathology). Types
Types of neglect that
of neglect that have
have been addressed
been addressed
16
16 SANDRA T.
SANDRA AZAR et
T. AZAR et al.
al.

include
include failure
failure to provide medical
to provide care,, supervision,
medical care supervision, nutrition,
nutrition, personal
personal hygiene,
hygiene,
emotional
emotional nurturing,
nurturing, education, and safe
education, and safe housing
housing (Gaudin, 1993).
(Gaudin, 1993).
The
The definitions
definitions ofof neglect have focused
neglect have focused on the types
on the types ofof outcomes
outcomes seen.
seen. For
For ex-
ex-
ample,
ample, neglect
neglect is
is often considered one
often considered cause of
one cause failure to
of failure to thrive and has
thrive and has been
been cited
cited
in
in the
the category
category ofof feeding
feeding problems
problems in some discussions.
in some Failure to
discussions. Failure to attend to med-
attend to med-
ical
ical needs
needs has been considered
has been considered inin the
the larger
larger category
category ofof treatment noncompliance.
treatment noncompliance.
The former
The former classification might lead
classification might lead to
to models
models regarding
regarding parent-infant
parent-infant transac-
transac-
tional
tional problems, whereas the
problems , whereas the latter
latter might
might focus models on
focus models on understanding
understanding motiva-
motiva-
tional
tional deficits.
deficits.

Assumptions
Assumptions
Because mothers are
Because mothers identified as
are identified as perpetrators,
perpetrators, models
models have focused espe-
have focused espe-
cially
cially on on characterological
characterological or or personal deficits of
personal deficits neglectful women.
of neglectful women. For For example,
example,
they
they have
have been described as
been described as having severe defects
having severe defects in in ego
ego and general personality
and general personality
development
development (e.g., immaturity, narcissism,
(e.g., immaturity, Cantwell, 1980;
narcissism, Cantwell, Meier, 1964;
1980; Meier, 1964; Young,
Young ,
1964). As
1964). As with
with physical
physical and and sexual
sexual abuse,
abuse, more
more fundamental
fundamental defects have also
defects have also
been
been posited
posited (e.g., psychoses and
(e.g., psychoses and mental retardation). More
mental retardation). More recently,
recently, however,
however, fac-
fac-
tors
tors more
more amenable
amenable to to change
change have have been
been emphasized, including lack
emphasized, including lack ofof knowledge
knowledge
about children's development, poor parental judgment, and motivational prob-
lems
lems (Cantwell, Polansky, Chalmers,
1980; Polansky,
(Cantwell, 1980; Buttenwieser, &
Chalmers, Buttenwieser, & Williams, 1981).
Williams, 1981).
In an
In an elaborate
elaborate personality-based explanation, Galdston
personality-based explanation, argued for
(1968) argued
Galdston (1968) for
what might be conceived of as a relational disturbance underlying neglect. He sug-
gested that
gested that neglect
neglect results
results fromfrom aa failure
failure to to perceive
perceive the the child
child asas one
one's own, such
's own, such
that
that mothers cannot accommodate
mothers cannot accommodate the the child
child inin any
any way. Such aa parent
way. Such parent is is seen
seen as
as
self-centered.
self-centered. Other potential mechanisms
Other potential mechanisms have been suggested
have been suggested that
that may account
may account
for
for this
this perceptual problem (e.g.,
perceptual problem attachment disturbances,
(e.g., attachment Crittenden, 1993;
disturbances, Crittenden, 1993; in-
in-
formation
formation processing problems, Azar,
processing problems, Azar, Robinson,
Robinson, Hekimian,
Hekimian, & Twentyman, 1984).
& Twentyman, 1984).
Contextual factors have also been highlighted as causal elements. Some of these
factors are low family income and and educational level (Garbarino, 1991; 1991; Polansky et
aI., 1981; Polansky,
al., 1981; Gaudin, Ammons,
Polansky, Gaudin, Ammons, & David,, 1985),
& David lack of
1985), lack of social
social support,
support, and
and
high
high life
life stress
stress (Gaudin
(Gaudin et et aI.,
al., 1993).
1993). TheThe direction
direction of of causality
causality is, however, open
is, however, open toto
question.
question. Although
Although it has has been found that
been found that lack
lack of resources (e.g.
of resources (e.g. food
food stamps,
stamps, hous-
hous-
ing,
ing, employment,
employment, available
available day day care;
care; Pelton,. 1994) can
Pelton, 1994) affect parental
can affect functioning, it
parental functioning,
is
is possible
possible that neglectful mothers
that neglectful mothers are are less
less able
able toto balance
balance thethe resources
resources theythey dodo
have.
have. ForFor example,
example, it it has
has been
been found
found thatthat neglectful
neglectful parents
parents tend
tend toto belong
belong toto sig-
sig-
nificantly
nificantly fewer formal organizations
fewer formal organizations than nonneglectful parents
than nonneglectful parents (Young,
(Young, 1964) but
1964) but
it is
it is not
not known whether this
known whether this external factor causes
external factor causes inappropriate
inappropriate parental
parental function-
function-
ing or
ing or whether
whether both both poor parenting and
poor parenting and lack
lack of such contacts
of such are related
contacts are related to some
to some
other
other third
third element
element (e.g.,
(e.g., poor social skills).
poor social skills).
Although
Although therethere do do not
not appear
appear to to be
be formal
formal models emphasizing mismatches
models emphasizing mismatches
between typical modes
between typical modes of of responding
responding and that which
and that which is is more
more appropriate
appropriate or or effec-
effec-
tive
tive inin aa given situation, it
given situation, it appears
appears that our culture,
that our with its
culture, with its emphasis
emphasis on on obtaining
obtaining
material
material goods
goods (e.g.,
(e.g., owning
owning your own home,
your own home, TV,TV, expensive
expensive cars),
cars), could
could contribute
contribute
to
to the neglect of
the neglect of children,
children, as as many
many parents emphasize these
parents emphasize these material
material factors
factors over
over
the
the kind
kind of self-sacrificing often
of self-sacrificing often required
required to to raise
raise children.
children. Economic conditions
Economic conditions
may
may alsoalso create
create aa situation
situation wherein
wherein neglect
neglect maymay bebe unavoidable (e.g., parents
unavoidable [e.g., who
parents who
are unable to afford child care being forced to leave children home alone while at
work).
work) . Promoting
Promoting some some forms
forms of of neglect
neglect maymay also
also be
be aa recent
recent increased
increased emphasis
emphasis in in
ETIOLOGICAL THEORIES IN
ETIOLOGICAL THEORIES IN INTRAFAMILIAL
INTRAFAMILIAL CIllLD MALTREATMENT
CHILD MALTREATMENT 17
17

our culture on children doing for themselves without the assistance of parents, of-
ten placing greater demands upon young children. This belief may be particularly
appealing in families where both parents work and where there are single parents
who are highly stressed. It
It also may be possible
possible that neglectful parents internalized
from their own childhoods a maladaptive schema or working model of relation-
ships, where children are seen as existing to meet adult needs.
Belsky'S (1980)
Belsky's (1980) integrative framework mentioned earlier in describing physi-
cal abuse is one of the few that considers neglect to be multidetermined, including
child, parent, family, community, and societal factors. For example, neglectful par-
ents may enter parenthood with a template that children are to meetmeet parent needs,
and may also have a predisposition toward depression, limiting their level of ini-
tiation with their children and others. As contextual stress increases and familial
supports decrease or are taxed, neglect may occur.

Levels of Analysis
As with the other types of maltreatment, causes for neglect have been suggested
suggested
at all levels of analysis. These include biological (e.g., mental retardation), person-
ality-emotional (e.g., ego deficiency), experiential (e.g., attachment during the first
year of life), and sociocultural (e.g., poverty, social isolation). Early research focused
on variables within the individual; the second wave has focused more strongly on
sociocultural forces (e.g.,
(e.g., poverty). Only recently there is beginning to be an empha-
sis on the interaction of factors at more than one level of analysis.

Complexity
Models of neglect often have not been separated from those of physical abuse
abuse,,
and they have traveled the same path of model development. Unfortunately, al-
though more complex models of parental aggression have begun to emerge, similar
complexity has been lacking for neglect. Presently, frameworks have progressed only
to lists that
that describe
describe single factors
factors distinguishing
distinguishing chronically neglectful mothers,
and
and this may not be applicable in less chronic situations or with fathers
fathers.. A sampling
of such frameworks is provided in the next section.

Model
Model Form
Structurally, almost all models of neglect are either type 11 frameworks (i.e., "If
(Le., "If
A,
A, then X") or weak typetype 22 models [i.e., "If A or B, then X"). Polansky, (Polansky
(Le., "If
et aI., 1981), one of the few theorists in this area, adopted a personality theory per-
al., 1981),
arguing for enduring character disorders as causes of neglect. His view is
spective, arguing
similar to that of theorists who tried to explain child maltreatment more more generally
(Galdston, 1968). Polansky saw the majority of neglectful mothers' behavior as re-
sulting from their own early
early histories of inadequate parental care. Based on two
care . Based
extensive studies, he developed a listlist of
oftypes
types of women who are likely to neglect
their children: the impulse ridden, individuals with mental retardation, women in in
reactive depression, those with a borderline personality disorder or even a psy-
chosis (which he saw as rare), and the apathetic-futile type. The most pervasive
of perpetrators was the last type, who appears passive, withdrawn, and lacking in
expression and whom he considered the most chronically immature. This is a type
18
18 SANDRA T.
SANDRA T. AZAR et aI.
AZAR et al.

22 model,
model, in that anyone
in that anyone of of these character problems
these character problems might might result
result inin neglect.
neglect. Evi- Evi-
dence that such
dence that disturbances alone
such disturbances alone would
would lead lead to to neglect
neglect is is limited, however.
limited, however.
In aa more
In more complex
complex model, model, Crittenden's
Crittenden's (1993) information-processing per-
(1993) information-processing per-
spective focuses
spective focuses on on four stages of
four stages responses required
of responses required for for successfully
successfully meeting
meeting chil- chil-
dren's
dren's needs where failures
needs where failures may result in
may result in neglect. These stages
neglect. These stages are
are (1) perception
(1) perception
of
of essential
essential aspects
aspects of of children's
children's states, (2) accurate
states, (2) interpretation of
accurate interpretation of the meaning
the meaning
of
of these
these perceptions,
perceptions, (3) selection of
(3) selection of adaptive
adaptive responses,
responses, and (4) responding
and (4) responding in in
ways that
ways meet children's
that meet children's needs.needs. TheThe neglect observed may
neglect observed may have
have different
different quali-quali-
ties
ties (e.g.,
(e.g., severity) depending upon
severity) depending which and
upon which and howhow many
many of of these stages are
these stages are failed.
failed.
Underlying these
Underlying problems in
these problems in information processing are
information processing are four
four factors: excluding
factors : excluding
the perception
the perception of child cues
of child cues to avoid rejection
to avoid rejection (defensive exclusion), faulty
(defensive exclusion), faulty at- at-
tributions leading to
tributions leading to role
role reversal,
reversal, aa limited repertoire of
limited repertoire of childrearing
childrearing responses,
responses,
and
and aa chaotic living environment
chaotic living environment produced
produced by by the parent where
the parent where children's
children's needs needs
are
are ignored
ignored or go unnoticed.
or go unnoticed. All of these
All of these factors
factors are are described
described as having their
as having their
roots in poor early parental attachment relationships
roots in poor early parental attachment relationships (an experiential assumption (an experiential assumption
where
where the the parent
parent failed
failed toto have their own
have their needs met
own needs met in in childhood).
childhood) . Azar Azar (1986,
(1986,
1989) posited a similar model to describe maltreating parenting
1989) posited a similar model to describe maltreating parenting more generally, in- more generally, in-
cluding
cluding neglect,
neglect, but but used
used aa social
social cognitive perspective. She
cognitive perspective. She argued
argued for for aa set
set of of
cognitive
cognitive distortions
distortions underlying social information-processing
underlying social information-processing difficulties difficulties in in chil-
chil-
drearing situations that
drearing situations interact with
that interact contextual stress
with contextual stress and and behavioral
behavioral skills skills
deficits
deficits to to result
result inin abuse
abuse or or neglect. This model
neglect. This model and and its
its recent
recent elaboration
elaboration (Azar (Azar & &
Siegel,
Siegel, 1990) will be
1990) will discussed in
be discussed in detail
detail later
later in this chapter.
in this chapter.
Gaudin (Gaudin, Polansky,
Gaudin (Gaudin, Polansky, Kilpatrick,
Kilpatrick, & Shilton, 1993)
& Shilton, takes aa different
1993) takes different per- per-
spective,
spective, placing
placing moremore emphasis
emphasis on on environmental
environmental factors. His starting
factors . His starting point
point is is the
the
strong relationship between
strong relationship between child neglect and
child neglect and poverty.
poverty. In In designing
designing his his research,
research, he he
attempts
attempts to to distinguish
distinguish between
between poor neglectful and
poor neglectful and nonneglectful parents. He
nonneglectful parents. He ar- ar-
gues
gues that
that itit is
is the interaction of
the interaction of poverty with intense
poverty with perceptions of
intense perceptions social isolation
of social isolation
that
that produces neglect. These
produces neglect. These last two models
last two represent more
models represent transactional views.
more transactional views.
Garbarino
Garbarino (1977) (1977) has has also
also argued
argued forfor an exclusively environmental
an exclusively environmental explana- explana-
tion for child
tion for child maltreatment
maltreatment (both (both physical
physical abuseabuse and and neglect).
neglect). He He postulates
postulates three three
environmental
environmental conditionsconditions as crucial to
as crucial to maltreatment:
maltreatment: (1) (1) a cultural context
a cultural context that that
condones violence in
condones violence in general,
general, (2) families who
(2) families experience stress
who experience stress in
in their
their life
life cir-
cir-
cumstances combined with
cumstances combined social isolation, and (3) consensual
with social isolation, and (3) consensual values concerning values concerning
family
family autonomy
autonomy and and parental
parental ownership
ownership of of children.
children. This This model
model differs from the
differs from the
others
others because
because all all three
three conditions
conditions are needed for
are needed for abuse-neglect
abuse-neglect to to occur.
occur.
Subcultural explanations
Subcultural explanations for neglect have
for neglect have not received much
not received attention. It
much attention. can
It can
easily be
easily be seen,
seen, however,
however, that that differences
differences in in values
values between
between cultures
cultures maymay result
result in in
practices that might be labeled neglectful (e.g., the
practices that might be labeled neglectful (e.g., the importance of school atten-importance of school atten-
dance,
dance, views
views on on how
how independent children should
independent children should be). be). Mismatches
Mismatches betweenbetween prac- prac-
tices that are
tices that acceptable in
are acceptable one culture
in one culture and and not not inin another
another may explain some
may explain some
neglectful situations. For
neglectful situations. For example,
example, aa mother
mother interviewed
interviewed by by the first author
the first author in in anan
urban
urban high-rise apartment was
high-rise apartment was charged
charged with
with neglect
neglect for letting her
for letting her young
young children
children
wander
wander outside
outside the the building alone. She
building alone. She explained
explained that that inin her
her home
home culture, adults
culture, adults
see it
see it as
as their responsibility to
their responsibility to monitor unattended children
monitor unattended children and and she she expected
expected
others would
others watch her
would watch her children.
children.
As
As data
data have
have accumulated regarding the
accumulated regarding pervasive impact
the pervasive impact of of neglect,
neglect, more more at- at-
tention
tention has has begun
begun to to focus
focus onon model
model building
building in in this area. Soon,
this area. Soon, more
more complexity
complexity
may
may emerge
emerge here,here, asas well
well asas for
for emotional maltreatment, discussed
emotional maltreatment, discussed next.next.
ETIOLOGICAL THEORIES IN
IN INTRAFAMILIAL ClllLD
CHILD MALTREATMENT 19
19

EMOTIONAL MALTREATMENT
EMOTIONAL MALTREATMENT

Of
Of the
the four
four types
types ofof child maltreatment discussed
child maltreatment discussed in in this
this chapter,
chapter, emotional
emotional
abuse
abuse hashas received
received thethe least
least attention. This is
attention. This is surprising,
surprising, asas some
some theorists believe
theorists believe
it
it is at the
is at the core
core of other forms
of other forms of maltreatment (Hart,
of maltreatment (Hart, Germain,
Germain, & Brassard, 1987).
& Brassard, 1987).
The
The paucity
paucity of research in
of research this area
in this may be
area may due to
be due to the greater ease
the greater ease with which
with which
more
more readily
readily identifiable
identifiable forms
forms of
of abuse
abuse can be studied
can be studied (Egeland
(Egeland & Erickson, 1987)
& Erickson, 1987)
and
and lack
lack of
of consensus
consensus on on both conceptual and
both conceptual and operational
operational definitions
definitions (McGee
(McGee & &
Wolfe, 1991).
Wolfe, As aa result,
1991). As result, our
our discussion ofthis
discussion of this area
area is speculative.
is speculative.

Definitions
Definitions
The main
The definitional dilemmas
main definitional dilemmas involve
involve aa delineation
delineation of behaviors that
of behaviors that form
form
the
the basis
basis ofof emotional
emotional maltreatment,
maltreatment, and and the
the question
question as to whether
as to whether it it is
is aa separate
separate
entity
entity or
or inin fact core to
fact core the other
to the forms of
other forms of maltreatment,
maltreatment, or or both.
both. Hart
Hart and
and associ-
associ-
ates (1987) offer
ates (1987) offer one
one ofof the most inclusive
the most inclusive conceptual
conceptual definitions
definitions of of emotional
emotional
maltreatment.
maltreatment. They They posit
posit that
that itit consists
consists of acts of
of acts of omission
omission or or commission
commission
deemed
deemed to to bebe psychologically damaging to
psychologically damaging children, including
to children, including those acts which
those acts which
pose
pose aa threat, either immediately
threat, either immediately or or ultimately,
ultimately, toto children's
children's behavioral,
behavioral, cognitive,
cognitive,
affective,
affective, or physical functioning.
or physical Thus, all
functioning. Thus, forms of
all forms maltreatment would
of maltreatment would be con-
be con-
sidered
sidered emotional maltreatment. Other
emotional maltreatment. Other writers,
writers, in discussing definitional
in discussing issues,
definitional issues,
argue
argue that such inclusive
that such inclusive conceptual definitions are
conceptual definitions are problematic
problematic due due to to redun-
redun-
dancy.
dancy. McGee
McGee and and Wolfe
Wolfe (1991)
(1991) posit that psychological
posit that maltreatment consists
psychological maltreatment consists of of
any communication pattern between adult and child that has
any communication pattern between adult and child that has the potential to un- the potential to un-
dermine the
dermine child's social,
the child's social, emotional,
emotional, cognitive,
cognitive, or social-cognitive development.
or social-cognitive development.
They argue for including only those forms of nonphysical acts
They argue for including only those forms of nonphysical acts or omission which or omission which
might
might cause
cause nonphysical
nonphysical damage
damage to to children.
children.
Following
Following from conceptual problems,
from conceptual problems, operational definitions have
operational definitions have also been
also been
difficult. McGee and Wolfe (1991), for example, provide a substantial
difficult. McGee and Wolfe (1991), for example, provide a substantial list of be- list of be-
haviors:
haviors: rejecting,
rejecting, degrading, terrorizing, isolating,
degrading, terrorizing, isolating, missocializing,
missocializing, exploiting,
exploiting, and and
denying
denying emotional responsiveness. The
emotional responsiveness. The consequences
consequences of of having such aa wide
having such wide range
range
of definitions has been discussed by Garbarino and Vondra (1987),
of definitions has been discussed by Garbarino and Vondra (1987), who argue that who argue that
narrow
narrow definitions capture only
definitions capture only the
the most severe forms
most severe forms of
of emotional maltreatment,
emotional maltreatment,
whereas
whereas more broad ones
more broad ones are
are likely
likely toto characterize
characterize allall parents
parents at at one
one time
time or or an-
an-
other. In contrast,
other. Egeland and
contrast, Egeland and Erickson
Erickson (1987) argueargue that
that caregivers
caregivers whowho are are psy-
psy-
chologically unavailable provide
chologically unavailable provide the most damaging
the most damaging formform of maltreatment, but
of maltreatment, but
this
this would
would be be overlooked
overlooked by by narrow definitions. Underlying
narrow definitions. Underlying this this discussion
discussion is is aa
debate
debate asas to whether maltreaters
to whether maltreaters are on the
are on the same
same continuum
continuum with with other
other parents.
parents.
We
We will
will return
return to to this issue as
this issue as we
we consider
consider an an overarching model of
overarching model of maltreatment.
maltreatment.

Assumptions
Assumptions
Defect models have
Defect models have not
not developed
developed in in this area as
this area as they
they have been in
have been in other ar-
other ar-
eas,
eas , although when emotional
although when emotional maltreatment
maltreatment is is viewed
viewed as as core
core to
to the
the other
other forms
forms of
of
maltreatment,
maltreatment, thethe same
same models might be
models might be discussed
discussed here.
here. Deeply
Deeply rooted impair-
rooted impair-
ments,
ments, such
such as
as neurological disturbances, that
neurological disturbances, may influence
that may parents'' emotional
influence parents emotional
regulation
regulation and their perception
and their perception of affect in
of affect in others, have not
others, have yet been
not yet been posited,
posited, al-
al-
though
though they
they may
may be
be viable explanations for
viable explanations for the
the failures
failures in
in caregiving observed.
caregiving observed.
20
20 SANDRA T.
SANDRA T. AZAR et al,
AZAR et aI.

Early theorizing in this area discussed parental psychiatric disturbances (e.g., (e.g.,
depression, personality disorders, or alcoholism). In her review of studies of emo-
tional
tional neglect, ShakelI (1987)
neglect, Shake describes studies
(1987) describes studies in which parents
in which parents were were viewed
viewed as as
recreating
recreating patterns
patterns of of emotional neglect and
emotional neglect stimulus deprivation
and stimulus deprivation that they expe-
that they expe-
rienced
rienced as as children.
children. They They let let their
their own
own needs
needs take
take precedence,
precedence, fail fail to
to achieve
achieve aa
feeling
feeling ofof competence
competence as parents, and
as parents, are unable
and are unable to provide adult
to provide adult role
role models
models forfor
their
their children. Shakel, however,
children. Shakel, however, points
points out that these
out that these responses
responses may may result
result from
from
parental
parental stress
stress oror their social situation
their social situation and,and, thus,
thus, emotional
emotional abuse abuse maymay be be ex-
ex-
plained just
plained just as easily by
as easily by external
external factors.
factors.
Deficiencies
Deficiencies in in the
the behavioral
behavioral or or cognitive
cognitive area may also
area may also explain
explain emotional
emotional
maltreatment (Azar,
maltreatment (Azar, 1989).
1989). ForFor example, psychologically maltreating
example, psychologically maltreating parents
parents maymay
not have
not have the
the ability
ability to interact with
to interact with their
their children
children in in aa normal
normal and and supportive
supportive
manner as a result of poor modeling experiences with their own parents. Simi-
larly, it
larly, it may
may be be assumed
assumed that that such parents may
such parents may notnot have
have thethe problem-solving
problem-solving
skills necessary
skills necessary to correct their
to correct their children's
children's misbehavior
misbehavior in in any
any manner
manner other
other than
than
aa verbally
verbally abusive
abusive one.one. ThatThat is,
is, they
they have more restricted
have more restricted repertoires, dominated
repertoires, dominated
by
by verbally
verbally coercive approaches. Finally,
coercive approaches. Finally, aa cognitive
cognitive perspective
perspective might might focus on
focus on
the self-efficacy of such parents. For example, these parents
the self-efficacy of such parents. For example, these parents may perceive par- may perceive par-
enting failures more
enting failures more negatively
negatively and and as personal failures.
as personal failures. Bugenthal
Bugenthal and and Shennum
Shennum
(1984) have
(1984) focused on
have focused perceptions of
on perceptions of control
control in parents at
in parents at risk for maladaptive
risk for maladaptive
parenting
parenting responses;
responses; they argue that
they argue such parents
that such parents perceive
perceive their
their children
children as as hav-
hav-
ing
ing more
more control
control thanthan they
they do. Emotional maltreatment
do. Emotional maltreatment may, may, therefore,
therefore, be be an
an at-
at-
tempt
tempt to to rectify
rectify aa perceived
perceived power differential. Depression
power differential. Depression may also be
may also present in
be present in
such
such parents, leading to
parents , leading to misperceptions
misperceptions that that children
children are are negatively
negatively evaluating
evaluating
them.
them. Indeed, there are
Indeed, there are some data that
some data that maltreating
maltreating parentsparents seesee their children as
their children as
intentionally
intentionally acting
acting to to annoy them (Azar,
annoy them (Azar, 1989).
1989). If If additional
additional perspective-taking
perspective-taking
deficits are present, then these parents would not be able to accurately appraise
the
the impact
impact of their words.
oftheir words.
Contextual
Contextual factors
factors may also influence
may also influence the the occurrence
occurrence of emotional maltreat-
of emotional maltreat-
ment.
ment . For
For example,
example, in in divorcing
divorcing families, single-parent families,
families, single-parent families, and and other highly
other highly
stressed families,
stressed parental functioning
families, parental functioning has has been
been found
found to be negatively
to be negatively affected
affected
(Belsky
(Belsky & & Vondra, 1989) and
Vondra, 1989) in the
and in the extreme,
extreme, emotional
emotional unavailability
unavailability and and higher
higher
levels
levels ofof verbally
verbally abusive
abusive behavior
behavior may result.
may result.

Levels
Levels of Analysis
of Analysis
Little
Little research exists on
research exists emotional maltreatment
on emotional maltreatment and, therefore, there
and, therefore, there are
are lim-
lim-
itations in
itations in the
the approaches people have
approaches people taken to
have taken positing etiological
to positing etiological factors. Socio-
factors. Socio-
biologists
biologists have explored animal
have explored animal models
models of of caregiver
caregiver rejection
rejection ofof offspring. For
offspring. For
example,
example, rhesus
rhesus monkeys
monkeys deprived
deprived early in development
early in development of of contact
contact with
with maternal
maternal
caretakers and
caretakers and contact
contact with peers show
with peers show higher levels of
higher levels of inadequate
inadequate caretaking
caretaking be-be-
haviors
haviors (Suomi, Lack of
1978). Lack
(Suomi, 1978). exposure to
of exposure to specific
specific types
types of caregiving behavior
of caregiving behavior
during critical periods of childhood have been implicated (e.g., (e.g., nursing and ven-
tral
tral contact). How deprivation
contact). How deprivation of these experiences
of these experiences translates
translates into inadequate
into inadequate
caregiving with
caregiving their own
with their offspring and
own offspring and whether the mechanisms
whether the mechanisms are are biological
biological isis
not
not clear as yet.
clear as A list
yet. A list of
of potential biological mechanisms
potential biological mechanisms might be generated
might be generated (e.g.,
(e.g.,
emotional regulation difficulties, neurological difficulties influencing respons responsiv-iv-
ity,
ity, hormonal
hormonal changes).
changes).
ETIOLOGICAL THEORIES IN
ETIOLOGICAL THEORIES IN INTRAFAMILIAL
INTRAFAMILIAL CIllLD MALTREATMENT
CIllLD MALTREATMENT 21

Theories of
Theories etiology involving
of etiology involving the
the personality and emotional
personality and emotional characteristics
characteristics of
of
the
the psychologically
psychologically maltreating parent are
maltreating parent the most
are the most common.
common. The The best
best known
known of of
these
these is is in
in the
the work
work of Egeland and
of Egeland and Erickson
Erickson (1987), who described
(1987), who described what they
what they
called
called thethe "psychologically unavailable" mother
"psychologically unavailable" mother (similar
(similar toto Polansky's apathetic-
Polansky's apathetic-
futile
futile neglectful mother category),
neglectful mother category), whose
whose children show the
children show worst outcomes.
the worst outcomes.
These women were withdrawn, displayed flat affect, and appeared depressed
compared
compared to control mothers
to control mothers and
and mothers
mothers who engaged in
who engaged in other
other forms
forms ofof abuse.
abuse.
They
They also
also identified
identified aa group
group ofof mothers
mothers who
who engaged
engaged in
in constant
constant harassment
harassment andand
degradation of their children. Core to these these responses are parental emotional states
(Pianta,
(Pianta, Egeland,
Egeland, & & Erickson,
Erickson, 1989). Similarly, Belsky
1989). Similarly, Belsky and
and Vondra
Vondra (1989) suggest
(1989) suggest
that parenting behaviors (including psychologically abusive ones) may be influ-
enced
enced by by characteristics
characteristics ofof the
the individual.
individual. It
It is
is posited
posited that the origins
that the origins of
of such
such re-
re-
sponses are within the parent's early developmental history and may affect
parenting behaviors directly and and indirectly by influencing the broader context in
which
which the the parent-child relationship exists,
parent-child relationship such as
exists, such as marital
marital relations
relations and
and social
social
networks.
networks. Indeed, Lesnik-Oberstein, Koers,
Indeed, Lesnik-Oberstein, Koers, and
and Cohen (1995) found
Cohen (1995) that psycho-
found that psycho-
logically
logically abusive mothers had
abusive mothers had negative childhood upbringings
negative childhood upbringings and and recalled
recalled less
less
caring mothers and overcontrolling fathers. They also reported having
caring mothers and overcontrolling fathers. They also reported having partner re- partner re-
lationships that werewere less affectionate and and more verbally and physically aggres-
sive It appears
sive.. It that the
appears that the high
high levels
levels of subjective distress
of subjective that result
distress that result are described
are described
as spilling over into parenting in the form of hostile feelings.
as spilling over into parenting in the form of hostile feelings.

Complexity
Complexity and Form
and Form
As can be
As can seen by
be seen by the
the limited
limited discussion
discussion above,above, theories
theories of of emotional
emotional mal-
mal-
treatment
treatment are limited. Most
are limited. Most are merely extensions
are merely extensions of of theories
theories designed
designed toto explain
explain
physical
physical child
child abuse (indeed there
abuse (indeed there isis often
often anan overlap
overlap between
between the the two).
two). For
For exam-
exam-
ple, Lesnik-Oberstein, Koers,
ple, Lesnik-Oberstein, and Cohen
Koers, and (1995) posit
Cohen (1995) posit that
that factors
factors at many systemic
at many systemic
levels (individual, family, community, subcultural) contribute to the occurrence of
psychological maltreatment. They
psychological maltreatment. They suggest
suggest that
that three main factors-parental
three main factors-parental hostil-
hostil-
ity,
ity, parental
parental inhibition
inhibition of of overt aggression, and
overt aggression, and focusing
focusing of of parental
parental aggression
aggression on on
children-are each
children-are each the
the outcome
outcome of of aa network
network of other subfactors.
of other subfactors. For For example,
example, lowlow
parental
parental inhibition
inhibition ofof overt
overt aggression
aggression is the outcome
is the outcome of six elements:
of six elements: preconven-
preconven-
tional
tional cognitive
cognitive developmental
developmental level level ofof moral reasoning, low
moral reasoning, low cultural
cultural inhibition
inhibition of
of
overt aggression, lack of insight into their own past abuse, alcohol or drug abuse,
absence of
absence of aa supportive
supportive partner
partner oror social
social network,
network, and and low
low level of empathy.
level of empathy. TheThe
type
type of
of child abuse (physical
child abuse (physical versus
versus emotional)
emotional) that that occurs depends upon
occurs depends upon the ratio
the ratio
of
of parental
parental hostility to parental
hostility to parental inhibition
inhibition of aggression. They
of aggression. They suggest
suggest that
that low
low cop-
cop-
ing skills, a negative developmental history, and a high level of stress lead to a high
level
level of
of parental hostility, which
parental hostility, which predisposes
predisposes the the parent
parent toto psychological
psychological abuse.
abuse.
Egeland
Egeland and and Erickson
Erickson (1987),
(1987), mentioned
mentioned earlier,earlier, posit
posit thatthat the
the responses
responses of of
psychologically unavailable mothers come from a combination of a mother's own
unmet
unmet emotional needs and
emotional needs and low levels of
low levels of social
social support.
support. In In more
more recent work, Pi-
recent work, Pi-
anta, Egeland, and
anta, Egeland, and Erickson suggest that
(1989) suggest
Erickson (1989) that these psychological characteristics
these psychological characteristics
of
of maltreating parents are
maltreating parents are more
more central
central to the cause
to the cause of all forms
of all forms of maltreatment
of maltreatment
than are all other external factors.
factors.
Integrated models
Integrated models have
have also
also been
been posited
posited (e.g., ones that
(e.g., ones that parallel
parallel Belsky's
Belsky's (1980)
(1980)
ecological
ecological framework
framework or developmental ones
or developmental ones that link children's
that link children's developmental
developmental
22
22 SANDRA T.
SANDRA AZAR. et
T. AZAR aI.,
et al

stage [Erikson's
stage [Erikson's (1950) stages)) to
(1950) stages)) to vulnerabilities
vulnerabilities of
of children
children in
in the
the parenting
parenting theythey
receive
receive [Hart, Germain, &
[Hart, Germain, & Brassard, Although these
1987]. Although
Brassard, 1987]. preliminary attempts
these preliminary attempts toto
posit such models
posit such models seem
seem viable,
viable, they may be
they may be premature,
premature, given
given the
the very
very limited
limited data
data
base
base available.
available. Less complex models
Less complex models ofof emotional
emotional maltreatment that are
maltreatment that are empiri-
empiri-
cally validated
cally may make
validated may make more
more sense
sense at
at this point in
this point development of
in development of the
the field
field.. The
The
findings from these
findings from simple attempts
these simple attempts ultimately
ultimately would
would be integrated into
be integrated into more
more
complex frameworks.
complex frameworks .

Conclusions
Conclusions
In
In the material presented
the material presented here,
here, one
one can
can see
see the
the beginnings
beginnings of of more
more complex
complex
views of etiology (model types 3 to 6) that will, one hopes, stimulate new
views of etiology (model types 3 to 6) that will , one hopes , stimulate new research. research.
With validation of
With validation of these
these new
new perspectives
perspectives should
should come
come more
more fine-tuned
fine-tuned treatment
treatment
efforts
efforts and better control
and better control of
of this
this social
social problem.
problem. Given
Given thethe overlap
overlap between
between forms
forms
of maltreatment and
of maltreatment and the similarity of
the similarity many of
of many of the factors that
the factors appear to
that appear to be associ-
be associ-
ated
ated with
with each, it might
each , it be useful
might be useful for
for the
the field
field to attempt to
to attempt integrate models
to integrate across
models across
forms. We
forms. We make
make aa preliminary
preliminary attempt
attempt toto do
do this
this inin the
the last
last section
section byby integrating
integrating
three
three different frameworks to
different frameworks explain child
to explain child maltreatment.
maltreatment. These These frameworks
frameworks in- in-
clude the specification
clude the specification of of cognitive-behavioral
cognitive-behavioral skills skills problems
problems that
that are
are linked
linked toto
multiple
multiple forms
forms ofof maltreatment,
maltreatment, factors that would
factors that would leadlead to failures in
to failures meeting the
in meeting the
developmental
developmental requirements
requirements of of children,
children, andand systemic
systemic factors that would
factors that would act
act as
as
setting
setting events for maltreatment
events for maltreatment to occur.
to occur.

AN
AN INTEGRATED META-MODEL OF
INTEGRATED META-MODEL OF CmLD
CIllLD MALTREATMENT
MALTREATMENT

In positing
In positing aa meta-model
meta-model of of child
child maltreatment,
maltreatment, aa number
number of of basic
basic criteria
criteria
might
might be considered. As
be considered. As noted
noted earlier,
earlier, one
one of
of the
the major goals of
major goals of theory
theory is is to
to inform
inform
treatment development. Thus,
treatment development. Thus, aa meta-theory
meta-theory should
should posit
posit factors
factors that
that are
are amen-
amen-
able
able toto change
change or that are
or that are of
of such
such aa nature
nature that intervention can
that intervention can allow
allow forfor some
some
"prosthetic" strategies
"prosthetic" strategies (i.e.,
(i.e., defects
defects that
that families
families could
could work
work around).
around). An An argument
argument
has also been
has also been made
made that
that theories
theories of of etiology
etiology in in child
child maltreatment
maltreatment need need to to be
be
linked to
linked to factors
factors that
that relate
relate toto child
child outcome
outcome (Azar,
(Azar, 1989,
1989, 1991).
1991). It is the
It is the negative
negative
impact of
impact of parental
parental behavior
behavior on on children's
children's outcomes
outcomes that that isis of
of most
most concern
concern to to
mental
mental health
health professionals.
professionals. Finally,
Finally, although
although theories that see
theories that abusive and
see abusive and ne-
ne-
glectful parents
glectful parents as as distinct
distinct from
from other
other parents
parents make
make sense
sense inin environments
environments where where
categorical classification
categorical classification is is crucial
crucial (e.g.,
(e.g., determining
determining fit versus unfit
fit versus unfit parents
parents inin
termination
termination of of parental
parental rights
rights hearings
hearings in in the
the legal
legal system)
system),, treatment
treatment does does not
not
typically involve families
typically involve families where
where such
such sharp
sharp distinctions
distinctions are are required. Thus, aa
required. Thus,
meta-model
meta-model might best begin
might best begin with
with aa continuum
continuum view. view. Such
Such aa model
model would conse-
would conse-
quently be
quently be aa model
model of of parenting
parenting competence
competence and and thus
thus,, would approach the
would approach the issue
issue
of maltreatment
of maltreatment from from aa broader
broader perspective
perspective than
than that
that undertaken
undertaken to to date
date..
Based
Based on on these
these criteria,
criteria, aa number
number of of factors
factors emerged
emerged fromfrom ourour review
review across
across
the forms of
the forms of maltreatment
maltreatment that would be
that would be the
the most
most fruitful
fruitful for
for inclusion
inclusion in in aa meta-
meta-
model of
model of child maltreatment and
child maltreatment and that would lead
that would lead most directly into
most directly into intervention
intervention
development. These
development. These include
include parent-based
parent-based cognitive
cognitive disturbances
disturbances and and behavioral
behavioral
skill deficits and
skill deficits and disrupting
disrupting socioenvironmental
socioenvironmental conditions.
conditions. In positing aa model,
In positing model,
 ETIOLOGICAL THEORIES IN INTRAFAMILIAL ClDLD
CIllLD MALTREATMENT 23

these must be
these must considered in
be considered in the
the context
context of of children's
children's needs needs at at various stages of
various stages de-
of de-
velopment
velopment and and the the tasks
tasks that
that allall parents
parents face face at at each
each of these stages
of these stages (adult
(adult devel-
devel-
opment).
opment). When When children's
children's needs needs are are violated
violated to such an
to such an extent
extent thatthat poor outcome
poor outcome
is
is likely,
likely, parenting incompetence might
parenting incompetence might legitimately
legitimately be be viewed
viewed as as of
of concern
concern to so-
to so-
ciety
ciety andand targeted
targeted for for intervention,
intervention, whether whether or or not
not it meets legal
it meets legal criteria
criteria for mal-
for mal-
treatment.
treatment. Inherent
Inherent in in this
this perspective
perspective is is aa continuum
continuum view view of parenting, with
of parenting, with
factors
factors that
that lead
lead to to aa continuum
continuum of risk.
of risk.
Five
Five general domains of
general domains parental disturbance
of parental disturbance might might be posited: (1)
be posited: (1) cognitive
cognitive
disturbances,
disturbances, (2) parenting skill
(2) parenting skill problems,
problems, (3) (3) impulse
impulse control problems, (4)
control problems, stress
(4) stress
management
management problems, problems, and and (5) social skill
(5) social skill problems
problems (Azar (Azar & Twentyman, 1986).
& Twentyman, 1986). In In
turn,
turn, these
these may may be be seen
seen as as also
also playing
playing aa rolerole in systemic difficulties
in systemic difficulties that that foster
foster
further
further child risk. For
child risk. For example,
example, poor poor parental
parental socialsocial skills
skills would
would lead lead toto fewer
fewer
friends,
friends , perceptions
perceptions of low intimacy,
of low intimacy, poor poor marital
marital relationships,
relationships, higher levels of
higher levels of
distress,
distress, poorer
poorer life life adjustment,
adjustment, higher levels of
higher levels negative arousal,
of negative arousal, and and aa lower
lower
mood state, all
mood state, of which
all of which have have been identified as
been identified as descriptive
descriptive of of maltreaters
maltreaters across across
types.
types. TheThe disturbances
disturbances outlined outlined may may have
have their
their origins
origins in in the parents' own
the parents' own child-
child-
hood
hood experiences,
experiences, mainly mainly through
through the modeling provided
the modeling provided by their adult
by their adult role
role mod-
mod-
els , but
els, but may
may alsoalso evolve
evolve under situational strain
under situational strain (e.g.,
(e.g., mood disturbances, marital
mood disturbances, marital
violence).
violence).
Children,
Children, for for their
their part,
part, at at various points in
various points in their development demand
their development demand the the
successful
successful completion
completion of specific parental
of specific parental tasks.
tasks. BothBoth parents
parents (and (and children)
children) also also
need specific types
need specific types of systemic supports
of systemic supports in in order
order for for their skills to
their skills be refined
to be refined and and
to
to be
be carried
carried out out without
without obstacles.
obstacles. For For example,
example, the the parent
parent of of an
an infant must have
infant must have
aa high
high tolerance
tolerance for for infant
infant crying
crying andand the parent of
the parent of aa newly
newly mobile toddler needs
mobile toddler needs
to
to have
have thethe capacity
capacity to monitor safety
to monitor safety issues
issues in in the
the home.
home. The The ability
ability to to marshal
marshal aa
cadre
cadre of of friends
friends and/or relatives supports
and/or relatives supports both both of of these capacities. Social
these capacities. Social support
support
helps
helps withwith child
child care,care, providing
providing additional
additional assistance
assistance when when the the infant
infant is is incon-
incon-
solable, or
solable, or when
when the the toddler
toddler is in need
is in need of of monitoring
monitoring while while thethe parent
parent is is engaged
engaged
in
in other
other tasks
tasks (e.g.,
(e.g., cooking dinner). The
cooking dinner). The level
level andand type
type offtustration
offtustration tolerance
tolerance and and
monitoring
monitoring skills skills needed
needed for for infants
infants andand toddlers,
toddlers , however,
however, is is different
different fromfrom that that
required
required for for teenagers.
teenagers. At At this
this later point in
later point in development,
development, good good communication
communication
skills and
skills and accurate understanding of
accurate understanding of adolescents'
adolescents' need need for autonomy are
for autonomy are required
required
to provide an
to provide an optimal
optimal environment
environment for for development.
development. However, However, the quality of
the quality of ver-
ver-
bal
bal communication
communication skills skills (e.g., modeling of
(e.g., modeling of negotiation
negotiation skills) skills) required
required with with teen-
teen-
agers may
agers may be be crucial, whereas, with
crucial, whereas, with an an infant,
infant, the amount of
the amount of communication
communication (e.g., (e.g.,
level
level of of verbal stimulation) may
verbal stimulation) may be be more
more important.
important. All All ofof the
the above
above tasks
tasks maymay be be
more
more difficult
difficult to to carry
carry out out effectively
effectively if if the
the parent
parent is is under
under extreme
extreme environmen-
environmen-
tal stress. For
tal stress. For example,
example, if poverty is
if poverty an issue,
is an issue, the the parent
parent may may have
have aa more
more difficult
difficult
time
time reducing
reducing environmental
environmental risks risks (e.g.,
(e.g., with
with aa toddler,
toddler, preventing
preventing lead lead paint
paint poi- poi-
soning because
soning because of limits on
of limits on housing
housing quality
quality available,
available, or, or, with
with aa teenager,
teenager, gang gang
membership),
membership), such such that even higher
that even higher levels
levels of monitoring skills
of monitoring skills are
are likely
likely toto bebe less
less
effective.
effective. Thus,Thus, underunder some some environmental
environmental contingencies,
contingencies, parental parental skillskill levels
levels
must
must be be of
of anan even
even higher
higher quality
quality thanthan is is typical
typical in in more benign contexts,
more benign contexts, what what
Cauce
Cauce (1995)
(1995) has has called
called "precision
"precision parenting
parenting in in anan unforgiving
unforgiving environment."
environment." We We
also
also know
know that that cognitive processing narrows
cognitive processing narrows under under stressstress and
and this
this would
would mean mean the the
presence
presence of of the
the cognitive disturbances posited
cognitive disturbances posited wouldwould be be even
even moremore detrimental
detrimental to to
functioning.
functioning.
24
24 SANDRA T. AZAR et al.
et al,

Azar
Azar and and Siegel (1990) posit
Siegel (1990) posit aa framework
framework for for child
child abuse
abuse and and neglect that
neglect that
argues
argues for for aa set
set ofof unique
unique taskstasks that that parents
parents mustmust accomplish
accomplish at at each
each level
level ofof aa
child's
child's development,
development, as as well
well as as ones
ones that
that cut across development.
cut across development. They They also
also out-
out-
lined
lined period-specific
period-specific child-basedchild-based and and contextual obstacles to
contextual obstacles to accomplishing
accomplishing
these
these tasks successfully and
tasks successfully and thethe interactional
interactional and and child outcomes to
child outcomes to be
be expected
expected
when
when they they fail.
fail. A preliminary list
A preliminary list of types of
of types of skills
skills problems
problems that that might
might emerge
emerge
and the
and the child outcomes seen
child outcomes seen has been compiled
has been compiled (Azar, Miller, &
(Azar, Miller, Breton, in
& Breton, in press).
press).
Much
Much as as Crittenden
Crittenden (1993) (1993) has has argued
argued for for neglect,
neglect, thethe foundational
foundational disturbance
disturbance
in
in this
this approach
approach is is an information-processing one.
an information-processing one. Difficulties
Difficulties at at this
this fundamen-
fundamen-
tal level would
tal level short-circuit all
would short-circuit all subsequent
subsequent responses
responses that that parents
parents would make.
would make.
That is,
That is, if
if one misperceives child
one misperceives child or situational cues
or situational cues inin childrearing,
childrearing, then then the
the re-
re-
sponses
sponses that that follow would by
follow would by definition
definition be be maladaptive
maladaptive or dissynchronous with
or dissynchronous with
children's
children's needs. needs. Effective parents are
Effective parents are seen
seen as approaching interactions
as approaching interactions with with their
their
children
children with with developmentally
developmentally sensitive sensitive schemata
schemata (expectations)
(expectations) (Azar, (Azar, 1986,
1986,
1989).
1989). That That is, such parents
is, such parents have have accurate
accurate perceptions
perceptions of their children's
of their children's capa-capa-
bilities,
bilities, as as well
well as as what their own
what their own role should be
role should be in moving them
in moving forward de-
them forward de-
velopmentally
velopmentally (Miller, (Miller, 1988).
1988). Indeed,
Indeed, such such accurate perceptions have
accurate perceptions have beenbeen
associated
associated with with optimal
optimal parenting
parenting and and child
child outcome
outcome and and inaccurate
inaccurate perceptions
perceptions
have
have beenbeen linked
linked to to maltreatment
maltreatment (Abel (Abel & Rouleau, 1995;
& Rouleau, 1995; Azar,
Azar, Robinson,
Robinson, Hekim-Hekim-
ian,
ian, & & Twentyman,
Twentyman, 1984; 1984; AzarAzar & Rohrbeck 1986)
& Rohrbeck 1986).. Parents
Parents with with inaccurate
inaccurate per- per-
ceptions
ceptions come come to to hold
hold children
children more more responsible
responsible for for their
their mishaps,
mishaps, aversive
aversive
behavior, and
behavior, the parent's
and the parent's own own lossloss of control. In
of control. In addition, inherent in
addition, inherent in their
their sche-
sche-
mata
mata regarding parent-child relationships
regarding parent-child relationships is is an
an expectation
expectation that that children
children willwill
provide
provide parentsparents withwith comfort
comfort and and carecare rather than the
rather than the other
other way around. In
way around. In the
the
extreme,
extreme, the expectancies may
the expectancies may be be so so distorted
distorted that the parent
that the parent may may expect sexual
expect sexual
gratification
gratification from from the child.
the child.
Along with
Along with accurate standards,, effective
accurate standards parents also
effective parents also have
have an an adequate-
adequate-
enough
enough repertoire
repertoire of of childrearing strategies and
childrearing strategies and problem-solving
problem-solving skills skills to
to allow
allow
them
them to to adapt
adapt their responses appropriately
their responses appropriately to any given
to any situation and
given situation and toto the skill
the skill
level
level of of their
their children.
children. For For example,
example, the the effective
effective parent recognizes that
parent recognizes that explana-
explana-
tions
tions maymay be be very
very effective
effective withwith an an adolescent
adolescent or school-aged child,
or school-aged child, but
but will
will bebe
less
less appropriate
appropriate as as the
the sale
sole strategy
strategy with with aa toddler.
toddler. Likewise,
Likewise, strategies
strategies that
that are
are ef-
ef-
fective
fective whenwhen the the child
child is in good
is in good health
health may may fail
fail when
when thethe child
child is is tired
tired or
or ill.
ill. Un-
Un-
like
like effective parents, maltreating
effective parents, maltreating ones ones havehave been seen as
been seen possessing aa narrow
as possessing narrow
repertoire
repertoire of childrearing skills
of childrearing skills (mostly
(mostly negative strategies)' as
negative strategies), as well
well as as poor prob-
poor prob-
lem-solving
lem-solving ability (Azar, Robinson,
ability (Azar, Robinson, Hekimian,
Hekimian, & Twentyman, 1984;
& Twentyman, Hanson, Pal-
1984; Hanson, Pal-
lotta,
lotta, Tishelman,
Tishelman, Conaway, Conaway, & MacMillan, 1989)
& MacMillan, 1989).. Consequently,
Consequently, they are more
they are more
likely
likely to to fail
fail at crucial tasks
at crucial tasks required
required of of parents;
parents; this
this leads
leads to increased frustration
to increased frustration
levels,
levels, lowered beliefs in
lowered beliefs self efficacy,
in self efficacy, and and perhaps,
perhaps, aa perception
perception that that the
the child
child
has
has more
more power power than than they
they do (Bugenthal &
do (Bugenthal Shennum, 1984)
& Shennum, 1984).. Effective
Effective parents
parents
also
also have
have aa positive
positive bias in their
bias in interpretations of
their interpretations events involving
of events involving their their children
children
that,
that, together
together with with their developmentally sensitive
their developmentally sensitive schemata
schemata and parenting skills,
and parenting skills,
allows them
allows them to maintain aa relatively
to maintain relatively positive
positive affective
affective state
state and
and to make adaptive
to make adaptive
and positive responses,
and positive responses, even even when
when aversive
aversive child
child behaviors
behaviors are are involved.
involved. For For ex-
ex-
ample, when
ample, when such such parents
parents find find that
that their 3-year-old has
their 3-year-old spilled milk,
has spilled milk, they
they will
will
draw
draw on on their understanding that
their understanding that 3-year-olds
3-year-olds have trouble holding
have trouble holding onto onto objects
objects
(Le., aa schemata
Ii.e., schemata regarding
regarding the the motor skills of
motor skills of 3-year-olds)
3-year-olds) and and will
will make
make attribu-
attribu-
ETIOLOGICAL THEORIES IN
ETIOLOGICAL THEORIES INTRAFAMILIAL CHILD
IN INTRAF.AMILIAL ClllLD MALTREATMENT
MALTREATMENT 25
25

tions
tions toto developmental
developmental factors factors Ie.g.,
(e.g., "She's only 3.")
"She's only 3.") or external factors
or external outside
factors outside
both
both their
their own
own and their children's
and their children's control,
control, thus
thus reducing stress and
reducing stress and frustration.
frustration.
Their script
Their script regarding
regarding parenting
parenting is is one
one in in which parents are
which parents are to
to be
be patient
patient in such
in such
situations and,
situations and, at at the
the same
same time,
time, they
they are are forgiving
forgiving of of themselves
themselves when when they they
experience
experience frustration.
frustration. AbusiveAbusive parents
parents havehave aa negative
negative biasbias and
and will often attri-
will often attri-
bute
bute their
their children's
children's mishaps mishaps to to spitefulness
spitefulness or or their
their own
own inadequacy
inadequacy to to get
get their
their
children
children to "mind" them
to "mind" them (Larrance
(Larrance & Twentyman, 1983).
& Twentyman, Such attributions
1983). Such attributions by by
abusive
abusive parents further contribute
parents further contribute to to their becoming overly
their becoming overly frustrated
frustrated and feeling
and feeling
ineffective
ineffective in in encounters
encounters with with their children. Thus
their children. Thus,, appropriate schemata, adap-
appropriate schemata, adap-
tive
tive attributions,
attributions , and and aa wide repertoire of
wide repertoire of childrearing
childrearing strategies
strategies andand problem-
problem-
solving skills
solving combine to
skills combine to produce
produce aa situation
situation in which parents
in which parents areare attuned
attuned to to the
the
developmental
developmental needs needs of of their children, can
their children, can discriminate situations where
discriminate situations where inter-
inter-
vention is required and where it is not not,, and are capable of meeting parenting
tasks more calmly, flexibly, flexibly, and and successfully. Lack of complexity and precision
in
in cognitive processing may
cognitive processing may contribute
contribute to to parental
parental maltreating behavior, dis
maltreating behavior, dis--
satisfaction in their roles as parents, inept parenting
satisfaction in their roles as parents, inept parenting more generally, and poor more generally, and poor
child outcomes.
Because
Because contextual
contextual stress stress may
may interfere further with
interfere further with cognitive processing, aa
cognitive processing,
positive
positive affective
affective state,state, andand parents' capacity to
parents' capacity respond optimally,
to respond optimally, parents
parents who who
are
are effective
effective alsoalso havehave skills
skills that
that help
help them
them to to handle
handle stress
stress well
well when
when it it does
does
occur, to develop buffers for themselves against its negative consequences, and
when
when possible,
possible, to anticipate and
to anticipate and prevent
prevent stressors
stressors from occurring in
from occurring the first
in the first
place.
place. For example, parents
For example, parents withwith optimal
optimal skills
skills may anticipate an
may anticipate an impending
impending
financial strain and adjust their budget accordingly, or when faced with a mari-
tal
tal breakup,
breakup, have have adequate
adequate social social skills
skills andand friends
friends to to provide
provide support
support and and toto
help
help them
them with parenting (e.g.,
with parenting alternative child
(e.g., alternative care). Such
child care). Such support
support networks
networks
have
have thethe added
added positive
positive effecteffect of providing information
of providing information to fine-tune parental
to fine-tune parental
schemata
schemata and introduce new
and introduce new behavioral
behavioral strategies
strategies through
through the the feedback
feedback and and role
role
modeling
modeling they provide. Unlike
they provide. Unlike effective
effective parents, maltreating parents
parents, maltreating parents are are more
more
impulsive
impulsive in their responses
in their responses (Rohrbeck
(Rohrbeck & Twentyman, 1986),
& Twentyman, 1986), andand this
this impul-
impul-
sivity,
sivity, together
together withwith poor poor problem-solving
problem-solving capacities
capacities and poor social
and poor social skills,
skills, re-
re-
sults in their experiencing many life stressors and having fewer social supports
to help them (Salzinger, Kaplan & & Artemyeff, 1983). Contextual stress and a
small
small social support network
social support surrounding the
network surrounding family also
the family also provides
provides the the child
child
with
with less
less opportunity
opportunity to to have
have alternative
alternative models
models and situations crucial
and situations crucial to to fur-
fur-
ther
ther development.
development.
Thus,
Thus, overall,
overall, this this model
model provides
provides explanations
explanations for for both
both parental
parental maladaptive
maladaptive
behaviors and
behaviors poor outcomes
and poor outcomes in in children.
children. As As stated,
stated, this model provides
this model provides explana-
explana-
tions for three
tions for three of the forms
of the forms of of child maltreatment (physical
child maltreatment (physical abuse,
abuse, neglect,
neglect, and and
emotional
emotional abuse),
abuse), and and for for many factors associated
many factors associated withwith sexually
sexually abusive behav-
abusive behav-
ior as well
ior as well (e.g.,
Ie.g., offender cognitive distortions,
offender cognitive social skill
distortions, social skill deficits,
deficits, and impulse
and impulse
control
control problems).
problems). AlthoughAlthough other other models
models have have posited
posited such
such aa developmental
developmental
perspective, arguing for
perspective, arguing for debilitating
debilitating and and compensatory
compensatory factorsfactors inin families
families at at risk
risk
for abuse and/or factors at multiple levels of analysis, this social cognitive model
prioritizes
prioritizes the area most
the area most in in need
need of of intervention
intervention and and thus
thus allows
allows forfor aa more
more tar-tar-
geted intervention strategy.
geted intervention strategy. Its Its continuum
continuum perspective
perspective allows
allows for for the
the develop-
develop-
ment
ment ofof prevention
prevention efforts efforts as as well.
well.
26
26 SANDRA T.
SANDRA T. AZAR et al.
AZAR et aI.

FUTURE DIRECfIONS
FUTURE DIRECTIONS

Progress has begun

Progress has begun to
to be
be made
made inin the
the development
development ofof more
more complex
complex models
models
of
of child
child maltreatment. Ultimately, well-validated
maltreatment. Ultimately, well-validated models
models for
for specific types of
specific types mal-
of mal-
treatment
treatment or
or for maltreatment more
for maltreatment more globally
globally would
would enhance
enhance both
both intervention and
intervention and
prevention
prevention efforts,
efforts, which until recently
which until recently have
have had
had aa "shot-gun"
"shot-gun" quality.
quality. More
More di-
di-
rective and
rective and empirically based interventions
empirically based interventions (e.g.,
(e.g., behavioral and cognitive
behavioral and cognitive behav-
behav-
ior approaches
ior have shown
approaches have shown the
the best
best outcomes.
outcomes.

ACKNOWLEDGEMENT
ACKNOWLEDGEMENT
The writing
The writing of
of this
this chapter
chapter was supported by
was supported by aa NIMH FIRST Grant
NIMH FIRST Grant Award (NIMH
Award (NIMH
grant
grant #MH46940)
#MH46940) to to the
the first
first author.
author.

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