Child Maltreatment

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Child Maltreatment
DOI: 10.1177/1077559507305832
2007; 12; 303 Child Maltreat
Marie-Claude Larrive, Marc Tourigny and Camil Bouchard
Dysnormality
Child Physical Abuse With and Without Other Forms of Maltreatment: Dysfunctionality Versus
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The fact that most etiological studies of physical abuse have
not taken into account co-occurrence of different forms of
maltreatment calls into question the validity of our knowl-
edge on the subject. The aim of this study, therefore, is to
compare the etiological patterns of cases of physical abuse
reported to Quebec child protective services (CPS) according
to whether the abuse occurs alone or co-occurs with other
forms of maltreatment. The data are taken from the Quebec
Incidence Study (QIS), which examined 4,929 reports
investigated by Quebec CPS in the fall of 1998. The cases
included 514 children who were physically abused: 269 of
them were not subjected to any other type of maltreatment
and 245 were also victims of one or two other forms of mal-
treatment. The survey form provided information on more
than 30 characteristics of the children reported, their
families, and their parental figures. Bivariate and direct
logistic regression analyses revealed that the profile of physi-
cal abuse cases varies depending on whether the physical
abuse occurs alone (what we are calling dysnormality) or in
combination with one or two other forms of maltreatment
(dysfunctionality). Those results will help deepen our etio-
logical knowledge of physical abuse and may serve to inspire
different types of intervention for the two groups of children.
Keywords: child physical abuse; co-occurrence; etiology
The etiology of child maltreatment is complex: it is
related to a range of characteristics that demand a
broad understanding of the problem (Brown, Cohen,
Johnson, & Salzinger, 1998; Herrenkohl, Herrenkohl,
& Egolf, 1983; Mayer, 1997). The contemporary liter-
ature describes personal, family, and social character-
istics that are supposedly good predictors of physical
abuse (Black, Heyman, & Smith Slep, 2001; Brown
et al., 1998; Dufour, Massicotte, & Mayer, 2005). For
example, children who have behavioral problems or
difficult relationships with their parents are said to be
at greater risk; parents who are young, have unrealis-
tic expectations of their childrens development, or
resort to corporal punishment are thought to be more
likely to physically abuse their children; and children
living in neighborhoods with a high proportion of
low-income or single-parent families may be at greater
risk of physical abuse.
As interesting as this list of etiological characteris-
tics associated with physical abuse may be, an increas-
ing number of researchers are uncomfortable with it.
Daro (1988) points out that sociofamilial etiologies
or typologies that distinguish families by forms of
maltreatment have failed to take into account cases
in which there is more than one form of maltreat-
ment. In fact, in the vast literature on the subject,
Child Physical Abuse With and Without Other
Forms of Maltreatment: Dysfunctionality
Versus Dysnormality
Marie-Claude Larrive
Member, GRAVE-ARDEC
Marc Tourigny
Universit de Sherbrooke
Camil Bouchard
Universit du Qubec Montreal
CHILD MALTREATMENT, Vol. 12, No. 4, November 2007 303-313
DOI: 10.1177/1077559507305832
2007 Sage Publications
Authors Note: The authors would like to thank the Quebec
Director of Youth Protection caseworkers for their invaluable help
with this project.
303
studies that tell us anything about co-occurrence of
maltreatment or mult-type maltreatment are rare (Higgins
& McCabe, 2001; National Research Council, 1993;
Ney, Fung, & Wickett, 1994; Rossman, Hughes, &
Hanson, 1998). Some researchers believe that
co-occurrence is fairly frequent among maltreated
children (Barnett, Manly, & Cicchetti, 1991; Briere &
Runtz, 1990; Higgins & McCabe, 2001; Kinard, 1994,
1998; Mash & Wolfe, 1991; Silverman, Reinherz, &
Giaconia, 1996; Trickett & McBride-Chang, 1995).
For example, in studies of children enrolled at a sum-
mer camp, children using health-care services, or
children taken into the child protective services
(CPS) system, estimated rates of multitype maltreat-
ment range from 34% to 95% (Manly, Kim, Rogosch,
& Cicchetti, 2001; McGee, Wolfe, Yuen, Wilson, &
Carnochan, 1995; Ney et al., 1994; Van Hasselt,
Ammerman, Glancy, & Bukstein, 1992).
If co-occurrence of different forms of maltreat-
ment is that frequent, it seems likely that some pro-
portion of the studies of physical abuse would be
based on samples of children who were solely victims of
physical abuse (PA) as well as children who were victims of
physical abuse plus other forms of maltreatment (PA+).
That, at least, is the hypothesis we have formulated on
the basis of a review of studies of physical abuse
reported to North American CPS agencies that have
clearly distinguished cases of physical abuse alone
from cases of multitype maltreatment (Larrive, 2005).
According to the eight studies reviewed, co-occurrence
is found in an average of 57% of cases of physical
abuse (minimum 24% and maximum 85%).
Any attempt to determine the extent of co-occurrence
in cases of physical abuse runs up against the
methodological problem of a mixed sample (Jonson-
Reid, Drake, Chung, & Way, 2003; Mash & Wolfe,
1991), which arises when a child experiences more
than one form of maltreatment but only one form is
identified (Jonson-Reid et al., 2003). This is the case,
for instance, in some studies based on administrative
data generated by CPS. The architecture of comput-
erized information systems often reduces the classifi-
cation of maltreatment to one main form, although
there may well be several forms of abuse involved
(Barnett et al., 1991).
The large number of unidentified mixed samples
casts serious doubt on the validity of our etiological
knowledge, which very likely does not reflect the
specificity of physical abuse that occurs alone. There
may well be evidence of risk factors (or correlates)
associated with samples that are either specific or
mixed, but we cannot tell which are which. From a
statistical standpoint, if the etiology of the cases of
physical abuse that occur alone is different from that
of cases of physical abuse that occur along with other
forms of maltreatment, then the interaction compo-
nents between group differences and risk factors are
in the error term. That, at least, is the hypothesis that
we have formulated on the basis of data obtained
from the only three CPS studies we are aware of that
document the correlates of physical abuse by clearly
distinguishing cases in which it occurs with and with-
out other forms of maltreatment (Bath & Haapala,
1993; DiLauro, 2001; Hartley, 2002).
These data paint two different etiological pic-
tures, depending on whether the physically abused
children are victims of other forms of maltreatment
or not. Physically abused children who are also neg-
lected (PA+Neg) (Bath & Haapala, 1993; DiLauro,
2001) or exposed to spousal violence (PA+SV)
(Hartley, 2002) seem to have more negative sociode-
mographic characteristics (single-parent, low-income
family) and live in a more difficult family climate
(higher parental stress, more episodes of spousal
violence) than those who are only physically abused.
Similarly, such children and their parental figures
seem to have more physical and mental health prob-
lems. These results corroborate those reported by
Daro (1988) and Higgins and McCabe (2000) (who
distinguished between forms of abuse that occurred
alone and cases of co-occurrence but without speci-
fying the different forms of maltreatment): multi-
type maltreatment seems to be associated with
families that have more problems.
The data obtained by Bath and Haapala (1993),
DiLauro (2001), and Hartley (2002) suggest that the
exhaustive list of characteristics associated with cases
of physical abuse, as seen in the contemporary liter-
ature, should be split into two lists, one for cases of
physical abuse that occurs with other forms of
maltreatment (PA+) and another for cases without
co-occurrence (PA). The small number of studies on
which this observation is based, and especially the
small samples from which this differential picture
emerges (60 to 292 children) and the use of only
bivariate analysis, means that caution should be used
in interpreting the differences noted between the
two groups of physically abused children. Our scien-
tific knowledge of this area is still embryonic. As a
result, it is currently hard to provide CPS agencies
with information adapted to the profile of physically
abused children, that is, which takes into account
whether they are solely physically abused or the vic-
tims of more than one form of maltreatment. In
short, Belskys (1993) statement that one focus for
future research would be to more clearly specify the
nature and degree of comorbidity and the conditions
that give rise to it (p. 413) still seems to apply.
304 Larrive et al. / PHYSICAL ABUSE AND CO-OCCURRENCE
CHILD MALTREATMENT / NOVEMBER 2007
OBJECTIVE
The main objective of this study is to contribute to
more specific knowledge about cases of physical
abuse reported to CPS by taking into account co-
occurrence. We aim to identify the characteristics
that distinguish the cases of children who are solely
physically abused (PA) from those of physically
abused children who are also the victims of other
forms of maltreatment (PA+) (neglect, sexual abuse,
abandonment, psychological abuse, or other).
METHOD
Sample
The data are taken from the Quebec Incidence
Study of Reported Child Abuse, Neglect, Abandonment
and Serious Behavioural Problems (QIS) (Tourigny
et al., 2002), which prospectively documented
9,790 reports received between October 1 and
December 31, 1998, by 16 of the 19 CPS centers in
Quebec.
During the survey period, CPS investigated 4,929
reports. The sample used in the study consists of all
the substantiated cases of physical abuse (N = 514)
brought to the attention of CPS during the survey
period. Of this number, 269 (52%) were solely phys-
ically abused, while there was co-occurrence of phys-
ical abuse and other forms of maltreatment in 245
(48%) cases.
In the few cases where there was more than one
report concerning the same child during the survey
period, we chose the earliest report. The unit of
analysis is therefore the child and not the report.
This choice is in line with Quebecs official strategy
for receiving and handling reports.
Procedure
When a report is investigated, a caseworker looks
into the allegations and determines whether they are
substantiated. The caseworker also has a legal
responsibility to investigate not just the primary com-
plaint but also whether the child has suffered other
forms of maltreatment. The caseworker then ana-
lyzes the situation in terms of the consequences to
the child and of the parents capacities and living
conditions, and makes a decision as to whether the
childs safety or development is compromised
(Ministre de la Sant et des Services sociaux, 1998).
The Child Well-Being Scale (Vzina & Bradet, 1990),
a validated tool designed for the systematic assess-
ment of these aspects, supports the caseworker in his
investigation. For the QIS, at the very end of each
investigation, caseworkers (n = 814) filled out a survey
form,
1
for which they had received 3 hours of train-
ing to introduce them to the study and review the
form and data collection procedures. A training
video was available in each CPS unit. To help them
complete the survey form, caseworkers could also
refer to a guidebook explaining each question and
consult a regional research assistant. It took an aver-
age of 20 minutes to complete the form. The mean
completion rate for investigated reports was 86%.
Instrument
The survey form, designed for the purposes of the
QIS, was largely based on those of similar surveys,
such as the Ontario Incidence Study (Trocm,
McPhee, & Tam, 1995), the Canadian Incidence
Study (Trocm, Tourigny, MacLaurin, & Fallon,
2003), and the American National Incidence Study
(Sedlak & Broadhurst, 1996). The Child Well-Being
Scale (Vzina & Bradet, 1990) was another major
source of inspiration.
The form consisted of 52 questions about the
report, the child, his or her living environment,
parental figures, abuse, and decisions made after
investigation.
The form gave uniform clinical definitions of six
forms of abuse (physical abuse, sexual abuse, neg-
lect, abandonment, psychological abuse, other) that
go beyond the legal definitions in force in Quebec.
Physical abuse was described in terms of six clinical
categories: (a) abusive corporal punishment, the use of
physical force to correct the child; (b) excessive phys-
ical deprivation, depriving the child of food or water;
(c) excessive physical restrictions, locking the child in;
(d) irrational, impulsive brutality, assaulting the child
in a disorganized emotional state unrelated to the
childs behavior; (e) shaken baby syndrome; and (f) any
other type of physical abuse.
To ensure that cases involving multiple forms of
maltreatment were tracked, the survey form had
room to detail up to three types of maltreatment,
and for each of them, the caseworker could make a
clinical judgment of whether the allegation was sub-
stantiated or not. This study examines substantiated
cases of physical abuse, that is, cases for which there
was sufficient evidence that the physical abuse had
actually taken place.
Dependent Variable
Among the 514 children whose cases involved at least
one form of substantiated physical abuse, co-occurrence
was defined as the presence of one or two other forms of
substantiated maltreatment (n = 245) (sexual abuse,
neglect, abandonment, psychological abuse, other) (see
Table 1). Table 2 shows the breakdown of categories
Larrive et al. / PHYSICAL ABUSE AND CO-OCCURRENCE 305
of physical abuse according to whether there was a
co-occurrence of another form of maltreatment.
Independent Variables
We selected 32 variables to determine the differ-
ential etiological patterns of cases of physical abuse
occurring alone or with other forms of maltreat-
ment. These variables were chosen for the frequency
with which they appeared in the literature as risk fac-
tors associated with physical abuse and other forms
of maltreatment (Black, Heyman, & Smith Slep,
2001, 2001a; Schumacher, Smith Slep, & Heyman,
2001). Furthermore, given the small number of stud-
ies surveyed (Bath & Haapala, 1993; DiLauro, 2001;
Hartley, 2002), we were careful to select variables
that made it easier to draw comparisons with those
used in these three studies as well as with other large-
scale incidence studies (Sedlak & Broadhurst, 1996;
Trocm, McPhee, & Tam, 1995; Trocm et al., 2003).
However, considering what is known about the cooc-
currence of cases of physical abuse, some variables
that do not appear in the survey of the literature
were also selected. This was true of the following
variables: CPS intervention, number of problems
experienced by reported child, mean number of
problems experienced by parental figures living with
child, cooperation of parental figures during CPS
investigation, and duration of maltreatment.
All variables have acceptable metric qualities in
terms of variance and missing data (less than 10%).
The 32 selected variables were grouped into four
broad categories: (a) characteristics of the reported
child, (b) characteristics of the family, (c) character-
istics of the parental figures living with the child, and
(d) characteristics of the physical abuse (see Table 3).
Analytical Strategies
Chi-square tests and t tests were first performed to
compare the children who were solely physically
abused with those who were also victims of other
forms of maltreatment, based on the 32 variables.
The comparisons revealed 23 significant differences
(p < .10) between the two groups of children. We
then performed a direct logistic regression analysis
to control for colinearity between the 23 variables.
An examination of multiple correlations revealed
that the tolerance for two variables was problematic
(less than 0.20). As a result, those two variables (num-
ber of problems experienced by the reported child and mean
number of problems experienced by parental figures living
with the child) were eliminated to avoid a problem of
multicolinearity. We therefore used 21 variables in
the regression analysis to assess the unique contribu-
tion of each variable to the explanation of the pres-
ence or not of co-occurrence in cases of physical
abuse. The asterisks in Table 3 identify the 21 vari-
ables examined.
Direct logistic regression analysis was performed
solely on cases not missing any data on any of the 21
variables selected. This condition brought the number
of children down from 514 to 426, an attrition rate of
17% of the original sample. A check was done to deter-
mine whether the cases of children excluded from the
regression analysis (n = 88) were significantly differ-
ent from those included (n = 426), on the basis of all
32 selected variables. The series of chi-square tests and
t tests (with Bonferroni correction: p = .05/32 = .002)
indicates that only 2 of the 32 variables significantly
distinguished the two groups of children. Fewer of the
excluded children (26%) than the included children
(54%) had been abused by their fathers [
2
(1, N =
514) = 21.3, p < .002], whereas more of the
excluded children (19%) than the included children
(7%) were abused by a relative or person outside the
family [
2
(1, N = 514) = 12.3, p < .002].
TABLE 1: Proportional Co-occurrence of Child Physical Abuse
(PA+) with Other Forms of Maltreatment (n = 245)
Form of Maltreatment n %
Physical abuse + psychological abuse 79 46.7
Physical abuse + neglect 78 46.1
Physical abuse + abandonment 5 3.0
Physical abuse + sexual abuse 4 2.4
Physical abuse + other form of maltreatment 3 1.8
Co-occurrence = 1 169 100.0
Physical abuse + neglect + psychological abuse 61 80.3
Physical abuse + abandonment + psychological abuse 8 10.5
Physical abuse + sexual abuse + psychological abuse 4 5.3
Physical abuse + neglect + sexual abuse 2 2.6
Physical abuse + neglect + abandonment 1 1.3
Co-occurrence = 2 76 100.0
TABLE 2: Categories of Physical Abuse with (PA+) or without
(PA) Co-Occurrence
PA PA+ Total
(n = 269) (n = 245) (N = 514)
Categories of physical abuse n % n % n %
Abusive corporal punishment 185 69.0 147 60.0 332 65.0
Excessive physical deprivation 1 0.4 8 3.0 9 2.0
Excessive physical restrictions 5 2.0 7 3.0 12 2.0
Irrational, impulsive brutality 72 27.0 80 33.0 152 30.0
Shaken baby syndrome 5 2.0 3 1.0 8 1.0
Other type of physical abuse 1 0.4 0 0.0 1 0.2
TABLE 3: Name and Description of 32 Selected Variables
Name Description Categories or Interval
Characteristics of reported child
Gender
a
Age
Previous report
CPS intervention
Developmental disabilities
a
Learning difficulties
a
Mental health problems
a
Behavioral problems
a
Number of problems
Characteristics of family
Number of children
a
Family structure
Characteristics of parental
figures living with child
At least one parental figure is
step-parent
At least one parental figure is in
a difficult financial situation
a
immigrant
a
At least one parental figure
does not cooperate fully
a
victim of spousal abuse
a
At least one parental figure has
alcohol or drug problem
a
mental health problems
a
going through difficult
separation or divorce
a
social problems
a
physical health problem
financial problems a
involved in criminal activity
a
Mean number of problems
Characteristics of physical abuse
Context of physical abuse
a
Single incident
a
Number of other children
reported
Alleged perpetrator: mother
Alleged perpetrator: father
Alleged perpetrtor: stepparent
a
Alleged perpetrator: other
Number of alleged perpetrators
a
Child has been subject of investigated report in year before current
report
Child has been subject of CPS intervention in 5 years before current
report
Developmental delay or impaired hearing, vision or speech
Learning disorder or attention deficit and disruptive behavior
Psychiatric disorder or depression and/or anxiety
Violence toward others, running away, irregular school attendance, etc.
4 problems above plus any others (e.g., substance abuse-related birth
defects or chronic health condition)
Number of children in household (including reported child)
Two-parent family (e.g., original or adoptive family, blended family)
or single-parent family (one parental figure)
Mothers partner or fathers partner is living with child
Person receives welfare benefits or employment insurance or
has no income
Born outside Canada
During investigation, person actively resists any contact with agencies
or is only slightly involved in planning care and services
Person is or has been physically, sexually or verbally abused
Person abuses or has abused alcohol or illegal drugs
Person appears to have or to have had mental health problems
Person is going through difficult separation or divorce
Inadequate social or family support (social isolation or lack of social
support in crisis)
Person is or has been in delicate health (chronic disease, frequent
hospitalizations, etc.)
Person has or has had frequent or ongoing financial crises
Person engages in criminal activity (rape, prostitution, drug dealing, etc.)
8 problems above plus cognitive impairment and any other type of
problem (irregular lifestyle, gambling problems, etc.)
Physical abuse is abusive corporal punishment or any other category of
physical abuse (excessive physical deprivation or restrictions; irra-
tional, impulsive brutality; shaken baby syndrome; other type of
physical abuse)
Physical abuse is chronic (going on for at least six months) or is one-
time incident
Number of other children in same household reported at same time
or during investigation
Biological or adoptive mother
Biological or adoptive father
Mother's or father's partner
Relative or nonfamily
Number of alleged perpetrators from list above
male / female
0-17 years
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
0 to 5
0 to 10
two parents / single parent
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
dichotomy
0 to 10
disciplinary other
dichotomy
0 to 6
dichotomy
dichotomy
dichotomy
dichotomy
1 to 4
a. The 21 variables examined in the regression analysis.
NOTE: Dichotomy (yes/no). CPS = child protective services.
RESULTS
Table 4 shows the results of chi-square tests and
t tests comparing physically abused children with
(PA+) and without (PA) co-occurrence. Like the
adults taking care of them, the PA+ children seemed
to have more social and health problems and their
families were more likely to be financially insecure.
These children also suffered worse physical abuse
the situation was more likely to be chronicand
there were more siblings who could potentially have
been maltreated in the same way.
Table 5 shows the results of the direct logistic
regression analysis of the 21 variables selected.
Overall, the logistic regression model [
2
(21, N =
426) = 109.2, p < .01] significantly distinguishes
the children who were solely physically abused (PA)
from those who suffered physical abuse plus one or
two other forms of maltreatment (PA+). The model
correctly categorizes 69% of the 210 PA children and
69% of the 216 PA+ children. The results of the
regression show no problem with convergence and
the standard errors for parameters are not exceed-
ingly large. Therefore, no multicolinearity is evident.
Of the 21 characteristics selected, 8 favor belong-
ing to the (PA+) group of children. Boys were thus half
as likely as girls to be both physically abused and the
victim of one or two other forms of maltreatment.
Children with behavioral difficulties were also half as
likely as those without to be in the PA+ group. Having
an immigrant parent (rather than a parent born in
Canada) reduced a childs probability of being in the
PA+ group by more than half. Conversely, if at least
one parental figure failed to cooperate with the CPS
(versus parental figure who cooperate with the CPS)
or had economic problems (versus no economic
problem) or little social support (versus adequate
social support), the child was twice as likely to be a vic-
tim of PA+. Last, when the physical abuse occurred in
a disciplinary context (rather than in another context,
e.g., irrational, impulsive brutality, shaken baby syn-
drome, etc.), the probability of co-occurrence was
reduced by a third. When the physical abuse was a sin-
gle incident (rather than a chronic situation), the
probability was reduced by half.
DISCUSSION
Co-occurrence is a very real problem in the lives
of physically abused children reported to Quebec
CPS agencies: close to half of them suffered other
forms of maltreatment. The estimate of frequency
determined in our study (48%) is therefore close to
the mean estimate (57%) calculated on the basis of
the eight American studies reviewed (Larrive, 2005).
The large proportion of cases of co-occurrent
physical abuse strongly supports the hypothesis con-
cerning mixed samples that might not have been
identified in most etiological studies on physical
abuse. Mixed samples cast serious doubt on the
validity and specificity of etiological knowledge of
physical abuse that occurs alone. In fact, our find-
ings, most of which corroborate those of the three
studies reviewed (Bath & Haapala, 1993; DiLauro,
2001; Hartley, 2002), indicate that children who are
solely physically abused (PA) are different from the
others (PA+). Based on the results of bivariate analy-
ses, we suggest that the profile of cases of physical
abuse alone (PA) is evidence of what we refer to as a
dysnormal environment, whereas the profile of cases
of physical abuse co-occurring with one or two other
forms of maltreatment (PA+) is evidence of a dys-
functional environment.
Among children solely physically abused (PA), the
abuse seemed more often to occur in a context of
abusive corporal punishment. The children of this
group, most of them boys, displayed more behavioral
problems. Although we do not claim to have estab-
lished a causal relationship, it is possible that in some
cases, physical abuse may be precipitated by the
childs disruptive behavior (Herrenkohl et al., 1983;
Trickett & Kuczynski, 1986). The childs more erratic
behavior might overload the parents, who might
adopt an authoritarian parenting style and harsher
disciplinary measures (Urquiza & McNeil, 1996).
It is also possible that in other cases, abusive cor-
poral punishment may be associated with child-rear-
ing standards and disciplinary strategies not shared
by the majority of parents and citizens born and
raised in Canada. It has been observed that there are
a greater number of immigrant parents who engage
in abusive corporal punishment in the PA group
(82%) than in the PA+ group (52%) [
2
(1, n =
120) = 11.84, p < .01]. The cultural component
associated with the use of excessive physical force to
discipline or correct children has been documented
in some studies (Clment & Ct, 2004; Tourigny &
Bouchard, 1990).
In the group of children who were solely physi-
cally abused, the physical abuse was more frequently
a one-time occurrence rather than recurrent. The
larger proportion of single incidents may be associ-
ated with the presence in this group of a greater
number of abusers who were related to the child or
third parties in positions of authority. In these cases,
the physical abuse would not be likely to recur, as the
parents would take steps to protect their child from
these people. In other cases, abuse that occurs only
once may be more likely related to a temporary loss
of control on the part of the abuser (very often a par-
ent). Such parents may see corporal punishment as
a necessary means of correcting their childs behavior,
and their discipline crossed the line into abuse. A
meta-analysis has highlighted the close relationship
between corporal punishment and physical abuse
(Gershoff, 2002). A Quebec-wide telephone survey
indicates that the prevalence of serious physical vio-
lence is six times higher in families in which the
mothers questioned also reported minor physical
TABLE 4: Statistical Associations between 21 Variables and Presence (PA+) or Absence (PA) of Co-Occurrence in Cases of Physical
Abuse (N = 514)
PA (n = 269) PA+ (n = 245)
Characteristics of Reported Child n % N %
2
p
Previous report (yes) 48 18 48 20 0.4 0.533
CPS intervention (yes) 30 11 37 16 1.8 0.175
Gender (male) 154 58 118 49 3.7 0.055*
Developmental disabilities (yes) 17 7 32 13 6.4 0.012*
Learning difficulties (yes) 54 21 78 33 8.5 0.003*
Mental health problems (yes) 18 7 41 17 12.2 0.000*
Behavioral problems (yes) 57 21 36 15 3.7 0.056*
M SD M SD t p
Age (years) 9 4.6 8 4.5 1.4 0.159
Number of problems 0.6 0.9 0.9 1.0 -3.0 0.002*
Number of children 2.2 1.1 2.5 1.2 3.1 0.002*
n % n %
2
p
Family structure (single parent) 78 29 64 26 0.6 0.436
Characteristics of parental figures living with child
At least one parental figure . . .
is a stepparent (yes) 75 28 80 33 1.2 0.272
is in a difficult financial situation (yes) 131 53 165 69 12.9 0.000*
is an immigrant (yes) 78 30 42 17 11.5 0.001*
Does not cooperate fully (yes) 79 30 126 52 24.7 0.000*
is a victim of spousal abuse (yes) 75 28 110 45 15.7 0.000*
has an alcohol or drug problem (yes) 51 19 91 37 20.8 0.000*
has mental health problems (yes) 48 18 78 32 13.3 0.000*
is going through a difficult separation or divorce (yes) 69 26 82 34 3.6 0.058*
has social problems (yes) 31 12 87 36 41.2 0.000*
has a physical health problem (yes) 30 11 25 10 0.1 0.707
has financial problems (yes) 60 23 129 53 50.1 0.000*
is involved in criminal activity (yes) 20 8 38 16 8.2 0.004*
Mean number of problems 1.1 1.2 2.1 1.4 -7.7 0.000*
Number of other children reported 0.8 1.1 1.2 1.2 3.7 0.000*
Number of alleged perpetrators 1.2 0.5 1.3 0.5 1.4 0.160
n % n %
2
p
Alleged perpetrators:
Mother (yes) 118 45 120 49 1.0 0.314
Father (yes) 131 49 120 49 0.0 0.918
Stepparent (yes) 40 15 52 21 3.2 0.072*
Other perpetrator (yes) 31 12 15 6 4.8 0.028*
Context of physical abuse (disciplinary) 185 69 147 60 4.3 0.038*
Single incident (yes) 76 32 37 16 15.6 0.000*
*p < .10.
NOTE: Missing data percentage ranges from 0% to 10%.
violence than in families in which the mother did
not report minor incidents (12% vs. 2%) (Clment,
Bouchard, Jett, & Laferrire, 2000). Last, the larger
proportion of one-time incidents of physical abuse
may perhaps indicate that the process of maltreat-
ment is just beginning in the PA group, whereas it
may be more advanced in the PA+ group, in which
other forms of maltreatment in addition to physical
abuse are more often accompanied by recurrent
physical abuse.
These various observations suggest that the etiol-
ogy of physical abuse that occurs alone more often
goes back to child-rearing practices that diverge
from the prevailing social standards, even though
the childs immediate surroundings may not be
severely pathological, disorganized, or morbid. Keep
in mind that the parents of children who are solely
victims of physical abuse have fewer problems of any
kind and are more co-operative with CPS. In fact,
one of Tourigny and Bouchards (1990) conclusions
is that at a given socioeconomic level, Haitian immi-
grant families reported chiefly for physical abuse are
more stable and have fewer problems than French-
Canadian Quebeckers. This suggests that in the PA
group, physical abuse may be the expression of
instrumental assault (Mammen, Kolko, & Pilkonis,
2002). We would then be dealing with situations of
what we call dysnormality, in which abuse would be
more attributable to parents whose child-rearing
standards or repertoire of disciplinary strategies put
the child at risk and cross the line into what prevail-
ing social standards consider to be abuse.
Dysfunctionality seems to be more applicable to the
surroundings of children who are victims of both physical
abuse and other forms of maltreatment (PA+). In this
group, the children more often seem to suffer as a
result of irrational, impulsive brutality (rather than
abusive corporal punishment) (see Table 2).
According to this clinical category of physical abuse,
parents physically abuse their child more often when
they are emotionally disorganized, under the influ-
ence of alcohol, or extremely frustrated. It is possible
that in this group, physical abuse is more frequently
the expression of impulsive, emotional aggression
(Mammen et al., 2002).
Furthermore, the high rate of psychological abuse
in this group of children (62%) (see Table 1) and
the recurrence of physical abuse suggest that the
TABLE 5: Results of Direct Logistic Regression Analysis of 21 Variables Predicting Cases of Children Suffering Physical Abuse Plus
One or Two Other Forms of Maltreatment (PA+)
Variable SD Wald Odds Ratio
Characteristics of reported child
Gender (male) 0.74 0.24 9.61** 0.47
Developmental disabilities (yes) 0.32 0.41 0.60 1.37
Learning difficulties (yes) 0.54 0.29 3.54 1.72
Mental health problems (yes) 0.48 0.39 1.52 1.61
Behavioral problems (yes) 0.63 0.31 4.02* 0.53
Number of children 0.08 0.16 0.25 1.08
Characteristics of parental figures living with child
At least one parental figure . . .
is in a difficult financial situation (yes) 0.27 0.25 1.16 1.31
is an immigrant (yes) 0.73 0.30 5.76* 0.48
does not cooperate fully (yes) 0.66 0.25 7.07** 1.93
is a victim of spousal abuse (yes) 0.01 0.26 0.00 0.99
has an alcohol or drug problems (yes) 0.24 0.29 0.70 1.28
has mental health problems (yes) 0.03 0.28 0.01 0.97
is going through a difficult separation or divorce (yes) 0.03 0.27 0.01 0.97
has social problems (yes) 0.74 0.31 5.70* 2.09
has financial problems (yes) 0.73 0.26 7.99** 2.08
is involved in criminal activity (yes) 0.13 0.42 0.09 1.14
Number of other children reported 0.11 0.16 0.49 1.12
Alleged perpetrators:
Stepparent (yes) 0.17 0.30 0.32 1.18
Other perpetrator (yes) 0.03 0.48 0.00 0.97
Context of physical abuse (disciplinary) 0.50 0.24 4.45* 0.60
Single incident (yes) 0.68 0.28 6.00* 0.51
(Constant) 1.75 0.55 10.07**
*p < .05. **p < .01.
incidents of physical abuse take place in a context of
persistent parental emotional distress. Many more
parental figures in this group also have various prob-
lems, such as spousal abuse, substance abuse, crimi-
nality, mental health problems, separation or
divorce, or a lack of social support. In this group, the
parental figures are also much more likely to be fac-
ing overwhelming financial problems. Poverty or low
income is a major stress factor, which may make it
more difficult for those in this group to fulfill their
parenting role, all the more so as they have twice as
many problems as the parents of physically abused
children without co-occurrence. Parental stress has
been repeatedly associated with physical abuse
(Whipple & Webster-Stratton, 1991). As to the
children themselves, more of them have develop-
mental disabilities, learning difficulties, or mental
health problems. The childrens difficulties require
more attention and care from parents who are
already struggling to cope with their own problems.
Add to that the fact that the parents in this group
also have more children to take care of. Parental
stress in this group may be related to chronic rather
than temporary conditions. The family environ-
ments also seem to be more dysfunctional, although
the parents are more often unwilling to cooperate
with CPS.
The profile of dysnormality versus dysfunctionality is
supported when the same data are subjected to
direct logistic regression. This type of very conserva-
tive analysis does not attribute shared variance (col-
inearity) to any variable, which explains why the
model produced is stripped down from 21 to 8 sig-
nificant differences.
As far as we know, our study is the first to associate
cases of physical abuse that occurs alone (PA) with
an aspect of dysnormality. With regard to dysfunction-
ality associated with physical abuse co-occurring with
other forms of maltreatment (PA+), our results cor-
roborate those of the three studies reviewed, which
found that in such cases, the family and environment
had serious shortcomings (Bath & Haapala, 1993;
DiLauro, 2001; Hartley, 2002). Our findings also sup-
port the observations of other researchers who have
studied co-occurrence without regard to the form of
maltreatment (Daro, 1988; Higgins & McCabe,
2000). Research on maltreatment has already shown
that maltreating families are obviously dysfunctional
in many ways (Harter, 1998). Erickson, Egeland, and
Pianta (1989) have also discussed the difficulty in
separating maltreatment from family dysfunction.
Our findings describe this dysfunctionality more
specifically: it appears much more clearly in cases of
multitype maltreatment. The profile we are proposing
here is obviously not the first attempt to account for
heterogeneity in cases of physical abuse. Other
researchers have tried to illustrate distinct profiles of
families that are physically abusive (Oldershaw,
Walter, & Hall, 1989) or that resort to corporal pun-
ishment (Wissow, 2001). However, in their studies
these authors did not take into account the phe-
nomenon of multitype maltreatment.
This study, by proposing a framework for analyz-
ing the characteristics associated with physical abuse
according to whether this form of maltreatment
occurs alone (dysnormality) or along with other
forms of maltreatment (dysfunctionality), helps
enrich our scientific knowledge of the etiology of
physical abuse. Of course, this portrait is not
intended to be anything more than a basic concep-
tual point of reference that provides a very rough
map of the contours of the etiology of physical
abuse. We do not claim that it takes into account the
dynamics of all cases of physical abuse studied. It is
merely a guide, as Crittenden (1996) says: No
family fully fits any one pattern, and some maltreat-
ing families fit none of them (p. 169). In fact, our
findings show that cases in which physical abuse
occurs alone (PA) and in which it co-occurs with
other forms of maltreatment (PA+) partially share a
common etiology: It would be surprising if it were
otherwise. For example, it can be seen that in the AP
group, 27% of children were the victims of irra-
tional, impulsive brutality, whereas in the AP+
group, 60% of children suffered abusive corporal
punishment.
That said, our study had to deal with a number of
limitations. Given that our chosen unit of analysis
was the child, caution must be exercised in general-
izing findings specifically concerning the character-
istics of the family and parental figures, because
brothers or sisters living in the same home as the
reported child might have been reported at the
same time. It is possible that the interdependence of
these observations about family and parental charac-
teristics may have increased the probability of detect-
ing significant correlations among these very
characteristics. We must also take into account the
fact that all the data on the survey form were pro-
vided by a single informant, a CPS caseworker. That
said, despite potential interpretation biases, psycho-
metric research indicates that the assessments of CPS
caseworkers are generally sound (Alter, 1985; McGee
& Wolfe, 1990). Our study does not allow us to deter-
mine whether co-occurrent forms of maltreatment
actually occur at the same time as physical abuse,
that is, in the same episode, or whether the forms
occur sequentially, in separate episodes. What we do
know is that the different forms were assessed as part
of the investigation of a single report. Last, despite
the use of the term etiology in this study, it must be
kept in mind that the QIS is a cross-sectional study,
and that cases of physical abuse are compared
among themselves and not with a control group.
CONCLUSION
From what we have been able to determine from
our review of the literature, very few studies done
with CPS have been methodologically careful about
distinguishing cases of pure physical abuse from
co-occurrent cases. Our study, which avoids the trap of
mixed samples, makes a significant contribution to
work in progress. Our findings indicate that the etiol-
ogy of physical abuse as hitherto known did not really
take into account the specificity of physical abuse when
it occurs alone. Our research also raises questions
about the best casework strategies to address the needs
and problems of physically abused children and their
families, depending on the presence or absence of
other forms of maltreatment. For physically abusive
families, support and educational information, respect-
fully stated in terms of their own cultural standards,
would seem to be preferable, particularly for immi-
grant parents. For families where children are also sub-
jected to other forms of maltreatment, longer-term
protection and more intense casework would probably
be necessary, because chronic conditions seem to be
closely associated with family dysfunctionality.
NOTES
1. A total of 814 caseworkers completed the survey form for
the 4,929 investigated reports.
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