Mother's feelings about infant's intentions may predict maltreatment

The extent to which an expectant mother believed that an infant behaved with negative intentions — dirtying his diaper on purpose, for example — increased the likelihood that she would mistreat her child, researchers reported.

“A pregnant woman’s hostile attributions about infant’s intentions signal risk for maltreatment and harsh parenting of her child during the first years of life,” the researchers wrote.

Lisa J. Berlin, PhD, of the University of Maryland School of Social Work, and colleagues examined the relationship between hostile attributions and child maltreatment and harsh parenting in 499 pregnant women who reported on attributions of positive and negative intentions of infants using an eight-item questionnaire. The questionnaire rated the extent to which mothers attributed hostile intent with respect to children’s behavior on a scale of one through five. Examples of the questions included, “Do babies seek praise when they do something clever?” and, “Do babies ignore their mothers to be annoying?”

Child maltreatment was assessed up to 26 months of age using official county records. The researchers used logistic regression analyses to establish the relationship between hostile attributions and child maltreatment.

Adjusting for demographic and psychosocial factors, Berlin and colleagues found that for every one-point increase in a mother’s hostile attributions, her child would face a 26% increased risk for maltreatment (adjusted OR=1.26; 95% CI, 1.02-1.56). Almost one-quarter of the children in the sample had mothers who received the maximum score for hostile attributions.

Results also indicated that mothers who reported more hostile attributions during pregnancy engaged in more harsh parenting behaviors when their children were toddlers (P<.05). Mothers who received the maximum score in hostile attributions had a 15% probability of reporting harsh parenting behaviors.

However, the two outcome measures of child maltreatment and harsh parenting were not significantly correlated. The researchers said harsh parenting may not be “sufficiently adverse” to predict maltreatment.

As a preventive measure, Berlin and colleagues said hostile attributions should be screened in mothers in formal and informal ways. For example, if a mother reports to her practitioner that her child is waking her up at night because he is “spoiled” or “naughty,” the practitioner could probe further to discover any more negative attributions.

“A brief reframing or more intensive parenting intervention addressing such topics may well be warranted,” the researchers said.

In an accompanying editorial, Joel S. Milner, PhD and Julie L. Crouch, PhD, of the Center for the Study of Family Violence and Sexual Assault in Northern Illinois University, said they questioned the effectiveness of the questionnaire used in the study, noting that the scoring algorithm may have difficulty differentiating between hostile and positive child-related attributions.

Milner and Crouch also said there was no specificity in the study about the types of maltreatment, but if the study sample were representative of national statistics, then about 70% of the cases would have been child neglect, which could explain why self-reported harsh parenting was not associated with child maltreatment because harsh discipline does not necessarily occur alongside child neglect as it does with child abuse.

Notwithstanding the validity of the questionnaire used in the study, Milner and Crouch said assessing hostile intent in mothers is important.

“We believe that the inventory merits further development, with perhaps a scoring algorithm that allows for a clearer differentiation of hostile and positive child-related attributions,” they wrote. “In addition to advancing our ability to assess maternal attributions of hostile intent for children’s behaviors, there remains a need for additional research on the methods that might have the greatest efficacy in changing maternal belief-based attributions, especially hostile attributions related to children’s behaviors.”

For more information:

Berlin LJ. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.1212.

Milner JS. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.1467.

The scale used in the study to screen for hostile attributions can be accessed here: http://www.childandfamilypolicy.duke.edu/engagement/maternal_beliefs.php.

Disclosure: The researchers report no relevant financial disclosures.