Lessons Learned from LONGSCAN:
Findings from a 23-yr prospective study of
maltreatment antecedents and consequences
Desmond K. Runyan, MD, DrPH
The Kempe Center
The University of Colorado School of Medicine
1
Introduction
•
LONGSCAN Consortium
• LONGitudinal Studies in Child Abuse and Neglect
• Completed 20 year prospective study
• Website <http://www.iprc.unc.edu/longscan>
• Age 4-18 data currently available (Data Archive:
Cornell University)
Overview of LONGSCAN
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Planning grant funded in 1989
Congressionally mandated
Intended to address antecedents and
consequences
Planning grants to UNC and JPA of Chicago
Solution to which type of sample: yes
LONGitudinal Studies of Child Abuse & Neglect
5 distinct studies (East, South, Midwest,
Northwest , & Southwest)
3
•Each site has integrity as an independent study
•Collective efforts magnify impact
•Measurement & data coordinated at UNC
coordinating center
•Common measures, coding, training, data entry
•Committees for governance, measurement,
analysis, and publications/dissemination
For more information, see Runyan et al.
1998 Violence & Aggression
LONGSCAN Ecological Model
Current Status
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Data collection on-going for participants in
their 20’s
- Youth now 23 - 29 years old
Data archived with the National Data Archive
on Child Abuse and Neglect (NDACAN)
- Age 4, 6, 8, 12, 14, 16, & 18 interviews
Including CPS record reviews
Over 130 scientific papers
Over 25 dissertations
6
Measurement
• Guided by Social-Developmental-Ecological
Theory (NRC, 1993; Bronfenbrenner, 1989; Hawkins &
Catalano, 1996).
• Domains assessed:
• Child/Youth: Characteristics, functioning
• Caregiver: Characteristic, functioning
• Family microsystem: Home environment,
functioning
• Macrosystem: Neighborhood, school,
support
8
Measurement
• Multiple sources & methods
• Developed “just-in-time measurement batteries
developed at 2 year intervals since age 6
• Reports/ratings/questionnaires (Child/Youth,
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Caregiver, and Teacher)
Performance (Child/Youth)
Situational tests/samples
Official records (CPS)
• Presentation of measures
• Interview & Audio-Computer Assisted Self
Interview (A-CASI) began at age 12 for child
9
Lesson 1:
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Children reported to CPS don’t look good
early in life
 Development
 Cognition
 Behavior problems
10
Battelle Screener at Age 4
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Battelle Screener at Age 4 Percentages of Children with Total
Battelle Scores By Ranges (N= 1180)
Age 4 Peabody Picture Vocabulary Test
Revised - PPVT-R (N = 951)
% of Kids in the Normal/Borderline/Clinical
Range for CBCL T Scores (at Baseline, age 4 or 6)
Age 4, N = 1220
Age 6, N = 1218
% in Average, Moderately Low, or Very
Low Ranges on Vineland Screener
Age 6, N = 1208
Age 8, N = 1129
Age12, N = 952
Lesson 2:
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•
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A multi-site, multi-jurisdictional study has
measurement problems for abuse
Most maltreatment is of low severity
Majority of reported maltreatment happens
in early years
15
LONGSCAN Maltreatment Coding Scheme *
Physical Abuse
9 subtypes
Choking
Head
Burns
Torso
Shaking
Buttocks
Nondescript
Limbs
Violent handling
Sex Abuse
Subtypes
Neglect
Emotional Abuse
Moral / Legal / Educational Neglect
Failure to
Provide
Lack of
Supervision
Food
Hygiene
Clothing
Shelter
Medical
Environment
Substitute Care
Severity Codes 27
Detail Types
* Modified Barnett, Manly, Cicchetti Coding Scheme 1993
LONGSCAN Maltreatment Coding* For Severity
• Severity is Coded on a Scale of 1 (low) through 6 (high)
• Each severity code has specific meaning
• Example: Physical Abuse to the Head/Face/Neck
• Severity 1 =
• Severity 2 =
• Severity 3 =
• Severity 4 =
• Severity 5 =
• Severity 6 =
No marks indicated
Minor marks
Numerous or non-minor marks
Emergency Room or medical treatment
Hospitalization for more than 24 Hours
Permanent Disability or Death
* Modified Barnett, Manly, Cicchetti Coding Scheme 1993
# of Allegations (Official Reports) by
Maltreatment Type (birth through age 18)
# of Allegations
Based on Baseline
Sample (N = 1354)
Age
# of Substantiations
# of Substantiations (Official Reports) by
Maltreatment Type (birth through age 18)
Based on Baseline
Sample (N = 1354)
Age
Number of Allegations by Severity, Birth through Age 18
Level of Severity
Low
(% of rows)
Types of Allegations
1/2
Physical Abuse
1165 (77)
282 (19)
71 (5)
1,518(25)
Sexual Abuse
78 (19)
138 (34)
190 (47)
406 (7)
Neglect: Failure to
Provide
1645 (65)
512 (19)
425 (16)
2,642 (43)
Neglect: Lack of
Supervision
757 (50)
244 (16)
520 (34)
1,521(25)
Total (percents of
rows)
3,645 (60)
1,333 (22) 1049 (17)
(%) 3
(%)
High
4/5
Total
(% of col.)
(%)
6,087
Lesson 3:
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You have to ask the children to learn what
happened.
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% of Children Self-Reporting Physical Abuse
Interviews
Age 12
(N = 881)
Age 16
(N = 717)
Age 18
(N = 756)
% Concordance between Self-Reports and MMCS
Substantiations of Physical Abuse
% of Children Self-Reporting Sexual Abuse
Interviews
Age 12
(N = 874)
Age 16
(N = 709)
Age 18
(N = 756)
% Concordance between Self-Reports and
MMCS Substantiations of Sexual Abuse
% of Children Self-Reporting Psychological Abuse
Interviews
Age 12
(N = 883)
Age 16
(N = 705)
Age 18
(N = 751)
% Concordance between Self-Reports and
MMCS Substantiations of Psychological Abuse
Lesson 3:
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ACEs matter but maltreated children are off
the charts
ACEs have a different impact by age
 IPV explains 4% of depression & behavior
problems in 4-8 year olds while sexual abuse &
neglect explain less than 2%
 At age 12, psychological victimization explains
more distress
 Not until age 14 does sexual abuse or physical
abuse explain more of the problems
28
Types of Life Events
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Family Transitions
Family Stress
Exposure to Violence
Family Transitions (Living Environments)
Legal/Justice Involvement
Neutral/Positive
Mean # of Stressful Life Events In Preceding
12 Months and Mean Cumulative # of
Stressful Life Events At Each Assessment
Mean number of
stressful life events in
preceding 12 months
+
Cumulative mean
number of stressful
life events
Adverse childhood experiences
• Categories of childhood adversity (ages 4, 6, 8 and 12)
1. psychological maltreatment
2. physical abuse
3. sexual abuse
4. child neglect
5. caregiver’s substance/alcohol use
6. caregiver’s depressive symptoms
7. caregiver’s being treated violently
8. criminal behavior in the household
• Child health at age 12 (both child and caregiver report)
Adversity’s effects
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Greater adversities during before age 6 associated with the
age 12 reports of
• somatic complaints
• any poor health outcome
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Childhood adverse exposures after age 6 associated with
• any health complaint
• child reports of poor health
• child & caregiver reports of child somatic complaints
• illness requiring medical attention
Lesson 4:
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Foster care impact is complicated
 More placements = more behavior problems
 More behavior problems= more placements
 Adopted children had caregivers with more
resources, then kin care, then reunified families
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Multiple Placements
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415 children (2 to 16 at removal)
CBCL: Time 1 (6-mos) - Time 2 (18 mos)
DSS record review (# placements 18 mos)
Findings:
• 1 to 15 placements (mean=4.23)
• Child BPs predicted # subsequent placements
• # placements predicted subsequent BPs for those
who did not have them initially
(Newton, Litrownik, & Landsverk, 2000)
• Children reunified by age 4 have more internalizing
problems at age 6 than children in foster care
• Reunified children reported being more connected to
their social environment (e.g., peers, adults) than
those who stayed in foster care
• Reunified children exposed to:
• More violence
• More caregiver mental health problems
• Worse family functioning
• Lower levels of parental support
• More stressful live events
• Reunified children are less likely to receive mental
health services
Maltreatment’s effect on risky sexual behavior
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Maltreatment before age 12 is significantly
associated with early initiation of sexual
intercourse at ages 14 and 16.
• Same results for sexual abuse alone, and for all
maltreatment other than sexual abuse combined
Gender differences
• These relationships are the same for males and
females for sexual abuse, psychological abuse
and neglect.
• The relationship between physical abuse before
age 12 and sexual intercourse at ages 14 and 16
is less strong for boys.
Lesson 5: Sexual Abuse may or may not be
the most destructive form of abuse
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Sexual abuse, physical abuse, and
psychological abuse all linked to risky
behavior
Externalizing behaviors less prominent over
time
Internalizing behavior problems become
more prominent
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Maltreatment’s effect on risky sexual behavior
at 16
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History of sexual abuse associated with risky
behavior.
Physical & emotional abuse, but not neglect
or witnessed violence, each contributed to
risky behavior (alcohol use & sexual
intercourse combined) over sexual abuse.
Child gender did not moderate the findings.
Health and risky behaviors (age)
Maltreated
(%)
7.5
Not maltreated
(%)
2.6
Delinquency (18)
5.7
3.9
Substance use (14)
8.7
7.0
Any criminal behavior (16)
46.9
37.1
Weapon (18)
25.5
16.9
Serious health problem (16)
34.8
27.1
Aggression (18)
CBCL Externalizing Scores by Age & Abuse
Status
19
17
S
C
O
R
E
15
Sex Abuse
13
CPS (no sex
abuse)
No CPS Reports
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9
7
5
6
8
10
12
14
16
Age
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CBCL Internalizing Scores by Age & Abuse Status
12
11
10
9
Sex Abuse
CPS (no sex abuse)
No CPS Reports
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7
6
5
4
6
8
10
12
14
16
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Lesson 6:
Adult evidence for GI disease associated with
abuse is already present in childhood
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Maltreatment and GI symptoms
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CPS sexual abuse allegations associated with
abdominal pain at age 12 years.
• Sexual abuse occurred before or with abdominal
pain significantly more than after it.
Youth report of ever having been psychologically,
physically, or sexually abused significantly
associated with both abdominal pain and
nausea/vomiting.
Lesson 7
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Child abuse does predict mental health
issues
Most maltreated children look normal later
in life
45
Early maltreatment
strongly predicts
depression/anxiety
symptoms through
age 12.
• Children with early
maltreatment get
worse over time.
• By age 10, dramatic
differences
between the
groups.
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% of Kids in the Normal/Borderline/Clinical
Range for Child Behavior Checklist T Scores
Age 4, N = 1220
Age 6, N = 1218
Age 8, N = 1124
Lesson 8: Suicide
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12-21% of age 8 maltreated youth express
suicidal thoughts
 Witnessing family violence, neglect, physical
abuse, & residential instability predict age 8
suicidal thoughts (not sexual abuse)
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Proportions similar at age 16
 Physical abuse, sexual abuse, psychological
abuse, & witnessing community violence predict
suicidal thoughts (not family violence)
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LONGSCAN was a remarkable experience with multiple
findings
– most previously documented in cross-sectional or
retrospective studies but confirmed
-major lessons about scope of risk and harm
Major lessons about measurement of exposure
-major lessons about social capital, networks and fathers
Most of our data are still untapped