Implicit measures of child abuse and neglect: A systematic review
Introduction
Child abuse and neglect constitute the most common types of child maltreatment, with long-term impacts on child development (De Paúl and Guibert, 2008, Hildyard and Wolfe, 2002). While aggressive behavior is the hallmark of abusive parenting, child neglect is characterized by parental omissions regarding child physical and educational needs or failure to provide sufficient supervision. Over the last two decades, child maltreatment has been a topic of interest for many researchers involved in the study of the complex and often private dynamics of families' daily interactions. However, the main approaches underlying this assessment, frequently based on self-report and observational measures, are known to be influenced by a set of variables that often do not allow the accurate assessment of the parental cognitions that may shape parental abusive or neglectful behaviors (e.g., Russa & Rodriguez, 2010). More recently, and based on a social information processing model applied to child maltreatment (Crittenden, 1993, Milner, 1993, Milner, 2003), some researchers have been employing methods adapted from social cognition research, in an attempt to access the implicit and spontaneous information processing underlying child maltreatment. This paper aims to present a systematic review of the research conducted on child maltreatment using these types of methods that, along with self-report and observational methods, may contribute to a more effective comprehension of the phenomena.
Child abuse and neglect has long been a topic in the literature but it is only during the 90s that the scientific community started to focus the research on the definition and evaluation of abusive parenting (e.g. Cicchetti, 1991, Cicchetti and Lynch, 1995, Dubowitz et al., 1998, Milner, 1993).
Abuse and neglect are among the most prevalent forms of maltreatment. Internationally, the World Report on Violence and Health (WHO, 2002) gives an account of the large number of deaths of children due to parental neglect and abuse, particularly in the age group between 0 and 4 years old. For example, in Portugal in 2013, there were 18,910 child neglect cases referenced to child protection services (almost 30% of the references), and 6864 cases of physical and emotional abuse (about 16%; Comissão Nacional de Proteção de Crianças e Jovens em Risco, Camilo and Garrido, 2013). However, if we consider the likelihood of unreported cases, as well as the constrains in identifying these cases, these numbers are probably underestimated.
The assessment of maltreating parental practices remains therefore a big challenge for researchers and professionals. The traditional approaches used in child abuse and neglect domain have been observational methods or self and family reports (Russa & Rodriguez, 2010; see Calheiros et al., 2015, Garrido et al., 2016 for reports by laypersons and professionals). These metrics depend upon a conscious awareness of feelings, cognitions and behaviors towards the child and are influenced by social desirability (e.g. Fazio and Olson, 2003, Greenwald et al., 2002), in an attempt to avoid social judgments or even legal intervention (Portwood, 2006). Moreover, maltreating parents may have unrealistic expectations, perceptual biases about their interactions with their children, or misattribute their children's behavior (Hansen and MacMillan, 1990, Lau et al., 2006) that influence the reports. There are also problems associated with retrospective reporting, namely memory distortions caused by time passage or by the informant's knowledge of subsequent events (Bauer & Twentyman, 1985), making these type of reports susceptible to misrepresentation (Fazio & Olson, 2003).
Recently, in the context of child maltreatment, a social information-processing model has been applied to parent–child interactions, suggesting that abusive and neglectful parents may incur in biases or errors in the information processing during these interactions (Crittenden, 1993, Milner, 1993, Milner, 2003). In this model, parental cognitive representations are a key element in the explanation of child abuse and neglect. These cognitive representations refer to the knowledge structures that help people organize their experiences and respond to stimulus events. Furthermore, they are characterized by their automaticity and low level of awareness (Bugental, 1992, Sigel, 1985) because “knowledge that is deeply processed, and routinized and easily activated will be automatized” (McGillicudy-DeLisi & Sigel, 1995, p. 347). In the implicit social cognition literature, these representations are understood as implicit cognitions, that include unconscious effects of past experiences on feelings, thoughts and actions (Greenwald & Banaji, 1995) or evaluations with an unknown origin, that are activated in an automatic manner, which may influence people's responses in an uncontrollable manner (Wilson, Lindsey, & Schooler, 2000).
In order to reduce the influence that explicit assessment techniques usually have on participant's candor and accuracy (Fazio & Olson, 2003), implicit measures may constitute an important way to assess parental cognitive representations. As a way to infer mental contents without asking directly for a verbal report, implicit measures reveal the spontaneous influence cognitive representations have on behavior (De Houwer, 2006, Fazio and Olson, 2003).
Current theory and research offers a very well established set of experimental paradigms that provide access to cognitive processes occurring beyond conscious awareness using implicit measures (e.g. Gawronski, 2009, Greenwald and Banaji, 1995). In these implicit means of assessment, individuals are less certain of what is being assessed or how scores are measured, and thus providing a better experimental control (Fazio & Olson, 2003).
The characterization of these paradigms is dependent on several factors. Namely, the inherent automaticity in the procedures, the level of awareness of the mental process, the level of intentionality (control of the person over the starting of the mental process), the level of controllability (control of the person over the ending of the mental process), and the overall level of cognitive load present (Bargh, 1994). In an attempt to measure individual differences in psychological phenomena, implicit measures have been particularly important in the study of attitudes, stereotypes, close relationships and health behavior (for a review, see Fazio & Olson, 2003).
Priming paradigms are very popular in social psychology and are often used as an implicit measure to assess what is activated from memory during the presentation of some attitude object. Early studies began with semantic priming (Meyer & Schvaneveldt, 1971), inferring that the presentation of a stimulus that activates related concepts in memory, reduces the time to identify those concepts. For example, nurse is recognized more quickly following doctor than following bread. Very similar to this is the evaluative priming paradigm, based on the assumption that the automatic activation of the evaluation associated with a prime produces a processing advantage for evaluatively congruent targets (Fazio & Olson, 2003). Therefore, participants are faster to identify a positive target when the prime is positive, and faster to identify a negative target when the prime is negative. For example, when primed with “cockroach” participants are quicker to identify a negative target word (i.e., “disgusting”) as negative, but are slower to identify a positive target word (e.g., “appealing”) as positive (e.g., Fazio, Sanbonmatsu, Powell, & Kardes, 1986). Priming techniques therefore reveal the influence of the accessibility of a schema (prime-related mental constructs) in information processing activities (encoding, interpretations, response selection; Bargh & Chartrand, 2000). Other popular implicit measures include the Implicit Association Test (e.g., Greenwald, McGhee, & Schwartz, 1998); Affect Misattribution Procedure (e.g., Payne, Cheng, Govorun, & Stewart, 2005); Approach/Avoidance Tasks (e.g., Solarz, 1960, Chen and Bargh, 1999); Go/No Go Association Task (e.g., Nosek & Banaji, 2001), among others.
Psychophysiological approaches (e.g., Cacioppo, Petty, & Andersen, 1988) such as facial electromyography, startle eye blink, blood pressure, heart rate and skin conductance, also constitute implicit measures with applications in several research areas. These techniques assess the emotional reactivity of the participants to the object, indicating a change in some behavior or measure of bodily function (Weisse, Davidson, & Baum, 1989). For example, cardiovascular measures, such as electrocardiograph waveforms and respiration, have been used as an index of adaptive emotional regulation and responsiveness to the social environment, based on the assumption that the heart produces electric signals sensitive to affective states, motivation, attention and reflexes. Hemodynamic responses, specifically blood pressure, have also been used to index psychological states like stress, threat and effort. Skin conductance has been used to measure peripheral responses to the extent that electrodermal activity is a measure of eccrine sweat glands that can be used as an indicator of general arousal. Another popular measure is electromyography, namely facial electromyography that measures facial muscle activity associated with emotional expressions. The startle eye blink modification is also a very popular measure, assessing muscle activity of the lower lid reacting to a startling stimulus, indicating the valence of the stimuli (for a review, see Blascovich et al., 2011, Snowden and Barrett, 2006).
Implicit measures are already extensively used in social cognition literature and can be easily extended to child abuse and neglect assessment to complement the traditionally self-report methods.
In order to assess parental cognitions and information processing related to parent–child interactions, some research has been using implicit measures to examine parents' errors in emotion recognition (e.g., Asla, De Paúl, & Pérez-Albéniz, 2011), physiological arousal (e.g., Frodi & Lamb, 1980), biases in the perceptions and attributions about children (e.g., Hiraoka et al., 2014), and parents' aggressive behaviors (e.g., Crouch, Skowronski, Milner, & Harris, 2008).
This paper presents a systematic literature review about the research in child abuse and neglect conducted with these types of measures, providing a comprehensive knowledge about the contribution of cognitive factors to the explanation of child abuse and neglect. The specific goals of this review are: (a) to summarize the research with implicit measures applied to the study of child abuse and neglect; (b) to analyze the different variables, methodologies and procedures used in these studies; (c) to compare the results testing the same hypotheses; and (d) to discuss this literature in light of the criteria and recommendations for the use of implicit measures pointed out in the literature (e.g., De Houwer, 2006).
Section snippets
Information sources and search strategy
A systematic electronic search was conducted in six databases, namely Academic Search Complete, ERIC, PsycARTICLES, PsycINFO, Psychology and Behavioral Sciences Collection and Scopus with the following restrictions: published between January 1970 and April 2015, from academic journals and in English language. The studies were identified using all possible combinations of the following groups of search terms: (a) child abuse OR child neglect OR abusive parents OR child maltreatment OR low-risk
Results
As shown in Fig. 1, 33 manuscripts were included for further analysis in this review. In order to provide a clear organization of the literature reviewed the included articles were divided into three sections based on the type of dependent variable assessed. The first section presents studies that explored the affective dimension of parents' representations, namely parents' errors in emotion recognition and physiological arousal. The second section includes research examining the cognitive
General discussion
The assessment of child maltreatment has largely been based on self-report and observational measures, known to be influenced by a set of variables that may bias the identification of parental abusive or neglectful behaviors (e.g., Russa & Rodriguez, 2010). More recently a few studies have been adopting social cognition research methods, attempting to access to the implicit and unconscious processes underlying parents' information processing related to parent–child interaction. This paper
Acknowledgments
This work was funded by the Portuguese Foundation for Science and Technology with grants awarded to the first (SFRH/BD/99875/2014) and second (PTDC/MHC-PCN/5217/2014) authors and by a Marie Curie fellowship (FP7-PEOPLE-2013-CIG; Grant Number 631673) awarded to the second author. Authors would like to thank Behavior, Emotion and Cognition research group (Cis-IUL) members for the comments and suggestions made to a previous version of this manuscript.
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