Diversity in adjustment of maltreated children - Department of ...
Diversity in adjustment of maltreated children - Department of ...
Diversity in adjustment of maltreated children - Department of ...
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Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812<strong>Diversity</strong> <strong>in</strong> <strong>adjustment</strong> <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>:Factors associated with resilient function<strong>in</strong>gMary E. Haskett ⁎ , Kennard Nears, Caryn Sabour<strong>in</strong> Ward, Andrea V. McPhersonNorth Carol<strong>in</strong>a State University, United StatesReceived 16 September 2005; received <strong>in</strong> revised form 3 February 2006; accepted 3 March 2006AbstractMany decades <strong>of</strong> research <strong>in</strong>dicate that physical abuse and neglect are associated with substantial risk for maladaptation acrossmany developmental tasks <strong>of</strong> childhood, adolescence, and adulthood. Recent <strong>in</strong>vestigations, however, <strong>in</strong>dicate that <strong>in</strong> spite <strong>of</strong>elevated risk for negative outcomes, some abused and neglected <strong>children</strong> demonstrate relatively positive <strong>adjustment</strong> and success <strong>in</strong>developmental tasks. An overview <strong>of</strong> studies <strong>of</strong> resilient function<strong>in</strong>g among <strong>maltreated</strong> <strong>children</strong> is provided, and results <strong>in</strong>dicatethat although a proportion <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> do appear to be resilient to harsh and <strong>in</strong>adequate caretak<strong>in</strong>g, resilient function<strong>in</strong>gmight be short-lived and/or limited to s<strong>in</strong>gle areas <strong>of</strong> function<strong>in</strong>g. A summary <strong>of</strong> factors associated with resilient function<strong>in</strong>gamong abused and neglected <strong>children</strong> is provided. Such factors <strong>in</strong>clude <strong>in</strong>dividual child characteristics (e.g., self-regulatoryprocesses), features <strong>of</strong> the child's family context (e.g., supportive parent<strong>in</strong>g), and experiences <strong>in</strong> the broader environment (e.g.,close friendships). Methodological considerations and recommendations for further research are provided, and implications <strong>of</strong> thisliterature for cl<strong>in</strong>ical and policy applications are presented.© 2006 Elsevier Ltd. All rights reserved.Several decades <strong>of</strong> research have documented adverse consequences <strong>of</strong> maltreatment for <strong>children</strong>'s developmentalstatus and psychological <strong>adjustment</strong>. The knowledge base generated by that research has been <strong>in</strong>strumental <strong>in</strong> progresstoward effective <strong>in</strong>terventions for <strong>maltreated</strong> <strong>children</strong>. Also important for develop<strong>in</strong>g successful treatments, however,is an understand<strong>in</strong>g <strong>of</strong> diversity <strong>in</strong> adaptation among <strong>maltreated</strong> <strong>children</strong>. Past research has largely ignoredheterogeneity <strong>in</strong> the quest to identify group differences between abused and nonabused <strong>children</strong>. In spite <strong>of</strong> that generaltrend there is a literature emerg<strong>in</strong>g that <strong>in</strong>dicates some <strong>children</strong> with a history <strong>of</strong> maltreatment demonstrate relativelypositive <strong>adjustment</strong> and even competent function<strong>in</strong>g <strong>in</strong> spite <strong>of</strong> the experience <strong>of</strong> maltreatment. This research isvaluable because studies <strong>of</strong> resilience <strong>in</strong> the presence <strong>of</strong> adversity can <strong>in</strong>form cl<strong>in</strong>ical practice and policy. Indeed,<strong>in</strong>terventions specifically designed to enhance factors associated with resilience have been designed <strong>in</strong> recent years(e.g., Cowen, Wyman, Work, & Iker, 1994; W<strong>in</strong>slow, Sandler, & Wolchik, 2005).In this review, a developmental perspective on risk and resilience (Sroufe, 1990) served to organize a literature thatis disjo<strong>in</strong>ted <strong>in</strong> terms <strong>of</strong> theoretical frameworks. Accord<strong>in</strong>g to organizational models, development is hierarchicallyordered such that early patterns <strong>of</strong> adaptation shape a child's success or failure <strong>in</strong> meet<strong>in</strong>g subsequent developmentaltasks. Although the organizational model implies cont<strong>in</strong>uity <strong>in</strong> adaptation over time, there is opportunity for <strong>children</strong> to⁎ Correspond<strong>in</strong>g author. <strong>Department</strong> <strong>of</strong> Psychology, Campus Box 7650, NC State University, Raleigh, NC 27695, United States.E-mail address: mary_haskett@ncsu.edu (M.E. Haskett).0272-7358/$ - see front matter © 2006 Elsevier Ltd. All rights reserved.doi:10.1016/j.cpr.2006.03.005
M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812797shift their general developmental trajectory given <strong>in</strong>terven<strong>in</strong>g experiences. Consistent with an organizationalframework, resilience has been def<strong>in</strong>ed as “good adaptation under extenuat<strong>in</strong>g circumstances and, from adevelopmental perspective, meet<strong>in</strong>g age salient developmental tasks <strong>in</strong> spite <strong>of</strong> serious threats to development”(Masten & Reed, 2002, p. 76).To <strong>in</strong>form readers <strong>of</strong> the typical developmental progress <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>, we provide a brief overview <strong>of</strong> thedisturbances abused and neglected <strong>children</strong> demonstrate as they strive to meet early developmental challenges. Next,reported rates <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong> are summarized. We then turn to a description <strong>of</strong> factorsassociated with competent adaptation or resilient function<strong>in</strong>g among <strong>maltreated</strong> <strong>children</strong>. The focus <strong>of</strong> this review ispeer-reviewed studies <strong>of</strong> resilient function<strong>in</strong>g among <strong>children</strong> who have experienced physical abuse and/or neglect,although some samples <strong>in</strong>cluded victims <strong>of</strong> sexual abuse as well. Studies that <strong>in</strong>cluded only sexually abused <strong>children</strong>were excluded because reviews <strong>of</strong> resilience among those <strong>children</strong> were already available (e.g., Wilcox, Richards, &O'Keefe, 2004). The majority <strong>of</strong> research <strong>in</strong>cluded was designed specifically to exam<strong>in</strong>e factors associated withresilience, but there are also relevant studies that address predictors <strong>of</strong> diverse function<strong>in</strong>g among <strong>maltreated</strong> <strong>children</strong>.Most <strong>of</strong> the latter studies were process-oriented <strong>in</strong>vestigations designed to identify mediators <strong>of</strong> the relation betweenmaltreatment and various developmental outcomes.1. Ability <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> to meet developmental tasksA primary developmental task <strong>of</strong> <strong>in</strong>fancy and early childhood is the formation <strong>of</strong> attachment relationships withcaregivers; quality <strong>of</strong> those relationships is associated with subsequent competence <strong>in</strong> social and emotional function<strong>in</strong>g(e.g., Parke & Ladd, 1992). Because the context <strong>in</strong> which <strong>maltreated</strong> <strong>children</strong> strive to develop early relations withparents is one <strong>of</strong> conflict, social isolation, and limited resources, it should not be unexpected that <strong>maltreated</strong> <strong>children</strong>show <strong>in</strong>secure attachment patterns (Morton & Browne, 1998) and a confused, conflictual pattern <strong>of</strong> relatedness toparents (Shields, Ryan, & Cicchetti, 2001). A second early developmental task is to ga<strong>in</strong> the ability to monitor,understand, and modulate affect <strong>in</strong> emotionally arous<strong>in</strong>g situations. Parents shape their <strong>children</strong>'s self-regulatoryfunctions by warm and sensitive care giv<strong>in</strong>g and through models <strong>of</strong> emotion expressivity and affect regulation(Contreras & Kerns, 2000). Given poor quality attachment comb<strong>in</strong>ed with limited discussion <strong>of</strong> emotion (Shipman &Zeman, 1999), and high rates <strong>of</strong> parental stress and depression (Whipple & Webster-Stratton, 1991) <strong>in</strong> the homes <strong>of</strong><strong>maltreated</strong> <strong>children</strong>, it follows that emotion dysregulation would be evidenced among those <strong>children</strong>. In fact,distortions <strong>in</strong> affective processes <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> are evident as early as <strong>in</strong>fancy (Gaensbauer, 1982), and by theage <strong>of</strong> 30months <strong>maltreated</strong> <strong>children</strong> tend to show a deficit <strong>in</strong> the ability to communicate their own affective states(Cicchetti & Beeghly, 1987). Abused <strong>children</strong> show related difficulties <strong>in</strong> recogniz<strong>in</strong>g, understand<strong>in</strong>g, and respond<strong>in</strong>gappropriately to the emotions <strong>of</strong> others (Cumm<strong>in</strong>gs, Hennessy, Rabideau, & Cicchetti, 1994; Klimes-Dougan &Kistner, 1990).In comb<strong>in</strong>ation, relatedness to others and <strong>in</strong>tegration <strong>of</strong> regulatory processes that occur dur<strong>in</strong>g early childhoodcontribute to the development <strong>of</strong> autonomy, <strong>in</strong>tr<strong>in</strong>sic motivation, and <strong>in</strong>ternalization (see Ryan, Deci, & Grolnick,1995). A substantial literature <strong>in</strong>dicates that harsh, unsupportive, and unresponsive parent<strong>in</strong>g practices can result <strong>in</strong>obstruction <strong>of</strong> <strong>children</strong>'s autonomy (see Harter, 2003). As would be expected, <strong>maltreated</strong> <strong>children</strong> are characterized bya host <strong>of</strong> problems related to disturbances <strong>in</strong> autonomy and development <strong>of</strong> the self, <strong>in</strong>clud<strong>in</strong>g such <strong>in</strong>ternaliz<strong>in</strong>gsymptoms as somatic compla<strong>in</strong>ts, depressive symptoms, and suicidal ideation (Kolko, 1992; McGee, Wolfe, & Wilson,1997). Furthermore, <strong>children</strong> and adolescents who have experienced maltreatment tend to report lower self-esteem(Gross & Keller, 1992) and more hopelessness and external locus <strong>of</strong> control (Cerezo & Frias 1994) compared tononabused youth.Another stage-salient task <strong>of</strong> childhood is to navigate the transition from relatively unstructured home or center careto elementary school. Given demands for self-regulation <strong>in</strong> school sett<strong>in</strong>gs and the importance <strong>of</strong> <strong>in</strong>volved parent<strong>in</strong>gfor school success (Shonk & Cicchetti, 2001), it is reasonable to expect that many <strong>maltreated</strong> <strong>children</strong> would not besuccessful <strong>in</strong> the transition to school. In fact, <strong>maltreated</strong> <strong>children</strong> are described by teachers as less ready thancomparison <strong>children</strong> to learn <strong>in</strong> school (H<strong>of</strong>fman-Plotk<strong>in</strong> & Twentyman, 1984) and as show<strong>in</strong>g poorer work habits(Erickson, Egeland, & Pianta, 1989). On broad <strong>in</strong>dices <strong>of</strong> academic success, <strong>maltreated</strong> <strong>children</strong> are more likely toreceive or be referred for special education services (Shonk & Cicchetti, 2001), experience more frequent graderetention (Rowe & Eckenrode, 1999), and drop out at a higher rate than nonabused <strong>children</strong> (Leiter & Johnson,1997).
798 M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812A critical task <strong>of</strong> early school-age years is to establish positive relationships with peers, which are highly predictive<strong>of</strong> subsequent <strong>adjustment</strong> dur<strong>in</strong>g adolescence and adulthood (Parker, Rub<strong>in</strong>, Price, & DeRosier, 1995). Becauseparent–child relationships play a central role <strong>in</strong> <strong>children</strong>'s ability to establish positive peer relations (Cicchetti, Lynch,Shonk, & Manly, 1992), abused and neglected <strong>children</strong> should be at risk for social mal<strong>adjustment</strong> and peer rejection.Indeed, young abused <strong>children</strong> tend to be less socially skilled (Darwish, Esquivel, Houtz, & Alfonso, 2001) and are lesswell liked by peers (Haskett & Kistner, 1991) compared to nonabused <strong>children</strong>. Abused <strong>children</strong> also show a host <strong>of</strong>disturbances <strong>in</strong> social <strong>in</strong>formation process<strong>in</strong>g operations, such as hostile attributions for peer's <strong>in</strong>tentions and limitedproblem solv<strong>in</strong>g skills (Dodge, Pettit, Bates, & Valente 1995; Price & Glad, 2003). F<strong>in</strong>ally, a serious difficultyassociated with peer relations <strong>of</strong> abused <strong>children</strong> is high rates <strong>of</strong> aggression and other externaliz<strong>in</strong>g problems (Jaffee,Caspi, M<strong>of</strong>fitt, & Taylor, 2004).In summary, extant literature provides compell<strong>in</strong>g evidence that maltreatment is associated with risk across many <strong>of</strong>the major developmental tasks <strong>of</strong> childhood. Given (a) significant risk for maladaptation <strong>in</strong> negotiation <strong>of</strong> early stagesalienttasks, (b) the coherence with which adaptation tends to be organized, and (c) the multiple risks that co-occurwith maltreatment (e.g., poverty, domestic violence), it seems that there would be little hope <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>diverg<strong>in</strong>g from a negative developmental trajectory. However, recent <strong>in</strong>vestigations <strong>in</strong>dicate that <strong>in</strong> spite <strong>of</strong> <strong>in</strong>crediblerisk for mal<strong>adjustment</strong>, a small proportion <strong>of</strong> abused and neglected <strong>children</strong> show evidence <strong>of</strong> relatively positive<strong>adjustment</strong> and success <strong>in</strong> developmental tasks.2. Rates <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong>Despite a plethora <strong>of</strong> studies on resilience conducted over the past two decades there is no consensus as to itsdef<strong>in</strong>ition, and form<strong>in</strong>g an operational def<strong>in</strong>ition <strong>of</strong> resilient function<strong>in</strong>g is a challeng<strong>in</strong>g task. Investigators mustdist<strong>in</strong>guish between factors def<strong>in</strong><strong>in</strong>g resilience and factors related to resilience, select types and number <strong>of</strong>sources <strong>of</strong> data to use, choose scor<strong>in</strong>g criteria to <strong>in</strong>dicate resilience, and determ<strong>in</strong>e when to measure resilience.Decisions on these issues can impact reported rates <strong>of</strong> resilient function<strong>in</strong>g and identification <strong>of</strong> protectivefactors. Rates also vary by characteristics <strong>of</strong> the <strong>children</strong> (e.g., age, gender) and typology <strong>of</strong> adversity. Someresearchers have def<strong>in</strong>ed resilience as positive adaptation relative to the adaptation <strong>of</strong> the full sample <strong>of</strong><strong>maltreated</strong> and at-risk <strong>children</strong> (e.g., Cicchetti & Rogosch, 1997). Other <strong>in</strong>vestigators have def<strong>in</strong>ed resilientfunction<strong>in</strong>g as achiev<strong>in</strong>g success on developmental tasks (e.g., Farber & Egeland, 1987) or obta<strong>in</strong><strong>in</strong>g scores onnormed measures that were <strong>in</strong>dicative <strong>of</strong> positive adaptation (e.g., Sagy & Dotan, 2001). As will be evident fromthis summary, wide variability exists <strong>in</strong> rates <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong> both across and with<strong>in</strong>studies.Kaufman, Cook, Arny, Jones, and Pitt<strong>in</strong>sky (1994) were specifically <strong>in</strong>terested <strong>in</strong> vary<strong>in</strong>g rates <strong>of</strong> resilience basedon the method used to def<strong>in</strong>e resilient function<strong>in</strong>g. Participants <strong>in</strong>cluded 56 <strong>maltreated</strong> <strong>children</strong> aged 7–12years. Theauthors def<strong>in</strong>ed resilience as the absence <strong>of</strong> pathology as measured by <strong>children</strong>'s self-reported competence, parent andteacher reports <strong>of</strong> child <strong>adjustment</strong>, and standardized achievement scores. Cut<strong>of</strong>f scores for resilient function<strong>in</strong>g werebased on norms for each measure. Rates <strong>of</strong> resilient function<strong>in</strong>g varied by measure, doma<strong>in</strong> <strong>of</strong> function<strong>in</strong>g, anddef<strong>in</strong>ition <strong>of</strong> resilience. Only 14% <strong>of</strong> <strong>children</strong> met the criteria <strong>of</strong> resilience for social competence, 27% met the criteriafor low cl<strong>in</strong>ical symptoms, and 38% met the criteria for academic achievement. A full 45% were not resilient on any <strong>of</strong>the three broad doma<strong>in</strong>s. If the def<strong>in</strong>ition <strong>of</strong> resilience was a high level <strong>of</strong> function<strong>in</strong>g on all three doma<strong>in</strong>s, very few(5%) would have met the criteria.Cicchetti et al. have designed some <strong>of</strong> the most sophisticated studies to exam<strong>in</strong>e resilient function<strong>in</strong>g among<strong>maltreated</strong> <strong>children</strong>. First, Cicchetti, Rogosch, Lynch, and Holt (1993) exam<strong>in</strong>ed features <strong>of</strong> resilience <strong>in</strong> a sample <strong>of</strong>127 <strong>maltreated</strong> <strong>children</strong> and 79 disadvantaged non<strong>maltreated</strong> <strong>children</strong> 8–13years <strong>of</strong> age. A composite <strong>of</strong> adaptivefunction<strong>in</strong>g was created for each child based on seven <strong>in</strong>dices (us<strong>in</strong>g reports <strong>of</strong> parents, camp counselors, and peers;self-reports; and school records). Indices <strong>in</strong>cluded prosocial behavior, disruptive–aggressive behavior, withdrawal,depression, <strong>in</strong>ternaliz<strong>in</strong>g and externaliz<strong>in</strong>g problems, and school risk (e.g., attendance, discipl<strong>in</strong>ary actions). Childrenwere categorized <strong>in</strong>to levels <strong>of</strong> competence based on the number <strong>of</strong> <strong>in</strong>dices for which they were function<strong>in</strong>g wellrelative to the full sample (i.e., <strong>in</strong> the top third). Maltreated (18%) and non<strong>maltreated</strong> (22%) <strong>children</strong> were equallyrepresented <strong>in</strong> the high function<strong>in</strong>g group. However, a much larger proportion <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> (43%) thannon<strong>maltreated</strong> <strong>children</strong> (26%) were <strong>in</strong> the low function<strong>in</strong>g group. While 22% <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> were not highfunction<strong>in</strong>g on any <strong>in</strong>dex, most were competent on at least one <strong>of</strong> the seven <strong>in</strong>dices.
M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812799A second study <strong>of</strong> Flores, Cicchetti, and Rogosch (2005) was designed to exam<strong>in</strong>e resilience among 76 <strong>maltreated</strong>and 57 non<strong>maltreated</strong> disadvantaged Lat<strong>in</strong>o <strong>children</strong> (mean age 8.2years). Us<strong>in</strong>g a multi-method assessment, n<strong>in</strong>e<strong>in</strong>dicators <strong>of</strong> function<strong>in</strong>g were measured, <strong>in</strong>clud<strong>in</strong>g prosocial and cooperative behavior, aggression and fight<strong>in</strong>g,withdrawal, disruptive behavior, shyness, and <strong>in</strong>ternaliz<strong>in</strong>g and externaliz<strong>in</strong>g problems. Children were classified ashigh function<strong>in</strong>g if they met criteria for success on at least six <strong>in</strong>dicators and as low function<strong>in</strong>g if they met criteria onone or no <strong>in</strong>dicators. A significantly greater proportion <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> (39.5%) than non-<strong>maltreated</strong> <strong>children</strong>(19.3%) was <strong>in</strong> the low function<strong>in</strong>g group. Moreover, only 9.2% <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> were high function<strong>in</strong>g, whichwas significantly lower <strong>in</strong> comparison to the proportion <strong>of</strong> non<strong>maltreated</strong> <strong>children</strong> (17.5%) labeled high function<strong>in</strong>g.F<strong>in</strong>ally, Cicchetti and Rogosch conducted two studies to exam<strong>in</strong>e diversity <strong>in</strong> function<strong>in</strong>g among elementaryschool-aged <strong>maltreated</strong> <strong>children</strong> over a 3-year period. The first study (Cicchetti & Rogosch, 1997) was an assessment<strong>of</strong> resilient function<strong>in</strong>g among 213 <strong>maltreated</strong> and non<strong>maltreated</strong> low-<strong>in</strong>come <strong>children</strong> who attended a summer camp.In addition to the measures used by Cicchetti et al. (1993), <strong>children</strong> completed a relatedness scale to assess perceptions<strong>of</strong> their relationship with their mother. Camp counselors gave reports <strong>of</strong> the quality <strong>of</strong> the counselor/child relationship.For each year <strong>of</strong> the study, an adaptive function<strong>in</strong>g composite was created based on the same seven <strong>in</strong>dices used byCicchetti et al. (1993). Children were assigned to either the high- or low-function<strong>in</strong>g group based on adaptivefunction<strong>in</strong>g over the 3-year period. Significantly more <strong>maltreated</strong> <strong>children</strong> (40.6%) than non<strong>maltreated</strong> <strong>children</strong> (20%)were members <strong>of</strong> the low function<strong>in</strong>g group. More non<strong>maltreated</strong> <strong>children</strong> (10%) than <strong>maltreated</strong> <strong>children</strong> (1.5%) werehigh-function<strong>in</strong>g. Only 9.8% <strong>of</strong> the <strong>maltreated</strong> <strong>children</strong> were function<strong>in</strong>g competently <strong>in</strong> any s<strong>in</strong>gle year <strong>of</strong> the study.The second study (Rogosch & Cicchetti, 2004) <strong>in</strong>volved an assessment <strong>of</strong> diversity <strong>in</strong> personality organizationamong 211 abused and nonabused <strong>children</strong> 6years <strong>of</strong> age at the <strong>in</strong>itial assessment. Camp counselors completed a Q-sortto derive a score for each <strong>of</strong> the Big Five personality dimensions for each child. Cluster analysis revealed five dist<strong>in</strong>ctsubgroups <strong>of</strong> <strong>children</strong> who shared a similar pattern <strong>of</strong> personality dimensions; the pattern <strong>of</strong> two clusters (i.e.,“Gregarious” and “Reserved”) was similar to the pattern <strong>of</strong> Resilient groups identified <strong>in</strong> other studies. Although themajority <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> (69.6%) were <strong>in</strong> the less adaptive clusters, some (30.4%) were members <strong>of</strong> theGregarious and Reserved clusters (65.8% <strong>of</strong> non<strong>maltreated</strong> <strong>children</strong> were members <strong>of</strong> those clusters). There wasevidence <strong>of</strong> stability <strong>in</strong> personality characteristics through age 9.Several other researchers exam<strong>in</strong>ed the resilient patterns <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> us<strong>in</strong>g longitud<strong>in</strong>al designs. Farberand Egeland (1987) exam<strong>in</strong>ed features <strong>of</strong> resilience us<strong>in</strong>g data from the Mother–Child Interaction Project, a study <strong>of</strong><strong>maltreated</strong> and comparison <strong>children</strong> followed from birth to adolescence. The authors def<strong>in</strong>ed child competence assuccess on the follow<strong>in</strong>g developmental tasks for each assessment period: attachment at 12 and 18months <strong>of</strong> age,autonomous function<strong>in</strong>g at 24months <strong>of</strong> age, self-awareness and socialization at 42months, and peer relations andsocialization <strong>in</strong> preschool. Although <strong>maltreated</strong> <strong>children</strong> were less competent than comparison <strong>children</strong> at each <strong>of</strong> theassessments, some <strong>maltreated</strong> <strong>children</strong> were function<strong>in</strong>g well (e.g., 53% were securely attached at 12 and 18months).Rates <strong>of</strong> competence varied widely by time and by doma<strong>in</strong> <strong>of</strong> function<strong>in</strong>g. For example, 40% <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>were competent on a problem-solv<strong>in</strong>g task at 24months, but only 22% were competent <strong>in</strong> peer relations at thepreschool assessment. Unfortunately, many <strong>maltreated</strong> <strong>children</strong> who were adapt<strong>in</strong>g well at one assessment perioddecl<strong>in</strong>ed at the next assessment. Not a s<strong>in</strong>gle child was resilient across all developmental tasks.In the Lehigh Longitud<strong>in</strong>al Study, Herrenkohl, Herrenkohl, and Egolf (1994) and Herrenkohl, Herrenkohl, Egolf,and Wu (1991) exam<strong>in</strong>ed resilient function<strong>in</strong>g among abused and neglected youth. The orig<strong>in</strong>al sample <strong>in</strong>cluded alarge number <strong>of</strong> abused and/or neglected <strong>children</strong> aged 18months to 6years and a comparison sample <strong>of</strong> non<strong>maltreated</strong><strong>children</strong>. Follow up assessments occurred <strong>in</strong> elementary school and late adolescence. At the <strong>in</strong>itial assessment, <strong>children</strong>were considered resilient if they received scores <strong>in</strong> the top 40% <strong>of</strong> the full sample on three composites <strong>of</strong> adaptivefunction<strong>in</strong>g (cognitive/academic, social, and emotional function<strong>in</strong>g) created from a teacher report scale. Results<strong>in</strong>dicated that 25 <strong>of</strong> the 88 resilient <strong>children</strong> had a history <strong>of</strong> be<strong>in</strong>g <strong>maltreated</strong>. Rate <strong>of</strong> resilient adaptation among<strong>maltreated</strong> <strong>children</strong> was 13% (rates for non<strong>maltreated</strong> <strong>children</strong> were not reported). In late adolescence, 61% <strong>of</strong> theresilient <strong>maltreated</strong> <strong>children</strong> had graduated from high school or were still <strong>in</strong> school at the time <strong>of</strong> the assessment. Thuslong-term resilience, as def<strong>in</strong>ed by cont<strong>in</strong>ued school attendance, did not persist over time for all <strong>of</strong> the <strong>maltreated</strong><strong>children</strong>.Fluidity <strong>in</strong> <strong>adjustment</strong> was also evident <strong>in</strong> a 3-year prospective longitud<strong>in</strong>al study conducted by Bolger andPatterson (2003). The <strong>in</strong>vestigators explored function<strong>in</strong>g <strong>of</strong> 107 <strong>maltreated</strong> <strong>children</strong> ages 8–10years. Positiveadaptation was def<strong>in</strong>ed as scor<strong>in</strong>g one standard deviation from the full sample on social preference, teacher rat<strong>in</strong>gs <strong>of</strong><strong>in</strong>ternaliz<strong>in</strong>g and externaliz<strong>in</strong>g problems, and scores on achievement tests. Dur<strong>in</strong>g at least 1year <strong>of</strong> the study, n<strong>in</strong>e
800 M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812<strong>maltreated</strong> <strong>children</strong> (8%) were identified as hav<strong>in</strong>g positive <strong>adjustment</strong> <strong>in</strong> at least one doma<strong>in</strong>. That rate is comparableto the rate reported by Flores et al. (2005) and consistent with the rate <strong>of</strong> <strong>children</strong> who showed resilient function<strong>in</strong>g <strong>in</strong> atleast 1year <strong>of</strong> Cicchetti and Rogosch's (1993) study. A composite <strong>of</strong> adaptation was created based on the four doma<strong>in</strong>sassessed, and <strong>children</strong> with composite scores at or above the median for the full sample were considered resilient.Us<strong>in</strong>g this def<strong>in</strong>ition, 21% <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> were identified as resilient dur<strong>in</strong>g at least 1year <strong>of</strong> the study, which iscongruent with the rate reported by Cicchetti et al. (1993). However, only five <strong>maltreated</strong> <strong>children</strong> (4%) wereconsistently well adjusted across all years <strong>of</strong> the study.F<strong>in</strong>ally, us<strong>in</strong>g retrospective methodology, McGlo<strong>in</strong> and Widom (2001) exam<strong>in</strong>ed resilience among adults whoexperienced maltreatment as <strong>children</strong>. At the time <strong>of</strong> the <strong>in</strong>terview, the 749 participants ranged <strong>in</strong> age from 18 to41years. Resilience was def<strong>in</strong>ed on the basis <strong>of</strong> eight doma<strong>in</strong>s <strong>of</strong> function<strong>in</strong>g <strong>in</strong>clud<strong>in</strong>g employment and hous<strong>in</strong>gstatus, educational atta<strong>in</strong>ment, level <strong>of</strong> social activity, mental health status, presence/absence <strong>of</strong> substance abuse andcrim<strong>in</strong>al record, and self-reports <strong>of</strong> violence. Each participant received a score <strong>of</strong> zero (not successful) or one(successful) for each doma<strong>in</strong>. Participants were categorized as hav<strong>in</strong>g a resilient pattern if they scored a 6 or higher onthe composite. Results <strong>in</strong>dicated that 22% <strong>of</strong> the <strong>maltreated</strong> <strong>in</strong>dividuals were resilient, a rate comparable to thatreported by Bolger and Patterson (2003) and Cicchetti et al. (1993). As was the case <strong>in</strong> other studies, rates <strong>of</strong> positivefunction<strong>in</strong>g on <strong>in</strong>dividual doma<strong>in</strong>s varied widely (19.3% for successful employment; 74.4% for avoid<strong>in</strong>ghomelessness).To summarize, percentage <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> identified as resilient varies widely with<strong>in</strong> s<strong>in</strong>gle studies and acrossstudies. It is clear however, that a small to moderate proportion <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> tend to be competent <strong>in</strong> one ormore developmental tasks dur<strong>in</strong>g at least one period <strong>of</strong> time. Based on global <strong>in</strong>dices <strong>of</strong> resilient function<strong>in</strong>g, thepercentage <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> function<strong>in</strong>g competently ranged from none to approximately 20% <strong>of</strong> the sample.Rates <strong>of</strong> resilience for developmental tasks <strong>of</strong> adulthood might be higher (McGlo<strong>in</strong> & Widom, 2001). Rates also arehigher for specific doma<strong>in</strong>s <strong>of</strong> function<strong>in</strong>g. In general, resilient function<strong>in</strong>g is less common among <strong>maltreated</strong> <strong>children</strong>than among <strong>children</strong> who have experienced other familial adversities. To illustrate, Luthar, D'Avanzo, and Hites (2003)found 35% <strong>of</strong> <strong>children</strong> whose mothers were characterized by substance abuse exhibited competent function<strong>in</strong>g basedon a psychiatric diagnostic <strong>in</strong>terview. Owens and Shaw (2003) found that 40% <strong>of</strong> low-<strong>in</strong>come <strong>children</strong> were welladjusted, def<strong>in</strong>ed on the basis <strong>of</strong> behavioral <strong>adjustment</strong> and social skills. Past research <strong>in</strong>dicates that there arecumulative effects <strong>of</strong> family adversity on <strong>children</strong>'s <strong>adjustment</strong> (e.g., Appleyard, Egeland, van Dulmen, & Sroufe,2005); thus, low rates <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong> may be due to the fact that abuse <strong>of</strong>ten co-occurs withother risk factors such as poverty, parental substance abuse, and marital violence.3. Protective factors and predictors <strong>of</strong> diversity <strong>in</strong> <strong>adjustment</strong> for <strong>maltreated</strong> <strong>children</strong>Us<strong>in</strong>g a developmental framework, protective factors have been def<strong>in</strong>ed as variables that “moderate the effects <strong>of</strong><strong>in</strong>dividual vulnerabilities or environmental hazards so that the adaptational trajectory is more positive than would bethe case if these protective factors are not operational” (Masten et al., 1990, p. 426). Over the past few decades,<strong>in</strong>vestigators have identified numerous attributes and experiences that contribute to competence among <strong>children</strong> at riskfor mal<strong>adjustment</strong>. For purposes <strong>of</strong> organiz<strong>in</strong>g this review, we borrow from the ecological perspective on childdevelopment (Bronfenbrenner, 1979) and divide those factors <strong>in</strong>to child attributes, features <strong>of</strong> the family environment,and community resources. It is important to note, however, that this dist<strong>in</strong>ction is highly contrived becausecharacteristics <strong>of</strong> <strong>children</strong> are heavily <strong>in</strong>fluenced by environmental factors; <strong>in</strong> turn, <strong>children</strong> shape family, peer, andcommunity contexts through reciprocal and transactional <strong>in</strong>fluences (Cicchetti & Toth, 1997).3.1. Individual child attributes as protective factorsPersonal characteristics <strong>of</strong> <strong>children</strong> have been exam<strong>in</strong>ed more frequently than any other source <strong>of</strong> <strong>in</strong>dividualdifferences <strong>in</strong> studies <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong>. Cognitive ability is one <strong>of</strong> the attributes most stronglyassociated with resilience among several populations <strong>of</strong> at-risk <strong>children</strong> (Luthar, 1991), but evidence for the protectivenature <strong>of</strong> <strong>in</strong>telligence for <strong>maltreated</strong> <strong>children</strong> is scant. Cicchetti et al. (1993) found that receptive vocabulary, used as an<strong>in</strong>dicator <strong>of</strong> cognitive ability, predicted scores <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> on a broad adaptive function<strong>in</strong>g composite. Theeffect was only marg<strong>in</strong>ally significant, however. The same measure did not predict resilient function<strong>in</strong>g among Lat<strong>in</strong>o<strong>maltreated</strong> <strong>children</strong> (Flores et al., 2005), perhaps due to low validity <strong>of</strong> the <strong>in</strong>strument for Lat<strong>in</strong>o samples. Cicchetti and
M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812801Rogosch (1997) found that cognitive ability <strong>of</strong> high function<strong>in</strong>g <strong>children</strong> (<strong>maltreated</strong> and disadvantaged <strong>children</strong>,comb<strong>in</strong>ed) was significantly higher than the cognitive ability <strong>of</strong> other groups. However, regression analyses <strong>in</strong>dicatedthat cognitive ability was not a significant predictor <strong>of</strong> 3-year adaptive function<strong>in</strong>g for <strong>maltreated</strong> <strong>children</strong>. F<strong>in</strong>ally, theprotective function <strong>of</strong> <strong>in</strong>tellectual ability was exam<strong>in</strong>ed <strong>in</strong> the Lehigh Longitud<strong>in</strong>al Study <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>(Herrenkohl et al., 1994; Herrenkohl, Herrenkohl, Rupert, Egolf, & Lutz, 1995). An assessment <strong>of</strong> <strong>in</strong>tellectualfunction<strong>in</strong>g <strong>in</strong> elementary school showed high function<strong>in</strong>g <strong>maltreated</strong> <strong>children</strong> could be discrim<strong>in</strong>ated on the basis <strong>of</strong>their IQ scores from those who were less successful. At the high school follow up, competent adolescents (i.e., thosewho had avoided drop out) had average or better than average IQ scores. It should be noted that even though IQ was aconsistent predictor <strong>of</strong> outcomes <strong>in</strong> these studies, it tended to be a less powerful predictor than SES and parent<strong>in</strong>gbehaviors.Processes by which <strong>in</strong>telligence serves a protective function for <strong>children</strong> are not well understood. The relationbetween IQ and adaptation is likely mediated by a host <strong>of</strong> complex factors, such as academic engagement andmotivation. Shonk and Cicchetti (2001) exam<strong>in</strong>ed the potential mediat<strong>in</strong>g <strong>in</strong>fluence <strong>of</strong> academic engagement as well associal competency and ego-resiliency <strong>in</strong> the path from maltreatment to success <strong>in</strong> academic and behavioral doma<strong>in</strong>s.The sample consisted <strong>of</strong> 229 <strong>children</strong> aged 5–12years; 146 <strong>children</strong> had experienced at least one type <strong>of</strong> maltreatment.Results <strong>in</strong>dicated scholastic competence, cognitive competence, academic effort, self-direction, and motivation (i.e.,components <strong>of</strong> academic engagement) accounted for much <strong>of</strong> the association between maltreatment and academicmal<strong>adjustment</strong>. Social competence and ego-resiliency accounted for the l<strong>in</strong>k between maltreatment and behavioral<strong>adjustment</strong>.Cicchetti and Rogosch (1997), Cicchetti et al. (1993) and Flores et al. (2005) designed three other studies to exam<strong>in</strong>ethe role <strong>of</strong> ego-resiliency <strong>in</strong> adaptation <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>. Ego-resiliency referred to <strong>children</strong>'s capacity to adjusttheir emotional and behavioral responses as a function <strong>of</strong> demand characteristics <strong>of</strong> a given situation. Ego control wasdef<strong>in</strong>ed as the ability to monitor and modulate one's feel<strong>in</strong>gs. Results <strong>of</strong> all three studies <strong>in</strong>dicated that both aspects <strong>of</strong>self-regulation predicted <strong>in</strong>dividual differences <strong>in</strong> successful adaptation <strong>in</strong> the presence <strong>of</strong> maltreatment. Additionalwork <strong>in</strong> the same research lab <strong>in</strong>dicated that emotion regulation abilities mediated the l<strong>in</strong>k between maltreatment andsocial competence (Shields, Cicchetti, & Ryan, 1994), and cognitive controls and understand<strong>in</strong>g <strong>of</strong> negative affectmediated the impact <strong>of</strong> maltreatment on the quality <strong>of</strong> peer relationships 3years later (Rogosch, Cicchetti, & Aber,1995). Consistent throughout this research is the strong <strong>in</strong>fluence <strong>of</strong> self-regulatory capacity on <strong>in</strong>dividual differences<strong>in</strong> outcomes for <strong>maltreated</strong> <strong>children</strong>.Related to self-regulatory skills and autonomy is a sense <strong>of</strong> personal control over events and relationships. A strongsense <strong>of</strong> personal control is protective for <strong>children</strong> at risk for mal<strong>adjustment</strong> due to a host <strong>of</strong> negative life experiences(e.g., Luthar, 1991), <strong>in</strong>clud<strong>in</strong>g maltreatment. To illustrate, Bolger and Patterson (2001) explored the role <strong>of</strong> perceived<strong>in</strong>ternal and external control <strong>in</strong> outcomes for elementary-school aged <strong>maltreated</strong> <strong>children</strong>. Results <strong>in</strong>dicated that<strong>in</strong>ternal control <strong>in</strong>teracted with maltreatment status to predict <strong>in</strong>ternaliz<strong>in</strong>g symptoms. Specifically, higher <strong>in</strong>ternalcontrol was associated with fewer <strong>in</strong>ternaliz<strong>in</strong>g symptoms for <strong>maltreated</strong> <strong>children</strong> (but not for non<strong>maltreated</strong> <strong>children</strong>),support<strong>in</strong>g the protective nature <strong>of</strong> <strong>in</strong>ternal control. Post hoc analyses <strong>in</strong>dicated that <strong>children</strong> who had experiencedmaltreatment at an earlier age reported lower levels <strong>of</strong> perceived <strong>in</strong>ternal control than did <strong>children</strong> with a later age <strong>of</strong>onset <strong>of</strong> maltreatment.The potential protective <strong>in</strong>fluence <strong>of</strong> locus <strong>of</strong> control was also exam<strong>in</strong>ed by Moran and Eckenrode (1992). The<strong>in</strong>vestigators were <strong>in</strong>terested <strong>in</strong> whether locus <strong>of</strong> control orientation and self-esteem protected aga<strong>in</strong>st depression for 33physically and/or sexually abused girls 12–18years <strong>of</strong> age. Results <strong>in</strong>dicated that self-esteem and locus <strong>of</strong> control forpositive, pleasant events <strong>in</strong>teracted with maltreatment status <strong>in</strong> predict<strong>in</strong>g depression. Specifically, <strong>maltreated</strong>adolescents with high self-esteem and an <strong>in</strong>ternal locus <strong>of</strong> control for positive events reported levels <strong>of</strong> depressioncomparable to that <strong>of</strong> control participants. In addition, age at which maltreatment occurred was related to self-esteemand locus <strong>of</strong> control. Specifically, adolescents who experienced maltreatment before the age <strong>of</strong> 11 reported lower selfesteem,lower <strong>in</strong>ternal locus <strong>of</strong> control for positive events, and higher levels <strong>of</strong> depression compared to adolescentswho experienced maltreatment after the age <strong>of</strong> 11. Such f<strong>in</strong>d<strong>in</strong>gs highlight the complex operation <strong>of</strong> protective factors,which likely <strong>in</strong>teract with other factors such as features <strong>of</strong> the maltreatment experience.Contrary to Moran and Eckenrode's expectations, an external locus <strong>of</strong> control for negative events was not protectivefor <strong>maltreated</strong> <strong>children</strong>. Heller, Larrieu, D'Imperio, and Boris (1999) suggested that perhaps an external locus <strong>of</strong>control specifically for the maltreatment experience, but not for other negative events, would predict resilience tomaltreatment. Several researchers <strong>in</strong> the area <strong>of</strong> child sexual abuse have found that, <strong>in</strong>deed, abuse-specific attributions
802 M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812predict <strong>in</strong>dividual differences <strong>in</strong> <strong>adjustment</strong> (Spaccarelli & Fuchs, 1997; Wolfe, Gentile, & Wolfe, 1989). McGee et al.(1997) tested the degree to which attributions for maltreatment experiences would contribute to <strong>in</strong>dividual differencesamong <strong>maltreated</strong> adolescents. Severity <strong>of</strong> maltreatment <strong>of</strong> 160 adolescents and attributions <strong>of</strong> blame for thoseexperiences were measured by <strong>in</strong>terviews with the adolescents. Results <strong>in</strong>dicated that attributions made a significantcontribution to self-report <strong>of</strong> <strong>in</strong>ternaliz<strong>in</strong>g problems even when controll<strong>in</strong>g for severity <strong>of</strong> maltreatment. Five types <strong>of</strong>attributions were measured; self-blam<strong>in</strong>g affect attributions contributed the most unique variance to outcomes. Theauthors described those beliefs as similar to feel<strong>in</strong>gs <strong>of</strong> “shame” exam<strong>in</strong>ed <strong>in</strong> other studies, which differed from feel<strong>in</strong>gs<strong>of</strong> responsibility for the abuse itself.Brown and Kolko (1999) also explored relations among abuse and attributions. Their sample consisted <strong>of</strong> 70<strong>children</strong> ages 6–13years who had experienced physical abuse or harsh physical force. Global attributional style andattributions for specific abusive events were assessed us<strong>in</strong>g multiple measures. Levels <strong>of</strong> anxiety, depression, andbehavior problem symptoms were <strong>in</strong>dicators <strong>of</strong> function<strong>in</strong>g. Results <strong>in</strong>dicated that both global attributional style andabuse-specific attributions accounted for significant variance <strong>in</strong> function<strong>in</strong>g beyond the variance accounted for byabusive parent<strong>in</strong>g. In addition to attributional style, Brown and Kolko (1999) exam<strong>in</strong>ed aspects <strong>of</strong> social <strong>in</strong>formationprocess<strong>in</strong>g as predictors <strong>of</strong> function<strong>in</strong>g. Specifically, they measured (a) attributions <strong>maltreated</strong> <strong>children</strong> held for thebehavior <strong>of</strong> peers and (b) the ability <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> to generate solutions to peer problems. Results <strong>in</strong>dicated thatattributions <strong>of</strong> hostile peer <strong>in</strong>tent contributed <strong>in</strong>cremental variance to abuse-specific fears (but not to global<strong>adjustment</strong>), beyond the variance accounted for by severity <strong>of</strong> abuse. However, <strong>children</strong>'s problem solv<strong>in</strong>g skills wereunrelated to <strong>adjustment</strong>.Those same two social <strong>in</strong>formation process<strong>in</strong>g operations (i.e., attributions <strong>of</strong> <strong>in</strong>tent and problem solv<strong>in</strong>g) wereexam<strong>in</strong>ed by Price and Landsverk (1998) as <strong>in</strong>dicators <strong>of</strong> <strong>in</strong>dividual differences among 124 <strong>maltreated</strong> <strong>children</strong> ages5–10years. Results <strong>in</strong>dicated caregivers' reports <strong>of</strong> social competence, but not behavior problems, were predicted bythe degree to which the <strong>children</strong> attributed hostile <strong>in</strong>tent to peer behavior. Price and Landsverk (1998) posited that thelack <strong>of</strong> relation between <strong>in</strong>tent attributions and behavioral problems could have been due to the fact that behaviorproblems were measured by broadband scales; attributional biases have been related <strong>in</strong> past research specifically toaggression. In contrast to the f<strong>in</strong>d<strong>in</strong>gs <strong>of</strong> Brown and Kolko (1999), problem-solv<strong>in</strong>g skills were predictive <strong>of</strong> bothsocial competence and behavior problems.In summary, f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong>dicate that several features <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>'s cognitive and social cognitive processeshave been l<strong>in</strong>ked to <strong>in</strong>dividual differences <strong>in</strong> <strong>adjustment</strong> and to resilient function<strong>in</strong>g. Many <strong>of</strong> those features <strong>in</strong>volve<strong>maltreated</strong> <strong>children</strong>'s views <strong>of</strong> self and their self-regulatory processes, <strong>in</strong>clud<strong>in</strong>g ego-control, ego-resilience, selfesteem,perceptions <strong>of</strong> control, attributional style, and social problem solv<strong>in</strong>g ability. Of particular <strong>in</strong>terest is the f<strong>in</strong>d<strong>in</strong>gthat <strong>children</strong>'s beliefs about their experiences <strong>of</strong> maltreatment contributed to their psychosocial <strong>adjustment</strong> even whencontroll<strong>in</strong>g for characteristics (e.g., severity) <strong>of</strong> the abuse itself. F<strong>in</strong>ally, child characteristics related to <strong>in</strong>dicators <strong>of</strong>school success <strong>in</strong>clude cognitive ability and academic engagement, although support for the role <strong>of</strong> cognitive ability issomewhat mixed.3.2. Protective factors <strong>in</strong> the family environmentIt has long been known that parent<strong>in</strong>g practices with<strong>in</strong> the social context <strong>of</strong> childrear<strong>in</strong>g are important predictors <strong>of</strong><strong>children</strong>'s adaptation from <strong>in</strong>fancy through adolescence (e.g., Booth, Rose-Krasnor, McK<strong>in</strong>non, & Rub<strong>in</strong>, 1994).Because abusive parents are characterized by low parental warmth and sensitivity and high negativity and<strong>in</strong>trusiveness, one might assume that dimensions <strong>of</strong> parent<strong>in</strong>g would not be related to positive adaptation for abused<strong>children</strong>. However, there is <strong>in</strong> fact variation among abusive parents <strong>in</strong> many aspects <strong>of</strong> parent<strong>in</strong>g (Haskett, Smith Scott,& Ward, 2004). So, it is possible that parent<strong>in</strong>g behaviors might <strong>in</strong>fluence the degree to which <strong>maltreated</strong> <strong>children</strong> aresuccessful <strong>in</strong> achiev<strong>in</strong>g developmental tasks.Egeland et al. have contributed a great deal <strong>of</strong> knowledge regard<strong>in</strong>g the impact <strong>of</strong> parent<strong>in</strong>g and the parent childrelationship on outcomes for <strong>maltreated</strong> <strong>children</strong>. For example, Farber and Egeland (1987) followed 44 maltreat<strong>in</strong>gmothers and their <strong>children</strong> from birth until the <strong>children</strong> were preschool age. At the 12-month assessment, mothers <strong>of</strong>securely attached (i.e., “successful) <strong>maltreated</strong> <strong>in</strong>fants were more sensitive to the <strong>in</strong>fants' cues <strong>in</strong> comparison to thelevel <strong>of</strong> sensitivity demonstrated by mothers <strong>of</strong> anxiously attached <strong>maltreated</strong> <strong>in</strong>fants. Mothers <strong>of</strong> attached <strong>maltreated</strong><strong>in</strong>fants at 18months <strong>of</strong> age scored lower on hostility <strong>in</strong> comparison to the level <strong>of</strong> hostility exhibited by mothers <strong>of</strong>anxiously attached <strong>maltreated</strong> <strong>in</strong>fants. At 42months, mothers <strong>of</strong> competent <strong>children</strong> were provid<strong>in</strong>g better quality
M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812803<strong>in</strong>struction, giv<strong>in</strong>g more emotional support, and show<strong>in</strong>g greater respect for autonomy <strong>in</strong> comparison to the parent<strong>in</strong>gbehavior demonstrated by mothers <strong>of</strong> less competent <strong>children</strong>.Aspects <strong>of</strong> parent<strong>in</strong>g cont<strong>in</strong>ue to predict differential outcomes <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> beyond <strong>in</strong>fancy and earlychildhood. To illustrate, Kim and Cicchetti (2004) exam<strong>in</strong>ed concurrent and longitud<strong>in</strong>al relations between mother–child relationship quality and <strong>adjustment</strong> <strong>of</strong> 206 <strong>maltreated</strong> and 139 non<strong>maltreated</strong> disadvantaged <strong>children</strong> aged 7–12years. A multi-method assessment was conducted to measure <strong>children</strong>'s relatedness to their mother (i.e.,psychological proximity seek<strong>in</strong>g and emotional quality) as well as self-esteem and <strong>in</strong>ternaliz<strong>in</strong>g and externaliz<strong>in</strong>gproblems. Data were collected dur<strong>in</strong>g two consecutive summer camps. Results <strong>in</strong>dicated that relatedness to mothers <strong>in</strong>the first year was predictive <strong>of</strong> <strong>children</strong>'s adaptation <strong>in</strong> the second year, and the l<strong>in</strong>k was mediated by self-esteem.Specifically, <strong>in</strong>secure relatedness was related to low self-esteem, which <strong>in</strong> turn predicted subsequent <strong>in</strong>ternaliz<strong>in</strong>g andexternaliz<strong>in</strong>g symptoms. Consistent with an organizational perspective on development, the degree to which <strong>children</strong>adapted to early challenges (i.e., attachment) set the trajectory for later stage-salient tasks (i.e., development <strong>of</strong> the selfsystem).The role <strong>of</strong> caretak<strong>in</strong>g quality <strong>in</strong> <strong>maltreated</strong> <strong>children</strong>'s adaptation cont<strong>in</strong>ues to be evidenced <strong>in</strong>to the teen years. TheLehigh Longitud<strong>in</strong>al Study (Herrenkohl et al., 1994; Herrenkohl et al., 1995) <strong>of</strong>fers <strong>in</strong>sight <strong>in</strong>to the role <strong>of</strong> parent<strong>in</strong>gand the family context <strong>in</strong> resilient function<strong>in</strong>g among <strong>maltreated</strong> youth. High function<strong>in</strong>g <strong>maltreated</strong> <strong>children</strong> hadmothers who were more affectionate and supportive and less hostile and controll<strong>in</strong>g than the mothers <strong>of</strong> <strong>children</strong> whowere less well adjusted. At the high school follow up, several commonalities <strong>in</strong> family environments <strong>of</strong> resilient<strong>maltreated</strong> adolescents were noted. Specifically, resilient adolescents had experienced only sporadic (as opposed tochronic) abuse, and they had stable caretak<strong>in</strong>g over the course <strong>of</strong> their youth. In addition, parents <strong>of</strong> several resilientadolescents expressed high expectations for their <strong>children</strong>'s self-sufficiency and <strong>in</strong>dependence, perhaps due to theirown health problems which <strong>in</strong>spired them to <strong>in</strong>sure their <strong>children</strong> were <strong>in</strong>dependent. It should be noted that stablecaretak<strong>in</strong>g and high parental expectations appeared to be protective for school drop out, a somewhat narrow <strong>in</strong>dicator<strong>of</strong> successful adaptation.In a retrospective study, W<strong>in</strong>d and Silvern (1994) exam<strong>in</strong>ed degree to which quality <strong>of</strong> early parent<strong>in</strong>g predictedfunction<strong>in</strong>g <strong>of</strong> adult women who had experienced physical (n=24) or sexual (n=17) abuse <strong>in</strong> childhood. Measures <strong>of</strong>family history and current function<strong>in</strong>g were adm<strong>in</strong>istered to women employed by a university. Results <strong>in</strong>dicated thatwomen's perceptions <strong>of</strong> parent<strong>in</strong>g support received <strong>in</strong> childhood were related to current reports <strong>of</strong> self-esteem anddepression. Furthermore, unsupportive parent<strong>in</strong>g mediated the relation between child abuse and adult depression andlow self-esteem.In contrast to the f<strong>in</strong>d<strong>in</strong>gs reported above, Brown and Kolko (1999) found that parent<strong>in</strong>g practices (i.e., monitor<strong>in</strong>g,discipl<strong>in</strong>e, and <strong>in</strong>teractional behaviors) were not related to severity <strong>of</strong> externaliz<strong>in</strong>g symptoms among <strong>maltreated</strong><strong>children</strong>. Parent-reported level <strong>of</strong> family conflict, however, was a significant predictor <strong>of</strong> outcomes. The authorsconcluded that childrear<strong>in</strong>g might impact child outcomes <strong>in</strong>directly, through the impact <strong>of</strong> specific parent<strong>in</strong>g behaviorson general family conflict. In fact, research <strong>in</strong>dicates relational processes and contextual stress with<strong>in</strong> families thatextend beyond the parent/child relationship are <strong>in</strong>fluential <strong>in</strong> both risk and resilience (Werner, 1989). Although thereare relatively few studies <strong>of</strong> these factors <strong>in</strong> families <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>, results <strong>in</strong>dicate that family function<strong>in</strong>g is animportant consideration <strong>in</strong> resilience for those <strong>children</strong>. Perk<strong>in</strong>s and Jones (2004) exam<strong>in</strong>ed function<strong>in</strong>g <strong>of</strong> 3281<strong>maltreated</strong> adolescents. All data, <strong>in</strong>clud<strong>in</strong>g abuse history, were obta<strong>in</strong>ed via a questionnaire. Teens reported<strong>in</strong>volvement <strong>in</strong> seven risky behaviors (e.g., alcohol use, attempted suicide, purg<strong>in</strong>g) and two “thriv<strong>in</strong>g” behaviors (i.e.,success <strong>in</strong> school and help<strong>in</strong>g others). The presence <strong>of</strong> eight potential protective factors also was exam<strong>in</strong>ed. Resultsshowed that higher level <strong>of</strong> family support and better parent–adolescent communication, the two protective factors atthe family context level, were associated with lower rates <strong>of</strong> alcohol and tobacco use, suicide attempts, and purg<strong>in</strong>g.Parent<strong>in</strong>g context was unrelated to thriv<strong>in</strong>g behaviors, however. A second study (Perk<strong>in</strong>s, Luster, & Jank, 2002)confirmed that family support was associated with lower risk <strong>of</strong> purg<strong>in</strong>g among <strong>maltreated</strong> adolescent girls.Several other illustrations <strong>of</strong> the relevance <strong>of</strong> family function<strong>in</strong>g are available <strong>in</strong> the extant literature. Farber andEgeland (1987) found that constructive family changes (e.g., <strong>in</strong>tervention for the family, abusive father no long allowedvisitations, placement <strong>of</strong> child with car<strong>in</strong>g foster parents) were associated with positive adaptation <strong>of</strong> <strong>maltreated</strong><strong>children</strong>. Kurtz, Gaud<strong>in</strong>, Howl<strong>in</strong>g, and Wodarski (1993) exam<strong>in</strong>ed function<strong>in</strong>g <strong>of</strong> 139 foster <strong>children</strong> ages 8–16years;69 had been physically abused or neglected. A large multi-method assessment battery was used to measure familyhistory as well as <strong>children</strong>'s school performance, social and emotional development, and adaptive behavior. Results<strong>in</strong>dicated fewer family life stressors (e.g., major illness, birth <strong>of</strong> a child, change <strong>in</strong> residence) were associated with
804 M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812numerous positive outcomes for <strong>children</strong>, <strong>in</strong>clud<strong>in</strong>g better school performance, fewer problem behaviors at home, andbetter <strong>adjustment</strong> with peers. Fewer foster care placements were associated with better <strong>adjustment</strong> at home, higher selfconcept,and lower levels <strong>of</strong> aggression.Coherence <strong>of</strong> the family environment, a construct associated with family stability, was found to be relevant tounderstand<strong>in</strong>g outcomes <strong>of</strong> <strong>maltreated</strong> adolescents <strong>in</strong> a study conducted by Sagy and Dotan (2001). The authors soughtto identify factors associated with resilient function<strong>in</strong>g among 81 abused (physical, emotional, and/or verbal) and/orneglected Israeli 8th graders. Resilience was manifested by high competence and low psychological distress. Potentialprotective factors <strong>in</strong>cluded parameters <strong>of</strong> the child's ecological circle, <strong>in</strong>clud<strong>in</strong>g their perceptions <strong>of</strong> family coherence,psychological sense <strong>of</strong> school membership, and community-level social support. Demographic factors (e.g., parenteducation and marital status) also were exam<strong>in</strong>ed as potential protective factors. Results <strong>in</strong>dicated that <strong>children</strong>'s sense<strong>of</strong> family cohesion was the ma<strong>in</strong> contributor to level <strong>of</strong> perceived competence. The other factors did not contribute asignificant amount <strong>of</strong> variance <strong>in</strong> competence, and none were related to level <strong>of</strong> psychological distress.In conclusion, several features <strong>of</strong> the family environment appear central to resilient function<strong>in</strong>g <strong>of</strong> <strong>maltreated</strong><strong>children</strong>, from <strong>in</strong>fancy through adolescence. Studies <strong>in</strong>dicate that specific dimensions <strong>of</strong> parent<strong>in</strong>g quality, <strong>in</strong>clud<strong>in</strong>gaffection, sensitivity, and support for autonomy, are important predictors <strong>of</strong> differential outcomes for <strong>maltreated</strong><strong>children</strong>. In addition to the importance <strong>of</strong> parent<strong>in</strong>g behavior on outcomes, results <strong>in</strong>dicate that broader familyfunction<strong>in</strong>g is related to resilient function<strong>in</strong>g. Specifically, <strong>children</strong>'s perceptions <strong>of</strong> their family coherence andmultiple <strong>in</strong>dicators <strong>of</strong> family stability are associated with positive adaptation among <strong>maltreated</strong> <strong>children</strong>. Thesef<strong>in</strong>d<strong>in</strong>gs <strong>in</strong>dicate that, even though the family environment <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> tends to be much more dysfunctionalthan that <strong>of</strong> non<strong>maltreated</strong> <strong>children</strong>, <strong>in</strong>dividual differences <strong>in</strong> parent<strong>in</strong>g and family processes are evident and arepredictive <strong>of</strong> diversity <strong>in</strong> outcomes for abused and neglected <strong>children</strong>.3.3. Extra-familial relationships and community factorsRelationships with <strong>in</strong>dividuals outside the immediate family are important <strong>in</strong> resilience among <strong>children</strong> at risk formaladaptation. In particular, high-quality peer friendships and supportive relationships with non-parental adults arel<strong>in</strong>ked with success for <strong>children</strong> at risk (Luthar & Zigler, 1991). Bolger, Patterson, and Kupersmidt (1998) explored therole <strong>of</strong> friendship reciprocity and quality as protective factors for <strong>children</strong> who had experienced maltreatment. Anetwork <strong>of</strong> relationships questionnaire was adm<strong>in</strong>istered to participants, and peers and participants reported onreciprocal friendships. Results <strong>in</strong>dicated that hav<strong>in</strong>g high-quality and reciprocal friendships moderated the relationbetween maltreatment and self-esteem. Over time, stronger friendships were associated with higher self-esteem for<strong>maltreated</strong> <strong>children</strong>. Maltreated <strong>children</strong> with a reciprocal friendship were three times more likely than <strong>children</strong> withoutclose friends to be classified as resilient <strong>in</strong> at least 1year <strong>of</strong> the 3-year study. F<strong>in</strong>d<strong>in</strong>gs were particularly strong forchronically <strong>maltreated</strong> and for physically abused <strong>children</strong>. It is important to note that friendship quality was a protectivefactor for self-esteem, but not for <strong>in</strong>ternaliz<strong>in</strong>g or externaliz<strong>in</strong>g problems.The value <strong>of</strong> friendships for <strong>children</strong> with a history <strong>of</strong> maltreatment was also exam<strong>in</strong>ed <strong>in</strong> research conducted bySchwartz, Dodge, Pettit, Bates, and The Conduct Problems Prevention Research Group (2000). The authors used aprospective design to exam<strong>in</strong>e the moderat<strong>in</strong>g role <strong>of</strong> dyadic friendships <strong>in</strong> the l<strong>in</strong>k between harsh parent<strong>in</strong>g andvictimization by peers. Children's early home environments (e.g., harsh discipl<strong>in</strong>e, marital conflict, abuse, maternalhostility) were assessed by parent <strong>in</strong>terview prior to first grade. In later elementary school, peer group acceptance,reciprocal friendships, and victimization by peers were assessed. Results showed a reduced “effect” <strong>of</strong> harsh parent<strong>in</strong>gfor <strong>children</strong> with numerous friendships. That is, the l<strong>in</strong>k between harsh parent<strong>in</strong>g (at Time 1) and victimization by peers(at Time 3) was significantly weaker for <strong>children</strong> with more reciprocated friendships (at Time 2). Together, thesestudies po<strong>in</strong>t to the special importance <strong>of</strong> positive peer relationships for <strong>children</strong> whose families might not providenecessary support, encouragement, and motivation for cop<strong>in</strong>g with developmental challenges.Neither Schwartz et al. (2000) nor Bolger et al. (1998) assessed attributes <strong>of</strong> the participants' friends. The protectivenature <strong>of</strong> friendships might vary by characteristics <strong>of</strong> the friends and the activities peers share. In fact, Perk<strong>in</strong>s and Jones(2004) found that hav<strong>in</strong>g close friends who engaged <strong>in</strong> risky behaviors was detrimental to <strong>maltreated</strong> adolescents'<strong>adjustment</strong>; <strong>in</strong> contrast, <strong>maltreated</strong> adolescents who engaged <strong>in</strong> a high rate <strong>of</strong> thriv<strong>in</strong>g behaviors had friends who alsoengaged <strong>in</strong> those healthy behaviors. That f<strong>in</strong>d<strong>in</strong>g is not unexpected given the significant <strong>in</strong>fluence <strong>of</strong> peer group normsand “contagion” (see Gifford-Smith, Dodge, Dishion, & McCord, 2005). In the case <strong>of</strong> bond<strong>in</strong>g with a deviant peergroup, close friendships could exact a toll on <strong>maltreated</strong> <strong>children</strong> rather than serv<strong>in</strong>g as a protective factor.
M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812805The protective <strong>in</strong>fluence <strong>of</strong> relationships with non-parental adults rema<strong>in</strong>s unclear for <strong>maltreated</strong> <strong>children</strong>, althoughit is <strong>of</strong>ten proposed that such relationships are important for resilience. Case-study f<strong>in</strong>d<strong>in</strong>gs from the Mother–ChildInteraction Project <strong>in</strong>dicated that mothers who had a history <strong>of</strong> maltreatment by their parents but who were adequatemothers themselves had experienced care from a supportive, nurtur<strong>in</strong>g adult <strong>in</strong> the course <strong>of</strong> their development (Pianta,Egeland, & Erickson, 1989). Cicchetti and Rogosch (1997) and Flores et al. (2005) found that the ability to form arelationship with a camp counselor differentiated <strong>maltreated</strong> <strong>children</strong> with low adaptive function<strong>in</strong>g from other<strong>maltreated</strong> <strong>children</strong>; however, <strong>children</strong>'s personal characteristics accounted for most <strong>of</strong> the variance <strong>in</strong> adaptivefunction<strong>in</strong>g. Just as the type <strong>of</strong> peers that <strong>maltreated</strong> <strong>children</strong> associate with might <strong>in</strong>fluence whether or not friendshipsare protective, so might the responsibility and maturity <strong>of</strong> non-parental adults determ<strong>in</strong>e whether those relationshipsprotect <strong>maltreated</strong> <strong>children</strong>. Indeed, Perk<strong>in</strong>s and Jones (2004) found adolescents' perceived support from non-parentadults predicted <strong>adjustment</strong>, but results were counter<strong>in</strong>tuitive. Support was associated with <strong>in</strong>creased <strong>in</strong>volvement <strong>in</strong>five <strong>of</strong> the risk behaviors and with lower school success. Similarly, Perk<strong>in</strong>s et al. (2002) found support from a nonparentadult was associated with <strong>in</strong>creased purg<strong>in</strong>g behavior by <strong>maltreated</strong> adolescent girls. It seems the adult “support”obta<strong>in</strong>ed by <strong>children</strong> <strong>in</strong> these studies was not conducive to success <strong>in</strong> meet<strong>in</strong>g developmental tasks.Broader environmental <strong>in</strong>fluences on resilience to maltreatment have received the least empirical attention to date.This is unfortunate s<strong>in</strong>ce knowledge <strong>of</strong> protective factors at the community level, <strong>in</strong> particular, could serve to <strong>in</strong>formpublic policy. For example, <strong>in</strong>volvement <strong>in</strong> structured extracurricular activities generally is related to healthy outcomesfor <strong>children</strong> and adolescents (see Larson & Mahoney, 2005); such f<strong>in</strong>d<strong>in</strong>gs could be used to encourage <strong>in</strong>creasedfund<strong>in</strong>g for availability <strong>of</strong> organized after-school programs and activities for <strong>children</strong> at risk. Egeland, Sroufe, &Erickson (1983) found that <strong>in</strong>volvement <strong>in</strong> extracurricular activities and hobbies was related to resilience. In contrast,Perk<strong>in</strong>s and Jones (2004) found that <strong>in</strong>volvement <strong>in</strong> extracurricular activities was related to <strong>in</strong>creased rates <strong>of</strong>del<strong>in</strong>quency. It seems reasonable to propose that the type <strong>of</strong> extracurricular activity should be considered. Althoughresearch shows there are benefits <strong>of</strong> <strong>in</strong>volvement <strong>in</strong> structured as well as <strong>in</strong>formal after-school activities (e.g., Cooper,Valent<strong>in</strong>e, Nye, & L<strong>in</strong>dsay, 1999), some activities are associated with negative outcomes. For example, <strong>in</strong>volvement <strong>in</strong>sports is related to many positive outcomes, but it is also associated with <strong>in</strong>creased alcohol use (e.g., Eccles & Barber,1999).Extant research provides abundant evidence <strong>of</strong> the protective nature <strong>of</strong> high-quality school environments for<strong>children</strong> at risk <strong>of</strong> failure <strong>in</strong> academic and social doma<strong>in</strong>s (e.g., Catterall, 1998; Gonzalez, 1997). Furthermore, as notedby Stipek (1997), success <strong>in</strong> the school environment is one <strong>of</strong> the strongest predictors <strong>of</strong> success <strong>in</strong> social and mentalhealth function<strong>in</strong>g. It is highly unfortunate, therefore, that school and community contextual variables have beenrelatively neglected areas <strong>of</strong> <strong>in</strong>vestigation by researchers <strong>in</strong>terested <strong>in</strong> resilience among <strong>maltreated</strong> <strong>children</strong>. Perk<strong>in</strong>sand Jones (2004) found that positive school climate was associated with lower risk <strong>of</strong> engag<strong>in</strong>g <strong>in</strong> six <strong>of</strong> sevenmeasured risky behaviors and with school success <strong>of</strong> <strong>maltreated</strong> adolescents. Sagy and Dotan (2001) exam<strong>in</strong>ed<strong>maltreated</strong> adolescents' sense <strong>of</strong> school membership and community-level social support (from family, friends,neighbors, adult figures <strong>in</strong> school, and others <strong>in</strong> the community) as <strong>in</strong>dicators <strong>of</strong> competence and psychologicaldistress. Sense <strong>of</strong> school membership correlated with perceived competence but not with psychological <strong>adjustment</strong>,and community support was unrelated to either outcome.In summary, given the importance <strong>of</strong> high quality peer relationships to the social and emotional <strong>adjustment</strong> <strong>of</strong><strong>children</strong>, it is remarkable that so few <strong>in</strong>vestigators have exam<strong>in</strong>ed the value <strong>of</strong> peer friendships for abused andneglected <strong>children</strong>. There appears to be concordance <strong>in</strong> relatedness across relationships, so <strong>maltreated</strong> <strong>children</strong> withconfused or disengaged relatedness to mothers are likely to experience similar patterns <strong>of</strong> relatedness to other adultsand peers (Lynch & Cicchetti, 1991). However, <strong>maltreated</strong> <strong>children</strong> who are able to form close attachments with peersmight have access to alternative work<strong>in</strong>g models <strong>of</strong> relationships as trustworthy and safe. In fact, the few studies thathave been conducted on the protective nature <strong>of</strong> peer relations <strong>in</strong>dicate there is <strong>in</strong>deed potential value to high-qualityand reciprocal friendships among <strong>maltreated</strong> <strong>children</strong>. Unfortunately, the potential protective nature <strong>of</strong> non-parentaladults and <strong>in</strong>fluences with<strong>in</strong> school and community environments have not been adequately addressed as protectivefactors for <strong>maltreated</strong> <strong>children</strong>.4. Clos<strong>in</strong>g commentsBased on f<strong>in</strong>d<strong>in</strong>gs <strong>of</strong> the Mother–Child Interaction Project, Egeland (1991) concluded “No one was immune or<strong>in</strong>vulnerable to the effects <strong>of</strong> maltreatment” (p. 51). Rates <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong> are <strong>in</strong>deed uniformly
806 M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812low, especially when resilient function<strong>in</strong>g is def<strong>in</strong>ed as competence across several doma<strong>in</strong>s <strong>of</strong> function<strong>in</strong>g or susta<strong>in</strong>edadaptation over time. This is not unexpected s<strong>in</strong>ce maltreatment is associated with a host <strong>of</strong> adversities, which requires<strong>maltreated</strong> <strong>children</strong> to recover from cumulative risks. Rates <strong>of</strong> adaptive function<strong>in</strong>g are substantially higher whenresilience is def<strong>in</strong>ed as competence <strong>in</strong> a narrow doma<strong>in</strong> <strong>of</strong> function<strong>in</strong>g. Success <strong>in</strong> one doma<strong>in</strong> at a s<strong>in</strong>gle po<strong>in</strong>t <strong>in</strong> timemight seem to be a bleak outcome; however, s<strong>in</strong>gle experiences <strong>of</strong> adaptation could prime <strong>children</strong> for a path <strong>of</strong>successful adaptation <strong>in</strong> subsequent developmental challenges. Unfortunately, the few longitud<strong>in</strong>al studies available<strong>in</strong>dicate that such “cascad<strong>in</strong>g” effects <strong>of</strong> protective factors, with cont<strong>in</strong>ued positive adaptation over time, is rare for<strong>maltreated</strong> <strong>children</strong>. Although evidence <strong>in</strong>dicates that few <strong>maltreated</strong> <strong>children</strong> are able to susta<strong>in</strong> resilient function<strong>in</strong>gover time, it is important to note that longitud<strong>in</strong>al studies <strong>of</strong> resilience among abused <strong>children</strong> have been relativelyshort-term and have not exam<strong>in</strong>ed function<strong>in</strong>g <strong>in</strong>to adulthood. Children who do not demonstrate positive adaptation <strong>in</strong>the early years might experience delayed benefits <strong>of</strong> struggl<strong>in</strong>g to meet challenges. Those benefits might be manifestedlater, <strong>in</strong> adulthood (Werner, 2005).In terms <strong>of</strong> protective factors for maltreatment, there has been far greater attention to personal attributes <strong>of</strong> <strong>children</strong>than to environmental <strong>in</strong>fluences. The focus on <strong>in</strong>dividual child characteristics is noteworthy because leaders <strong>in</strong> thefield <strong>of</strong> resilience (e.g., Luthar & Zelazo, 2003) argue that <strong>children</strong>'s personal characteristics are probably less<strong>in</strong>fluential <strong>in</strong> competence among <strong>children</strong> at risk for maladaptation than are aspects <strong>of</strong> the parent–child relationship andthe child's broader environment. Cicchetti and Rogosch (1997) and Flores et al. (2005) concluded that <strong>in</strong>dividual childfactors were more relevant to positive social and academic outcomes among <strong>maltreated</strong> <strong>children</strong> than were<strong>in</strong>terpersonal relationships. The <strong>in</strong>vestigators hypothesized that <strong>maltreated</strong> <strong>children</strong> might have essentially abandonedthe potential value <strong>of</strong> relationships <strong>in</strong> their striv<strong>in</strong>g to adapt to developmental demands, and <strong>in</strong>stead were focused onself-reliance. Ask<strong>in</strong>g whether <strong>in</strong>dividual child attributes or the childrear<strong>in</strong>g context <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> are morecritical to outcomes is perhaps illogical s<strong>in</strong>ce complex <strong>in</strong>teractions <strong>of</strong> both child resources and family supports arelikely the best predictors <strong>of</strong> resilience. Such <strong>in</strong>teractions <strong>of</strong> personal and environment factors should receive greaterattention <strong>in</strong> future studies. In addition, the potential protective role <strong>of</strong> school and other community contexts deserve farmore consideration. Given the extreme risk with<strong>in</strong> the homes <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>, elucidat<strong>in</strong>g protective factors <strong>in</strong>the <strong>children</strong>'s neighborhoods, schools, and religious <strong>in</strong>stitutions is critically important.4.1. Considerations for future researchFortunately, research on resilience to maltreatment has progressed far beyond early formative publications basedlargely on cl<strong>in</strong>ical observation (e.g., Mrazek & Mrazek, 1987). There cont<strong>in</strong>ue to be methodological challengesassociated with this research, however. One challenge is the fact that samples <strong>of</strong>ten are comprised <strong>of</strong> <strong>children</strong> withhighly diverse experiences. There is variation <strong>in</strong> abuse typology and <strong>in</strong> associated risk factors to which abused <strong>children</strong>have been exposed. Past research <strong>in</strong>dicates that there are different outcomes associated with various types <strong>of</strong> abuse(Cohen, Brown, & Smailes, 2001), and there are overlapp<strong>in</strong>g but unique outcomes associated with the risks that tend toco-occur with maltreatment. Use <strong>of</strong> samples that are highly heterogeneous might obscure rather than clarifyunderstand<strong>in</strong>g <strong>of</strong> resilient function<strong>in</strong>g among <strong>maltreated</strong> <strong>children</strong>, thus, it might be argued that different types <strong>of</strong>maltreatment should be exam<strong>in</strong>ed separately (e.g., English et al., 2005). On the other hand, forms <strong>of</strong> maltreatmentrarely occur <strong>in</strong> isolation (Barnett, Manly, & Cicchetti, 1993), so samples that <strong>in</strong>clude all types <strong>of</strong> maltreatment andmultiple risks probably have external validity. Researchers typically address multiple risks <strong>in</strong> samples us<strong>in</strong>g cumulativerisk models, but there are drawbacks to that approach (Masten & Powell, 2003). Thus, when sample sizes are adequate,<strong>in</strong>vestigators should exam<strong>in</strong>e protective factors for subgroups separately. At a m<strong>in</strong>imum, details about maltreatmentexperiences should be provided us<strong>in</strong>g a validated classification system such as the system for translat<strong>in</strong>g childprotective services (CPS) records developed by Barnett et al. (1993). Investigators also should report additionaladversities experienced by the <strong>maltreated</strong> <strong>children</strong> <strong>in</strong> their samples. This <strong>in</strong>formation will assist <strong>in</strong> <strong>in</strong>tegration <strong>of</strong>f<strong>in</strong>d<strong>in</strong>gs across studies, and will aid <strong>in</strong> establish<strong>in</strong>g generalizability <strong>of</strong> f<strong>in</strong>d<strong>in</strong>gs.Exist<strong>in</strong>g studies <strong>of</strong> resilience to maltreatment have <strong>in</strong>cluded samples <strong>of</strong> <strong>children</strong> with histories <strong>of</strong> abuse and neglectsubstantiated by formal child protection systems. The reliability and validity <strong>of</strong> CPS substantiations are highlyquestionable (Hussey et al., 2005; Leiter, Myers, & Z<strong>in</strong>graff, 1994). In addition, many abused and neglected <strong>children</strong>never reach the attention <strong>of</strong> formal child protection systems. For these reasons it is likely that research samples are nonrepresentative<strong>of</strong> the larger population <strong>of</strong> <strong>maltreated</strong> <strong>children</strong>. F<strong>in</strong>d<strong>in</strong>gs <strong>of</strong> studies based on samples <strong>of</strong> <strong>maltreated</strong><strong>children</strong> referred for <strong>in</strong>tervention services (e.g., summer camp programs, outpatient cl<strong>in</strong>ics) are even less generalizable.
M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812807An alternative method <strong>of</strong> recruitment and identification <strong>of</strong> maltreatment status should be considered. For example, an<strong>in</strong>-depth parent <strong>in</strong>terview <strong>of</strong> community parents might be utilized. Such a method was developed as a measure <strong>of</strong>physical maltreatment for the Multisite Child Development Project (Dodge, Bates, & Pettit, 1990), and it appears to bea valid alternative to social services designations <strong>of</strong> abuse status (e.g., Jaffee et al., 2005). Of course, this strategy wouldrequire wide screen<strong>in</strong>g to identify an abuse sample, and its use would negate the use <strong>of</strong> classification systems formaltreatment typology because those systems rely on CPS records (see Herrenkohl, 2005; Runyan et al., 2005).There is a great need for additional longitud<strong>in</strong>al studies <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong>. The benefits <strong>of</strong>longitud<strong>in</strong>al research are numerous (Black, 1991). Because resilience is a transactional process, <strong>children</strong> candemonstrate features <strong>of</strong> resilience at one po<strong>in</strong>t <strong>in</strong> time but fail to show positive adaptation later <strong>in</strong> development.Unfortunately, processes related to susta<strong>in</strong>ed resilient function<strong>in</strong>g have been relatively unexplored. Longitud<strong>in</strong>alstudies are also needed to formulate a development model <strong>of</strong> resilience; protective factors are likely to be sensitive to<strong>children</strong>'s developmental stage such that different variables predict resilience at different developmental periods. Inaddition, some factors that appear to contribute to resilience <strong>in</strong> earlier periods might <strong>in</strong> fact be detrimental for<strong>maltreated</strong> <strong>children</strong> at a later developmental period. For <strong>in</strong>stance, self-reliance and <strong>in</strong>dependence, which generally areassociated with positive adaptation, could result <strong>in</strong> role reversal with<strong>in</strong> the parent child relationship as the child ages.F<strong>in</strong>ally, longitud<strong>in</strong>al studies can contribute to knowledge <strong>of</strong> protective factors beyond a s<strong>in</strong>gle generation, and they canprovide valuable <strong>in</strong>formation for break<strong>in</strong>g the cycle <strong>of</strong> maltreatment, which is clearly not <strong>in</strong>evitable (Starr, MacLean, &Keat<strong>in</strong>g, 1991). Several long-term follow up studies are beg<strong>in</strong>n<strong>in</strong>g to be fruitful regard<strong>in</strong>g multi-generational resilience(see Werner, 2005).An emerg<strong>in</strong>g area <strong>of</strong> study with promise for achiev<strong>in</strong>g an advanced understand<strong>in</strong>g <strong>of</strong> both risk and resiliency is<strong>in</strong>vestigations <strong>of</strong> <strong>in</strong>teractions between biological and environmental risk factors (see Deater-Deckard, Ivy, & Smith,2005). To illustrate, several recent studies have <strong>in</strong>dicated that certa<strong>in</strong> biological risk factors <strong>in</strong>teract with maltreatmentsuch that <strong>children</strong> with high biological risk are more negatively impacted by the abuse experience. One such biologicalrisk is a functional polymorphism <strong>in</strong> the promoter <strong>of</strong> the monoam<strong>in</strong>e oxidase A (MAOA) gene. This gene encodes theMAOA enzyme, which metabolizes neurotransmitters (dopam<strong>in</strong>e and seroton<strong>in</strong>) that contribute to regulation <strong>of</strong> moodand behavior <strong>in</strong> response to threat. Studies show that maltreatment (Caspi et al., 2002) and <strong>in</strong>adequate parent<strong>in</strong>g (Foleyet al., 2004) are more strongly associated with antisocial behavior among youth with low levels <strong>of</strong> MAOA activity thanamong youth with adequate MAOA activity. Knowledge <strong>of</strong> these nature–nurture <strong>in</strong>teraction effects can addsubstantially to the prediction <strong>of</strong> resilience among <strong>maltreated</strong> <strong>children</strong>, beyond knowledge <strong>of</strong> simple ma<strong>in</strong> effects <strong>of</strong><strong>in</strong>dividual risk factors.4.2. Cl<strong>in</strong>ical and policy implicationsWith respect to implications <strong>of</strong> this literature for cl<strong>in</strong>ical practice, we echo the caution <strong>of</strong> Doll and Lyon (1998) whoexpressed concern that cl<strong>in</strong>icians and educators might be hasty to develop programs to promote resilience without thebenefit <strong>of</strong> methodologically rigorous research. Research on resilience to maltreatment is <strong>in</strong> its “toddlerhood,” and thereare very few studies that have been designed to replicate f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong> different labs and across diverse samples. There arealso many methodological limitations (e.g., reliance on a s<strong>in</strong>gle data source, small sample sizes, use <strong>of</strong> measures withweak psychometric properties) that reduce the confidence <strong>in</strong> f<strong>in</strong>d<strong>in</strong>gs <strong>of</strong> these studies. In addition, most <strong>of</strong> the extantliterature has identified correlates <strong>of</strong> resilient function<strong>in</strong>g as opposed to processes <strong>in</strong>volved <strong>in</strong> resilience.With those cautions <strong>in</strong> m<strong>in</strong>d, the literature does <strong>of</strong>fer some direction for cl<strong>in</strong>ical practice. Our recommendationsshould be taken <strong>in</strong> the context <strong>of</strong> what is already known about evidence-based practices for child abuse treatment(Chaff<strong>in</strong> & Friedrich, 2004). Early <strong>in</strong>tervention is particularly important given research reviewed <strong>in</strong> this paper that<strong>in</strong>dicates <strong>children</strong> who experience maltreatment early <strong>in</strong> life might be less likely to develop protective attributes like<strong>in</strong>ternal locus <strong>of</strong> control. Research on protective factors for maltreatment supports parent<strong>in</strong>g programs that optimizeparents' efforts to provide warm and sensitive caregiv<strong>in</strong>g and stable family environments. Those factors might serve toprotect <strong>maltreated</strong> <strong>children</strong> from <strong>in</strong>secure attachment, low autonomy, and the associated difficulties that follow thoseproblems. There has been recent success with attachment-centered <strong>in</strong>terventions specifically designed to enhance thequality <strong>of</strong> the attachment relationship between depressed mothers and their toddlers, and outcomes show benefits forthe child's developmental status (Cicchetti, Toth, & Rogosch, 1999). Those <strong>in</strong>terventions could be comb<strong>in</strong>ed with moretraditional behavioral parent tra<strong>in</strong><strong>in</strong>g programs, which tend to direct the <strong>in</strong>tervention to the parent's child managementskills.
808 M.E. Haskett et al. / Cl<strong>in</strong>ical Psychology Review 26 (2006) 796–812In terms <strong>of</strong> <strong>in</strong>dividual child characteristics, the key role <strong>of</strong> self-esteem <strong>in</strong> mediat<strong>in</strong>g the path between maltreatmentand social–emotional competence <strong>in</strong>dicates that self-efficacy and personal confidence might be important to foster <strong>in</strong><strong>in</strong>tervention efforts for <strong>maltreated</strong> <strong>children</strong>. Of course, enhanced skills might be required to <strong>in</strong>crease <strong>children</strong>'s feel<strong>in</strong>gs<strong>of</strong> confidence. Based on the studies reviewed here, problem-solv<strong>in</strong>g skills tra<strong>in</strong><strong>in</strong>g and self-regulatory skillsenhancement might be especially beneficial <strong>in</strong> this regard. Given the importance <strong>of</strong> <strong>children</strong>'s cognitive appraisals <strong>of</strong>the abuse experience <strong>in</strong> prediction <strong>of</strong> social and emotional <strong>adjustment</strong>, it might be critical to assess <strong>children</strong>'sattributions and consider cognitive restructur<strong>in</strong>g <strong>of</strong> beliefs surround<strong>in</strong>g the maltreatment. F<strong>in</strong>ally, social skills tra<strong>in</strong><strong>in</strong>gand other efforts to assist <strong>maltreated</strong> <strong>children</strong> <strong>in</strong> establish<strong>in</strong>g and ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g close friendships with prosocial peers are<strong>in</strong>dicated by this literature.Available literature on resilience to maltreatment <strong>of</strong>fers little direction for <strong>in</strong>terventions at the exosystem level (e.g.,schools, religious <strong>in</strong>stitutions, and workplace); too few <strong>in</strong>vestigations have been conducted to draw conclusions aboutpossible protective factors beyond <strong>children</strong>'s personal characteristics and their <strong>in</strong>terpersonal relationships. However,because there are likely to be <strong>in</strong>teractions <strong>of</strong> child, family, and community factors <strong>in</strong> resilient outcomes for <strong>maltreated</strong><strong>children</strong>, it is safe to assume that the most successful efforts to enhance protective factors likely will be multi-level,such as school–community partnerships or family–school collaborations (Haugaard & Feerick, 2002). Evidence<strong>in</strong>dicates that such partnerships are <strong>in</strong>deed effective for <strong>maltreated</strong> <strong>children</strong> (e.g., Fantuzzo, Manz, Atk<strong>in</strong>s, & Meyers,2005). It will be important to rigorously evaluate the impact <strong>of</strong> <strong>in</strong>terventions designed to support resilient function<strong>in</strong>g<strong>of</strong> <strong>maltreated</strong> <strong>children</strong>. If appropriately designed, <strong>in</strong>tervention studies can provide an empirical test <strong>of</strong> protective factorsthat are <strong>in</strong>itially identified via correlational research (e.g., Eckenrode et al., 2001). Thus <strong>in</strong>terventions can be <strong>in</strong>formedby, as well as contribute to, theoretical models <strong>of</strong> risk and resilience.Research reviewed here<strong>in</strong> <strong>in</strong>dicates that a number <strong>of</strong> <strong>children</strong> who experience maltreatment will be able to developpositive personal resources, benefit from favorable experiences with<strong>in</strong> the family, and/or capitalize on support fromtheir environment (especially high-quality friendships). Certa<strong>in</strong>ly, these f<strong>in</strong>d<strong>in</strong>gs should lead to some degree <strong>of</strong>optimism. However, resilience among <strong>maltreated</strong> <strong>children</strong> is an exceptional outcome, not a typical outcome. The factthat some <strong>children</strong> appear to demonstrate features <strong>of</strong> resilience should not be used to justify a cont<strong>in</strong>uation <strong>of</strong><strong>in</strong>adequate mental health services for <strong>children</strong> and families <strong>in</strong> this country. Indeed, given typical developmentaloutcomes associated with maltreatment, support for these vulnerable <strong>children</strong> and their families must be provided even<strong>in</strong> times <strong>of</strong> deep f<strong>in</strong>ancial constra<strong>in</strong>t. It is hoped that <strong>in</strong>vestigators will cont<strong>in</strong>ue to pursue an understand<strong>in</strong>g <strong>of</strong> processesassociated with positive adaptation <strong>of</strong> <strong>maltreated</strong> <strong>children</strong> across developmental tasks <strong>of</strong> childhood, adolescence, andadulthood; such research will provide further build<strong>in</strong>g blocks toward <strong>in</strong>tervention efforts and fund<strong>in</strong>g and policy<strong>in</strong>itiatives for <strong>children</strong> who have suffered the experience <strong>of</strong> harsh and <strong>in</strong>adequate parent<strong>in</strong>g.AcknowledgementAfter the first author, order <strong>of</strong> authorship was determ<strong>in</strong>ed by a draw; the contribution <strong>of</strong> each co-author wasequivalent. 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