Article |

Examining Pregnant Women's Hostile Attributions About Infants as a Predictor of Offspring Maltreatment

Lisa J. Berlin, PhD; Kenneth A. Dodge, PhD; J. Steven Reznick, PhD
JAMA Pediatr. 2013;167(6):549-553. doi:10.1001/jamapediatrics.2013.1212.
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Importance Child maltreatment is a serious public health problem that disproportionately affects infants and toddlers. In the interest of informing prevention and intervention efforts, this study examined pregnant women's attributions about infants as a risk factor for child maltreatment and harsh parenting during their children's first and second years. We also provide specific methods for practitioners to assess hostile attributions.

Objective To evaluate pregnant women's hostile attributions about infants as a risk factor for early child maltreatment and harsh parenting.

Design Prospective longitudinal study.

Setting A small Southeastern city and its surrounding county.

Participants A diverse, community-based sample of 499 pregnant women.

Main Outcomes and Measures Official records of child maltreatment and mother-reported harsh parenting behaviors. Hostile attributions were examined in terms of women's beliefs about infants' negative intentions (eg, the extent to which infants purposefully dirty their diapers).

Results Mothers' hostile attributions increased the likelihood that their child would be maltreated by the age of 26 months (adjusted odds ratio, 1.26 [90% CI, 1.02-1.56]). Mothers who made more hostile attributions during pregnancy reported engaging in more harsh parenting behaviors when their children were toddlers (β = 0.14, P < .05). Both associations were robust to the inclusion of 7 psychosocial covariates.

Conclusions and Relevance A pregnant woman's hostile attributions about infant's intentions signal risk for maltreatment and harsh parenting of her child during the first years of life. Practitioners' attention to women's hostile attributions may help identify those in need of immediate practitioner input and/or referral to parenting services.

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Figure 1. Probability of child maltreatment, predicted by mothers' prenatal hostile attributions.

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Figure 2. Probability of mothers' “high” harsh parenting behaviors, predicted by mothers' prenatal hostile attributions.




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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