Child Abuse & Neglect 63 (2017) 84–94

Contents lists available at ScienceDirect

Child Abuse & Neglect

Intergenerational transmission of child abuse and neglect: Do

maltreatment type, perpetrator, and substantiation status
matter?
Jessica Dym Bartlett a,∗ , Chie Kotake b , Rebecca Fauth b , M. Ann Easterbrooks b
a
Child Trends, Bethesda, United States
b
Tufts Evaluation Interdisciplinary Evaluation (TIER), Tufts University, Medford, MA, United States

a r t i c l e i n f o a b s t r a c t

Article history: A maternal history of childhood maltreatment is thought to be a potent risk factor for child
Received 27 June 2016 abuse and neglect, yet the extent of continuity across generations is unclear, with studies
Received in revised form 29 October 2016 reporting vastly different rates of intergenerational transmission. Disparate findings may
Accepted 21 November 2016
be due to lack of attention to the nature of maltreatment experiences in each generation. We
Available online 30 November 2016
sought to expand the current literature by examining the role of maltreatment type, per-
petrator identity, and substantiation status of reports to child protective services (CPS) on
Keywords:
intergenerational maltreatment among adolescent mothers (n = 417) and their children. We
Child maltreatment
found that when mothers had at least one report of childhood maltreatment (substantiated
Child abuse and neglect
Intergenerational transmission or not), the odds that they maltreated their children increased by 72% (OR = 2.52), compared
Adolescent mothers to mothers who are not maltreated, but the odds were considerably lower when we lim-
Young children ited analysis to substantiated reports. Both a maternal history of substantiated neglect and
multiple type maltreatment (neglect and physical or sexual abuse) were associated with
increased risk of child maltreatment, yet the likelihood of children experiencing multi-
ple maltreatment perpetrated with their mothers identified as perpetrators increased over
300% when mothers had a childhood history of multiple maltreatment.
© 2016 Elsevier Ltd. All rights reserved.

Child abuse and neglect is widespread and is associated with adverse consequences for children that cascade throughout
the life course (Institute of Medicine & National Research Council [IOM & NRC], 2014), in areas including physical and mental
health (Gilbert et al., 2009; Nanni, Uher, & Danese, 2012), insecure attachments (Baer and Martinez, 2006; Stronach et al.,
2011), small brain size, and negative alterations to brain circuitry (Jedd et al., 2015; Pollak et al., 2010; Sheridan, Fox, Zeanah,
Nelson, & McLaughlin, 2012). Worldwide, approximately 23 percent of adults have suffered physical abuse as a child, 36
percent have experienced emotional abuse, and 16 percent have experienced physical neglect (World Health Organization,
2014). In the U.S., child protective service agencies received 3.6 million reports of child abuse and neglect involving an
estimated 6.6 million children in 2014 alone (U.S. Department of Health & Human Services (USDHHS), 2016). The vast
majority of maltreated children (79.5%) suffer neglect, and biological parents are most likely to be their perpetrators (88.6%).
Children born to adolescent mothers are at especially heightened risk for maltreatment (Connelly & Straus, 1992), with one
study showing that they were twice as likely to be maltreated than children of adult mothers (Stevens-Simon, Nelligan, &
Kelly, 2001).

∗ Corresponding author at: Child Trends, 56 Robbins Street, Acton, MA 01720, United States.
E-mail address: jbartlett@childtrends.org (J.D. Bartlett).

http://dx.doi.org/10.1016/j.chiabu.2016.11.021
0145-2134/© 2016 Elsevier Ltd. All rights reserved.
 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94 85

While considerable progress has been made with regard to developing, disseminating, and evaluating programs that
aim to address child abuse and neglect, the evidence on how best to prevent child maltreatment lags far behind (Howard
& Brooks-Gunn, 2009). Extant literature reflects a traditional approach to child welfare in the U.S., which focuses largely
on child maltreatment once it has already occurred versus primary prevention (Stagner & Lansing, 2009). A critical step
in developing effective prevention approaches is attaining a thorough understanding of its etiology so that programs can
be designed to address the most salient risk factors (Dubowitz et al., 2014) and to promote protective factors that support
resilient child and family functioning (Harper Browne, 2014; Horton, 2003). As there is no single cause of child abuse and
neglect, etiological models informed by an ecological perspective implicate not only parents’ individual characteristics,
such as their histories of childhood maltreatment, but also the social environments in which children and their parents live,
including neighborhood characteristics, poverty, or community violence (Belsky, 1993; Bronfenbrenner, 1979; Cicchetti
& Valentino, 2006). A parental history of childhood maltreatment is postulated as one potent risk factor, yet the extent to
which a mother’s history of abuse or neglect increases the odds that she will maltreat her offspring is unclear.

1. Intergenerational child abuse and neglect

One reason that child abuse and neglect is so difficult to prevent may be that abusive and neglectful parenting is passed on
from one generation to the next. However, a thorough review of the empirical literature reveals markedly inconsistent find-
ings regarding the degree to which parents’ own experiences of maltreatment in childhood predispose them to abusive and
neglectful behavior. Studies support the intergenerational transmission hypothesis – that parents who experienced abuse
and neglect when they were children are at elevated risk for maltreating their own children compared to non-maltreated
parents (Heyman & Slep, 2002; Newcomb & Locke, 2001; Pears & Capaldi, 2001). However, criticisms for methodological
weaknesses have been levied (Ertem, Leventhal, & Dobbs, 2000). Kaufman and Zigler (1987) first estimated that approxi-
mately 30% of maltreated parents continued the cycle of maltreatment, Ertem et al. (2000) reviewed the literature over a
decade later, concluding that much of the evidence was flawed and that transmission rates varied widely among studies
(1% to 38%). A more recent review by Thornberry, Knight, and Lovegrove (2012) found mixed evidence of support for the
intergenerational transmission hypothesis among studies with the strongest designs. As a result, it remains unclear the
extent to which prevention efforts would benefit from focusing on this issue.
Several methodological challenges contribute to conflicting findings on intergenerational maltreatment, including incon-
sistent definitions, measurement techniques, and study designs. For example, associations among different measures of
maltreatment (e.g., state child welfare records, self-reported child welfare system involvement, self-reported maltreat-
ment) are weak to moderate at best (Leve, Khurana, & Reich, 2015). Official records from child protection service (CPS)
are used most widely and have the advantage of being systematically collected, but this method has the disadvantage of
undercounting actual instances of child abuse and neglect, as they only represent maltreatment that has been reported to
child welfare authorities and also may constitute the most severe cases. There is also evidence that there is little associa-
tion between substantiation status and child outcomes (Hussey et al., 2005). Thus, to identify a larger number of children
who have been victimized, child maltreatment may best be defined as any report of abuse and neglect to CPS (i.e., both
substantiated and unsubstantiated reports). Putnam-Hornstein, Cederbaum, King, Eastman, and Trickett (2015) tested this
approach in a population-level longitudinal study on intergenerational maltreatment by adolescent mothers and found that
a maternal history of either unsubstantiated or substantiated maltreatment was a strong predictor of maltreatment and CPS
involvement in the next generation.
Another common measurement flaw is the failure to distinguish between intergenerational continuity and transmission,
the former representing situations in which children of maltreated parents have been abused or neglected irrespective of
whether or not the perpetrators were actually their parents, and the latter referring to a subgroup of these families in which
parents who were maltreated also have been identified as the perpetrators of maltreatment (Berlin, Appleyard, & Dodge,
2011; Valentino, Nuttal, Comas, Borkowski, & Akai, 2012). Studies that do not distinguish perpetrators may find higher rates
of intergenerational maltreatment than do researchers who narrow their investigations to instances in which the parent
was both the victim and the perpetrator. Further, rates of continuity may vary depending on the number of perpetrators.
Overall, a parental history of childhood maltreatment may be a stronger predictor of parent-perpetrated child maltreatment
than of child maltreatment in general, though this remains to be explored in the empirical literature.
Another methodological issue that may affect rates of intergenerational transmission and continuity is the nature of
the sample. Some subgroups are exposed to more risks associated with child maltreatment, such as adolescent mothers
with young children. For example, parenting prior to adulthood may expose young families to a wide variety of factors
(e.g., cognitive immaturity, single parent status, poverty, social isolation) that are linked to child abuse and neglect (Coley &
Chase-Lansdale, 1998; Whitman et al., 2001). Indeed, research suggests that teenage mothers are more likely than are adult
mothers to perpetuate cycles of maltreatment, with recent prospective studies reporting rates of transmission as high as
54% by the time children reached 21 years of age (Valentino et al., 2012). Finally, one aspect of measuring intergenerational
maltreatment that holds considerable promise for reconciling the debate about continuity versus discontinuity is type-to-
type (e.g., physical abuse, neglect, sexual abuse) transmission. At present, the majority of studies do not account for variation
in the type of maltreatment in each generation (Kim, 2009).
86 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94

1.1. Intergenerational transmission by maltreatment type

Traditionally, researchers either focused on a single type of maltreatment (e.g., physical abuse alone) or developed an
aggregate measure that conflates two or more types (e.g., physical abuse and/or neglect and/or sexual abuse) (Berzenski,
Yates, & Egeland, 2014). Such approaches overlook differences in patterns of maltreatment from one generation to the next.
This is of particular concern given compelling evidence that different forms of child maltreatment have disparate causes and
effects (Erickson, Egeland, & Pianta, 1989; Yates, Dodds, Sroufe, & Egeland, 2003). Berzenski et al. (2014) suggest “a focus
on subtype specificity will reveal that, just as the experiences of subtypes of maltreatment have different correlates and
consequences, the continuity of these experiences across generations may vary as well” (p. 117).
Few researchers have employed a type-specific approach in their investigations, but our review of the limited existing
literature indicates that homotypic continuity of maltreatment (i.e., type-to-type correspondence from one generation to
the next) occurs more often than does heterotypic continuity (i.e., different types in each generation). For example, Kim
(2009) compared transmission patterns between physical abuse and neglect and found that parents who were neglected
as children were more likely to engage in neglectful parenting than they were to be physically abusive. Conversely, parents
who were physically abused as children were more likely to be physically abusive than they were to be neglectful. An
earlier investigation by Pianta, Egeland, and Erickson (1989) did not find type-to-type correspondence, but the researchers
observed that maltreating mothers who were neglected in childhood most often demonstrated neglectful behaviors toward
their children. Additional research is needed to expand the evidence on type-to-type transmission and to reconcile variability
in study findings.
Disaggregation of maltreatment type may help resolve inconsistent findings on the continuity of intergenerational mal-
treatment, but an important complication of type-to-type intergenerational maltreatment research is that individuals may
experience more than one form of abuse and neglect (i.e., multiple type maltreatment). Comorbidity is common, though,
and research is not yet conclusive about the extent of co-occurrence or the degree to which different maltreatment types
are correlated (Higgins & McCabe, 2001). There is some evidence that multiple type maltreatment is associated with higher
rates of transmission (Kim, 2009), but it is not evident whether a maternal history of multiple maltreatment has a stronger
link with one form of child maltreatment compared to another.

1.2. The current study

The current study aimed to address specific methodological weaknesses of prior research by (a) conducting type-to-type
examination of intergenerational child abuse and neglect among adolescent mothers; (b) distinguishing transmission from
continuity by identifying cases in which the mother is both a victim and a perpetrator; (c) investigating the impact of a
maternal history of multiple-type maltreatment on children’s risk for different types of maltreatment; and (d) defining child
abuse and neglect as both unsubstantiated and substantiated reports of maltreatment to CPS. We hypothesized that inter-
generational transmission would be more common when assessing homotypic transmission, and that risk for transmission
of neglect and multiple type maltreatment is highest when mothers experienced multiple forms of maltreatment during
childhood. As the rate of physical abuse is typically low in early childhood, we did not expect to be able to examine physical
abuse in both generations.

2. Method

2.1. Participants and procedure

Data were drawn from the Massachusetts Healthy Families Evaluation-2 (MHFE-2), a longitudinal randomized controlled
trial (RCT) evaluation of Healthy Families Massachusetts, a statewide paraprofessional infant home visiting program designed
to support first-time mothers under age 21 across multiple domains of functioning, including the prevention of child abuse
and neglect. [Program name blinded] provides home visits, goal-setting activities, group-based activities, and referral services
to young parents, prenatally through the first year of parenting, until the child’s third birthday.
Of the 837 young women who were recruited for the study and randomly assigned to either the program group (home
visiting services, HVS, 60%) or the control group (referral and information only, RIO, 40%),1 704 mothers (n = 433 HVS; n = 271
RIO) participated in telephone interview and/or granted access to administrative state public agency data, including CPS from
the Massachusetts Department of Children and Families (DCF). Data were collected at home visiting program enrollment
(Time 1, T1), and approximately one (T2), two (T3), and 4–5 (T4) years post-enrollment, with attrition rates of 17%, 13%, and
30% at follow-up time points, respectively. Of the original 704 mothers who participated at T1, the current study used data
from 471 mothers (59% HVS) who participated at T4 and consented to a new DCF data release.
Mothers in the analytic sample reported their race/ethnicity as Hispanic (35%), non-Hispanic White (37%), non-Hispanic
Black (21%), and other (7%). Participating mothers were 19 years of age (M = 18.8, SD = 1.3), on average, at the time of their

1
Eligibility requirements for participating in the RCT included being a consenting English- or Spanish-speaking female aged 16 years or older who had
not received any HFM services in the past. Random assignment occurred at the program site level through an algorithm in its web-based management
information system, with assignment to the control group capped at 40% to minimize the number of women denied home visiting services.
 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94 87

Table 1
Sample Descriptive Statistics (n = 471).

n M (SD) %

Program status (HVS) 280 59.4%

Maternal age at birth of child (years) 471 18.78 (1.27)
Child age at T4 471 4.82 (0.46)
Child sex (female) 223 47.3%
Maternal race/ethnicity
White (non-Hispanic) 174 36.9%
Black (Non-Hispanic) 98 20.8%
Hispanic 164 34.8%
Other (Non-Hispanic) 35 7.4%
DCF reports of maternal history of maltreatment
Substantiated or unsubstantiated
Total maltreatment (1 or more reports) 252 53.5%
Type
Neglect only 90 35.7%
Physical abuse only 17 6.7%
Sexual abuse only 5 2.0%
Multiple type 140 55.6%
Substantiated
Total maltreatment (1 or more substantiated reports) 208 44.2%
Type
Neglect only 107 51.4%
Physical abuse only 15 7.2%
Sexual abuse only 4 1.9%
Multiple type 82 39.4%
DCF reports of child maltreatment (any perpetrator)
Substantiated or unsubstantiated
Total maltreatment (1 or more reports) 216 45.9%
Type
Neglect only 139 64.4%
Physical abuse only 12 5.6%
Sexual abuse only 4 1.9%
Multiple type 60 27.8%
Substantiated
Total maltreatment (1 or more substantiated reports) 131 27.8%
Type
Neglect only 110 84.0%
Physical abuse only 3 2.3%
Sexual abuse only 2 1.5%
Multiple type 16 12.2%
DCF reports of child maltreatment (mother perpetrator)
Substantiated or unsubstantiated
Total maltreatment (1 or more reports) 177 37.6%
Type
Neglect only 112 63.3%
Physical abuse only 8 4.5%
Sexual abuse only 1 0.6%
Multiple type 55 31.1%
Substantiated
Total maltreatment (1 or more substantiated reports) 99 21.0%
Type
Neglect only 83 83.8%
Physical abuse only 2 2.0%
Sexual abuse only 0 0%
Multiple type 14 14.1%

first child’s birth. Children were 5 years old (M = 4.8, SD = 0.5), on average, at T4, and 53% were male. Mothers in our analytic
sample were compared with mothers who did not participate at T4 on T1 background and demographic characteristics
and state administrative data. Few differences were found between mothers who were retained and those who were not:
Mothers who participated (T4) were more likely to be English-speaking, engaged or married to the fathers of their babies
(T1), and less likely to have dropped out of high school (T1) than mothers lost to attrition. To ensure the T4 sample is
generalizable to the original sample, we created inverse probability weights to adjust for biases due to sample attrition over
time. Sample descriptives appear in Table 1.

2.2. Measures

Data on maternal and child background and demographic characteristics were obtained through phone interviews, and
maltreatment data maltreatment were collected from DCF.
88 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94

2.2.1. Program status. We used an indicator variable for assignment to the HVS program group (1) or RIO control group (0).

2.2.2. Background and demographic characteristics. Demographic characteristics included: child’s age at T4 and sex
(1 = female), maternal age at first birth, and maternal self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black,
Hispanic, non-Hispanic other).

2.2.3. Maternal history of childhood maltreatment. To determine whether the participating mothers had been victims of
maltreatment while growing up, cumulative records of victimization from DCF records covering the period between each
participant’s birth and her 18th birthday were coded. The records provide data on maltreatment type (i.e., physical abuse,
sexual abuse, neglect, congenital drug addiction, emotional maltreatment), the allegation decision of the report (i.e., sub-
stantiated vs. unsubstantiated) and the timing and dates of the reports filed. To further refine the definition of maltreatment,
we created dichotomous variables indicating the presence (1) or absence (0) of reports by type (i.e., neglect, sexual abuse,
physical abuse, and multiple type defined by some combination of neglect, sexual abuse, and physical abuse) and by sub-
stantiation (i.e., substantiated reports, both substantiated and unsubstantiated reports). The small number of participants
who experienced physical or sexual abuse alone (see Table 1) precluded their inclusion in data analysis.

2.2.4. Child maltreatment. The maltreatment of children was assessed using cumulative records comparable to those
described for their mothers. The current study used the records collected between each child’s birth and November 30,
2014, reflecting the end of T4 data collection when children were 4.74–7.61 years of age. To illuminate the nuanced relations
between maternal histories and children’s experiences of maltreatment, we created dichotomous variables indicating the
presence (1) or absence (0) of reports by: (a) type (as described in maternal history); (b) substantiation (as described in mater-
nal history); and (c) perpetrator (i.e., mother only, any perpetrator) during a child’s lifetime. “Any perpetrator” included all
individuals other than the mother, whether intra- or extra-familial. Similar to mothers, children who experienced physical
abuse and sexual abuse alone were omitted from the type-to-type analyses.
The university’s Institutional Review Board approved all procedures and measures, and we obtained participant consent
before administration of any procedures. Full details of the evaluation and related findings have been presented and published
elsewhere (Bartlett & Easterbrooks, 2015; Easterbrooks et al., 2013; Jacobs et al., 2016; Tufts Interdisciplinary Evaluation
Research, 2013; Tufts Interdisciplinary Evaluation Research, 2015).

2.3. Data analysis plan

We ran a series of unadjusted logistic regression models to explore intergenerational associations between mothers’ and
children’s maltreatment history. First, we examined the probability that children of mothers with a history of maltreatment
experienced maltreatment themselves (relative to children whose mothers did not have a maltreatment history). Second,
we examined intergenerational associations separately by substantiation and perpetrator identity. Children who experi-
enced reports perpetrated by mother and other were omitted from analyses examining reports perpetrated by mother only.
Finally, we examined type-to-type associations between mothers’ and children’s maltreatment. For type-to-type analyses,
we examined the percentage of children who experienced neglect and multiple types of maltreatment, respectively. Given
the small sample sizes of children with substantiated reports of multiple types of maltreatment, we also examined the
Fisher’s Exact Test as a test of the association between mothers’ and children’s maltreatment.
As a robustness check, we ran all models a second time, controlling for program status and child age at T4, and incorporat-
ing attrition weights and robust standard errors to adjust for clustering of mothers within HFM catchment areas from which
participants were recruited. Maternal age at birth, maternal self-reported race/ethnicity, and child sex were also initially
included as control variables, but were excluded from the second set of models because of their insignificant contribution
to explaining the model variances. Analyses were conducted in Stata 14.0. All summarized associations between mothers’
and children’s maltreatment reports were statistically significant at p < 0.01 or lower, unless otherwise noted.

3. Results

3.1. Maternal childhood history of maltreatment

Approximately half of the mothers in the sample had a report of childhood maltreatment to child protective services
(substantiated or not; n = 252; 53.5%); the majority of mothers with a report of childhood maltreatment had at least one of
these reports substantiated (n = 208; 82.5%). The majority of maltreated mothers experienced multiple types of maltreatment
(n = 140; 55.6%) or neglect (n = 90; 35.7%). Among mothers with substantiated reports, a greater proportion experienced
neglect (n = 107; 51.4%) than multiple types (n = 82; 39.5%). See Table 1 for additional on about maternal childhood history
by type of maltreatment.

3.2. Maltreatment of children

Just under half of the children in the sample (n = 216; 45.9%) had one or more reports (substantiated or not) of abuse and
neglect by the end of the study, when children averaged approximately five years of age. Of children with a report, 131 (60.6%)
 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94 89

Fig. 1. Intergenerational Transmission of Child Maltreatment by Substantiation Status and Perpetrator Identity.

had one or more substantiated reports, and 177 (81.9%) involved mothers as one of the identified perpetrators. In contrast
to their mothers, children who had any report of maltreatment most often experienced neglect (n = 139; 64.4%), followed by
multiple types of maltreatment (n = 60; 27.8%). Children with substantiated reports followed a similar pattern; neglect was
the most frequently reported type of maltreatment (n = 110; 84%). Most children with one or more substantiated reports
were maltreated by their mothers, acting alone or with other perpetrators (n = 99; 75.6%). When mothers were perpetrators,
the most common maltreatment type was neglect (n = 83; 83.8%). See Table 1 for further information on child maltreatment.

3.3. Intergenerational maltreatment

As a whole, the children of maltreated mothers were maltreated more often than were children of non-maltreated
mothers. Overall, of the 252 (53.5%) children whose mothers had a report of maltreatment in childhood, over half (n = 137;
54.4%) were reported to be maltreated. In comparison, 36.1% (n = 79) of children whose mothers did not have a report of
maltreatment in childhood were reported to have experienced maltreatment (see Fig. 1).

3.3.1. Intergenerational maltreatment and substantiation status. When we examined rates of intergenerational continuity
among mothers and children with substantiated reports of maltreatment, we also found that the frequency of child mal-
treatment was higher among families in which mothers were maltreated in childhood compared to families in which mothers
were not maltreated. Of the 208 (44.2%) children whose mothers had a substantiated report of maltreatment in childhood,
77 (37.0%) had at least one substantiated report, compared to 20.5% (n = 54) of children whose mothers had no substantiated
reports (see Fig. 1).

3.3.2. Intergenerational maltreatment and perpetrator identity. Intergenerational continuity was especially prevalent in
instances of maltreatment that were perpetrated by mothers (i.e., mother was an identified perpetrator with or without
another perpetrator). Approximately half (50.9%; n = 119) of children with mothers who had any reports of maltreatment in
childhood had at least one any report of maltreatment perpetrated by their mother, whereas for children of non-maltreated
mothers, 29.3% (n = 58) experienced one or more reports of maltreatment perpetrated by mother. This was also the case
for substantiated reports. The intergenerational transmission rate for substantiated reports of maltreatment by mothers
was 33.5% (n = 66) among children with maltreated mothers who had a substantiated report, compared to 13.6% (n = 33) of
children with substantiated reports of maltreatment whose mothers were not maltreated (see Fig. 1).

3.3.3. Type-to-type transmission. Considerable variations emerged in the intergenerational transmission rates when account-
ing for the types of maltreatment (see Fig. 2). Mothers’ history of reported neglect was associated with children’s reports
only for mother-perpetrated substantiated neglect: While 11.8% (n = 28) of children born to non-maltreated mothers had at
least one substantiated report of mother-perpetrated neglect, the rate nearly doubled for children of mothers with a history
of substantiated childhood neglect in childhood (23.5%; n = 23).
A difference in the frequency of child maltreatment emerged between the offspring of mothers with different maltreat-
ment history only when we examined neglect-to-multiple types for substantiated reports by any perpetrator: 8.5% (n = 7) of
children had one or more substantiated report of multiple-type maltreatment when their mothers had at least one substan-
tiated report of neglect, whereas 1.9% (n = 4) of children of non-maltreated mothers had at least one substantiated report of
multiple-type maltreatment (see Fig. 2).
90 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94

Fig. 2. Intergenerational Transmission of Child Maltreatment by Perpetrator Identity and Maltreatment Type.

Over one-third of children (36.8%; n = 32) whose mothers had any report of multiple-type maltreatment in childhood had
at least one report of multiple-type maltreatment themselves. A similar pattern was observed for multiple type-to-multiple
type transmission for substantiated reports (regardless of perpetrator), although sample sizes are quite small.
When we examined intergenerational transmission involving a maternal history of multiple-type maltreatment and
offspring neglect, similar patterns emerged. Among children of mothers with reports of multiple-type maltreatment, just
under half (46.6%; n = 48) had one or more reports of neglect. When mothers were not maltreated, a smaller percentage, 28.6%
(n = 56) of their children had reports of multiple-type maltreatment. After limiting reports of neglect that were perpetrated
by mothers, we found that the transmission rate was even higher among mothers with report of multiple-type maltreatment
(43.9% versus 22.7%). When examining transmission by substantiation status, we found that when mothers had substantiated
reports of multiple-type maltreatment, 42.1% (n = 32) of their children had at least one substantiated report of neglect. A
lower percentage of children (18.7%; n = 48) had at substantiated reports of neglect when we examined the offspring of non-
maltreated mothers. Finally, when we isolated maltreatment patterns to a maternal history of substantiated multiple-type
maltreatment and substantiated child neglect, the transmission rate increased (37.1% vs. 11.8%; see Fig. 2).

3.4. Adjusted intergenerational transmission of child maltreatment

Table 2 summarizes findings from logistic regression models examining intergenerational patterns of maltreatment. The
table presents odds ratios (ORs) and 95% confidence intervals of children having a maltreatment report as a function of their
mothers’ history, adjusted for program status, child age at T4, and sample attrition over time. Findings confirmed the pat-
terns we observed descriptively in the intergenerational transmission of maltreatment. Notably, we saw strong evidence of
intergenerational associations between mothers’ and children’s maltreatment: overall, children whose mothers experienced
any reports that they were maltreated were 50% more likely to have experienced any reports of maltreatment themselves
than children whose mothers did not (55% vs. 36.6%, respectively). Further analyses revealed that such associations varied
by substantiation, perpetrator type, and maltreatment type. Intergenerational associations remained strong in instances of
mother-perpetrated reports of maltreatment. When mothers had any reports that they were maltreated, the likelihood that
their children experienced mother perpetrated reports increased by 72% compared to when mothers did not have any reports
of maltreatment (51.6% vs. 30.1%, respectively). This was also the case for the substantiated reports, where the likelihood
that children experienced mother perpetrated substantiated reports was more than double that of children whose mothers
did not have a substantiated maltreatment report (31.2% vs. 14.6%, respectively) (see Table 2).
Differences emerged in intergenerational transmission of child maltreatment according to maltreatment type, in com-
bination with substantiation and perpetrator identity. Specifically, children of mothers who had at least one substantiated
report of childhood neglect were 63% more likely to have at least one report of mother perpetrated substantiated neglect
(20.7%) than children of non-maltreated mothers (12.7%; association significant at p < 0.05 only); this association was not
significant when we examined neglect to neglect transmission of substantiated reports by any perpetrator. Maternal history
of substantiated neglect was also associated with their children having at least one substantiated report of multiple type
maltreatment: children of mothers who had at least one substantiated report of neglect were more likely to have experi-
 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94 91

Table 2
Intergenerational Transmission of Child Maltreatment by Substantiation Status, Perpetrator Identity, and Maltreatment Type Adjusted for Home Visiting
Program Status and Child Age.

Child Maltreatment Maternal history

Any report Substantiated report

Total Neglect Multiple Total Neglect Multiple

Any Perpetrator
Total Reports 2.14
[1.42, 3.23]**
Neglect Reports 1.61 2.21
[0.76, 3.38] [1.34, 3.66]**
Multiple Type 1.73 5.02
[0.65, 4.58] [2.27, 11.09]***
Total Substantiated Reports 2.05
[1.57, 2.69]***
Substantiated Neglect 1.1 2.75
[0.74, 1.65] [1.87, 4.05]***
Substantiated Multiple Type 4.86 4.28
[1.10, 21.52]* [1.10, 16.67]*
Mother Perpetrated
Total Reports 2.52
[1.68, 3.77]***
Neglect Reports 1.66 2.69
[0.72, 3.85] [1.60, 4.52]**
Multiple Type 1.91 6.35
[0.66, 5.54] [2.90, 13.87]***
Total Substantiated Reports 2.71
[2.06, 3.57]***
Substantiated Neglect 1.84 3.71
[1.11, 3.04]* [2.23, 6.15]***
Substantiated Multiple Type 2.82 4.28
[0.61, 13.08] [1.10, 16.67]*

Note. Table presents odds ratios [95% Confidence Intervals]. All analyses include probability weights to adjust for sample attrition over time and robust
standard errors to adjust for clustering of mothers within home visiting program catchment areas from which participants were recruited.
*
p < 0.05.
**
p < 0.01.
***
p < 0.001.

enced substantiated reports of multiple types than children who mothers who did not experience substantiated reports of
neglect; this association was strongest for substantiated reports perpetrated by any perpetrator (8.8% vs. 2%, respectively;
association significant at p < 0.05 only; see Table 2).
Children of mothers who had at least one report of multiple types of maltreatment were significantly more likely to have
at least one report themselves, regardless of substantiation status, perpetrator identity, and type (see Table 2), although
findings for children’s substantiated reports of multiple type are based on very small sample sizes and should be interpreted
with caution and replicated with a larger sample. The greatest variation emerged for multiple-to-multiple transmission for
mother perpetrated reports: There was more than a 300% increase in the likelihood of children having at least one mother-
perpetrated report (substantiated or unsubstantiated) of multiple type maltreatment when mothers themselves had at least
one report of multiple type than not (34.6% vs. 7.8%, respectively). Mothers’ experience of substantiated or any reports for
multiple types was also associated with children having substantiated or any reports of neglect, but associations were not
as strong as multiple-to-multiple transmission (see Table 2).
In summary, the presence of maternal history of maltreatment was strongly associated with an increased likelihood
that children in the next generation also experienced abuse and neglect; these associations were robust to variation in
substantiation status and perpetrator identity. Analyses of type-to-type transmission revealed that children of mothers who
had reports for both abuse and neglect were more likely to have maltreatment reports themselves than when mothers had
reports for neglect only.

4. Discussion

Our study provided robust evidence of intergenerational continuity and transmission of child maltreatment in an at-risk
sample of young mothers and their preschool-aged children. When a mother had a childhood history of being maltreated,
there was a strong increase in the likelihood of child abuse and neglect in the next generation. In order to move the field
forward, it is important to “unpack” some of the challenging issues that complicate understanding of these relations (e.g.,
distinguishing between continuity and transmission, where a parent who was maltreated in childhood becomes a perpetrator
in the next generation; investigating type-to-type [e.g., neglect to neglect] associations; and examining differential prediction
according to whether a report was supported). We draw several conclusions from our work, which we will discuss below.
92 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94

The intergenerational associations held across substantiation status and perpetrator identity, and were strongest for reports
that were supported by CPS investigation, and when mother was both victim and perpetrator across generations. Support
was provided for the importance of examining type-to-type transmission and the relative impact of more than a single
type of maltreatment experience. As expected, although type-to-type (homotypic) transmission of neglect was strongly
predicted across generations, when mothers had childhood histories of abuse and neglect, the likelihood of their own children
experiencing multiple types of maltreatment, even by preschool age, increased sharply.
References to a “cycle of violence” are commonplace; however, the literature addressing the likelihood of maltreatment
across generations is replete with inconsistencies, with estimates ranging from 1% to 50% or more. Even though the seminal
study of the intergenerational cycle of maltreatment (Kaufman & Zigler, 1987) suggested a rate of approximately 30%, others
(e.g., Ertem et al., 2000) consider that a liberal estimate, and note that methodological concerns sometimes result in inflated
figures. Indeed, there is substantial evidence of the need to consider maltreatment type, substantiation status, multiple type
maltreatment, and data source when drawing conclusions about intergenerational continuity and transmission. Whereas
some studies have relied on self-report of maltreatment in either/both generations, we used CPS reports (both supported
and unsupported reports). In our sample of women who became mothers by age 20, half (53%) had documented childhood
histories of maltreatment (83% of these with supported cases), with the majority of these participants experiencing multiple
types of maltreatment or neglect. A child whose mother had a childhood history of maltreatment was 50% more likely to
experience a maltreatment report compared to a child whose mother was not maltreated during childhood. By the average
age of just under 5 years, half (54%) of children whose mothers had childhood histories of maltreatment had reports of
maltreatment themselves. Strikingly, this rate is equivalent to that (54.3%) cited in a recent study (Valentino et al., 2012),
despite differences in offspring age (five years in ours, 21 years in the Valentino study) and the fact that we excluded one
particular type of intergenerational maltreatment (physical abuse only; we included neglect and multiple type maltreatment)
due to small sample size.
As we expected, intergenerational rates were highest for type-to-type transmission (neglect was >60% more likely when
mothers had neglect histories), and for multiple type maltreatment (there was a 300% increase in multiple-type maltreatment
when mothers had any multiple-type exposure, with a similar pattern observed for substantiated multiple-type exposure).
The sizeable increases in transmission in the case of reports of multiple maltreatment may reflect the severity of the maltreat-
ment, heightening the likelihood of similar supported cases in the next generation. In a large-scale study of >8000 adults,
multiple type maltreatment was a strong predictor of mental health concerns (Edwards, Holden, Felitti, & Anda, 2003).
Further, although there was evidence of continuity (e.g., maltreated mother and child, but perpetrator someone other than
mother), the associations were stronger when considering the mother as both victim in her childhood and perpetrator of her
child’s maltreatment (transmission). Taking a systemic approach in considering both maternal and child histories provides
a more nuanced understanding of children’s maltreatment. We view our results regarding intergenerational transmission
as quite robust, and sobering, given that they held across variations in home visiting program status and child age (since
maternal age at childbirth and race/ethnicity did not contribute to the model they were not included.)

4.1. Study strengths and limitations

Our study sample consisted of women who became mothers at a young age (before age 21) and their preschool-aged
children. Teen mothers and their children both represent high risk groups for childhood maltreatment. Because of the
prevalence of maltreatment in these samples, they present a vigorous test of the research question. Although this was
not the focus of the current investigation, future studies might compare the risk of intergenerational transmission for
adolescent mothers to adult mothers. Our sample also included only young children (almost five years old, on average).
Although the infant and early childhood years are high risk for child maltreatment, the prevalence of maltreatment in the
sample—particularly for types other than neglect—likely will rise as children grow older. Whether our findings will generalize
to a broader population of older mothers and children is unclear. Our findings most probably are conservative estimates of
the likelihood of intergenerational continuity and transmission in this population. Other methodological issues, including
sample size and data source, constrain both analyses and interpretation. One of our goals was to examine type-to-type
transmission (for example, physical abuse to physical abuse, and neglect to neglect). This was possible for neglect, and, to
some extent, for “neglect plus” (multiple type), but small sample size prevented us from conducting a more comprehensive
analysis of intergenerational patterns. For example, reports of child physical abuse were too few to include in analyses, as
were reports of sole perpetration by persons other than mother. Further, sample sizes for children’s reports of substantiated
multiple type maltreatment were quite small in this analysis; although the correspondence in findings between substantiated
and any (i.e., substantiated and unsubstantiated) for children’s reports of multiple type suggest the findings are robust.
Second, our data were drawn from state CPS records. Reliance on CPS reports, and particularly supported cases, means
that our findings likely underrepresent the actual prevalence of abuse and neglect, and perhaps represent more extreme
incidents. Even though CPS records still may miss a substantial portion of actual maltreatment incidents, these data are
considered more reliable than self-report data, particularly with regard to maltreatment that occurs during early childhood,
and in cases of neglect. Leve et al. (2015) found “weak to modest” associations between measures of maltreatment based
on CPS and self-report. Another methodological issue that varies across investigations involves the use of (unsubstantiated)
reports of maltreatment, or post-investigation supported cases. However, distinguishing between reports and supported
cases of maltreatment may be a “distinction without a difference” (Hussey et al., 2005); in their study, children’s functioning
 J.D. Bartlett et al. / Child Abuse & Neglect 63 (2017) 84–94 93

did not vary according to whether maltreatment reports were supported by CPS investigations. Based on the eleven method-
ological criteria proposed by Thornberry et al. (2012) for determining the quality of studies of intergenerational continuity
of maltreatment, our study meets most, if not all, of the benchmarks for establishing confidence in the study findings.

4.2. Study implications and conclusions

There are several policy, programmatic, and research implications of this research, including implementation of screening,
and additional research. Early screening, ideally prenatal screening, of mothers is essential to the prevention of maltreatment
during the vulnerable period of infancy and early childhood, when children’s brains are developing at a rapid pace. Support-
ive relationships, including with romantic partners or therapeutic professionals, are one important aspect in breaking the
cycle of maltreatment (Egeland, Jacobvitz, & Sroufe, 1988; Milan, Lewis, Ethier, Kershaw, & Ickovics, 2004). Since intimate
partner violence is associated with risk for child maltreatment (Taylor, Guterman, Lee, & Rathouz, 2009), taking a broader
ecological approach that includes assessing household and partner risks is important. Utilizing obstetric or pediatric venues
to identify risks for intergenerational continuity and transmission, and then offering resources or referrals to bolster or build
supportive relationship capacities may contribute to breaking the cycle of maltreatment, and promoting the positive health
of family members (Garner et al., 2012). Screening with attention to types of abuse and neglect that mothers may have
experienced during childhood will inform a more nuanced understanding of child maltreatment prevention among moth-
ers with histories of abuse and neglect. One review of preventive interventions for child abuse and neglect concluded that
different interventions are more or less effective in prevention and treatment of different types of maltreatment (MacMillan
et al., 2009). Similarly, research that isolates particular patterns of type-to-type transmission (including physical abuse and
other types of abuse and neglect) is an essential component to understanding intergenerational maltreatment. Inquiry into
different patterns of maltreatment by perpetrator identity in each generation also may help to elucidate factors involved in
continuity and discontinuity in intergenerational cycles of maltreatment. A resilience approach, where knowledge of protec-
tive assets, circumstances, and experiences promotes positive functioning under conditions of risk (in this case, breaking the
“cycle of maltreatment”) has distinct advantages over a deficit approach, yet it requires research establishing those factors
that protect against intergenerational transmission.
The goal of our study was to address key questions in the literature on the intergenerational experience of child abuse
and neglect. This research helps to clarify some inconsistencies in the extant literature regarding the rate of transmission
by highlighting several influential factors. Still, there are features of the intergenerational maltreatment experience, such
as severity and chronicity of abuse and neglect, duration, and developmental timing, that remain as important, yet little-
understood issues that require attention.

Acknowledgements

This study was funded by Children’s Trust of Massachusetts, MA #5014. We are grateful for the support of the Children’s
Trust of Massachusetts, as well as the Massachusetts Department of Children and Families.

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