There are two main types of research: primary and secondary. In primary research, you collect your own data to analyze a topic of interest. For this Assignment, you will be conducting secondary research. In secondary research, you research information already collected by a primary researcher. Performing secondary research includes evaluating existing literature for strengths, limitations, and ethical considerations. When evaluating literature, think about questions such as the following:

• Were the author’s interpretations and conclusions supported by the evidence he or she presented?
• Was there any apparent bias?
• Were there other ways that specific data could be interpreted other than how the author approached it?
• Were any important variables left out of the study?
• Was every assertion supported by fact?
• Did the text use reliable resources?

(Walden University Writing Center, 2009, p. 1)

When conducting secondary research, you have the responsibility of evaluating your own research to avoid ethical issues.

To Prepare

Find three peer-reviewed journal articles in the Walden Library databases related to a human and social services program that interests you professionally. You may wish to use the program you selected for this week’s Discussion. Consider strengths and limitations when evaluating the articles. Finally, consider potential ethical issues in conducting secondary research.

The Assignment (3–4 pages):

• Briefly summarize each article you selected.
• In your summary, provide an evaluation of the articles (accuracy, authority, objectivity, currency, and coverage).
• Finally, explain one potential ethical issue of conducting secondary research. Include how you might avoid this ethical issue.
• Be specific, and provide examples to support your answer

Culturally Deprived
Children: Implications
for Child Welfare

Four conditions signifying cultural
deprivation are identified. If child
welfare agencies are to have an impact
on a significant number of deprived
children, they must direct more of their
resources into services for children
in their own homes and into extending
the concept of child welfare beyond the
current narrow definition.

ELIZABETH G. MEIER, D.S.W.

“Cultural deprivation” has recently become
a fairly popular term. But, some months ago
I used the phrase and was taken to task by
one of the students in my class who pointed
out to me that the phrase was no longer good
form. “Cultural deprivation,” she explained,
is able to connote only that the persons af-
fected have not had some experiences or op-
portunities they ought to have had. This is
not enough, my student pointed out, for one
ought also to be able to convey that the
persons about whom we are concerned not
only have been deprived of constructive ex-
periences, but they also have had destructive
experiences. Therefore, she concluded, the

D R . M E I E R is Professor of Social Work,
School of Applied Social Sciences, Western Re-
serve University, Cleveland, Ohio. This paper
was presented at the CWLA Central Regional
Conference, Toronto, Canada, March 18,1965.

term “culturally disadvantaged” is much
more inclusive and much to be preferred.

On the other hand, Riessman warns that
in his book the phrases ” ‘culturally de-
prived,’ ‘educationally deprived,’ ‘deprived,’
‘underprivileged,’ ‘disadvantaged,’ ‘lower
class,’ [and] ‘lower socio-economic group,’
are used interchangeably.” ^

Terms are peculiar things. Long ago there
were children whose intelligence did not
develop normally, and they were called
idiots, imbeciles, and morons—or perhaps
all of these groups were included in the
strongly descriptive word feebleminded.
Later these persons were referred to as
mentally retarded, and now there is a
Journal of Exceptional Children, whose con-
tents concern these very same children. The
Bible and even some current legal terminol-
ogy refer to bastards. But this word was
harsh; so then there were illegitimate chil-
dren, and now there are children bom out
of wedlock.

This is not to suggest that there is some-
thing inherently valuable about harsh terms
for harsh realities, but the softening of words
may have consequences that are harmful
rather than helpful to the groupings of per-
sons about whom we are concerned.
Euphemisms may cause us to forget tliat
so far as the individual child and his family
are concerned, the old responses of shame
and hurt, fear and humilitation are evoked,
and these are not dispelled by new terminol-
ogy. John has referred to a second unfortun-
ate consequence:

“The terms ‘socially disadvantaged’ or ‘cul-
turally deprived’ enable us as social scientists

1 Frank Riessman, The Culturally Deprived Child
(New York: Harper and Row, 1962), p. 1.

CHILD WBLFARE February 1966 65

MEIER

to neutralize our feelings about life for chUdren
in the midst of abject poverty. The synthetic
quality of these words perhaps reflects our
anger and shame about the plight of these chil-
dren and our ignorance and confusion about
how best to help them.” ^

Social workers cannot afford to permit
their feelings to be neutralized. The very
reason for the social worker’s professional
existence is that of bringing about change
—change in individuals, in persons within
groups, and in communities. This calls not
for a neutralization of feeling, but for an ap-
propriate channeling of physical, intellectual,
and emotional energies.

Culture Defined

What, then, is “culture,” of which—or
perhaps by which—^persons are deprived?
From the hundreds of available definitions,
Kroeber and Kluckhohn derived the follow-
ing definition:

“Culture consists of pattems, explicit and
implicit, of and for behavior acquired and
transmitted by symbols, constituting the dis-
tinctive achievement of human groups, includ-
ing their embodiments in artifacts; the essential
core of culture consists of traditional (i.e.,
historically derived and selected) ideas and
especially their attached values; culture systems
may, on the one hand, be considered as pro-
ducts of action, on the other as conditioning
influences upon further action.” s

These culturally determined ways of think-
ing, feeling, and behaving help to shape per-
sonality structure. The family is a primary
institution through which the child has his
earliest experience in having transmitted to
him the patterned behavior and values of
the culture. The family and all other social
institutions affect the development of the
entire personality by the manner in which
the individual is indoctrinated into the cul-
ture. All cultures must necessarily make pro-
vision for acceptable ways of expressing in-
stinctual needs, although the patterning for
these expressions varies from one culture to
another.

sVera P. John, “The Intellectual Development of
Slum Children: Some Preliminary Findings,” American
Journal of Orthopsychiatry, XXXIII (1963), 822.

a Richard Kluckhohn, ed., Culture and Behavior:
The Collected Essays of Clyde Kluckhohn (New
York: The Free Press of Glencoe, 1962), p. 73.

The development of the many functions
of the ego are culturally influenced. Our
perceptions and the meanings we read into
them are culturally derived. Our opinions as
to what is beautiful or ugly, melodious or
raucous, delicious or nauseous, are culturally
conditioned. Our ideas about behavior ap-
propriate to social roles are similarly derived.
Even the differential values placed upon the
various ego defenses vary from one culture
to another, as do the attitudes concerning
health and illness. Our culture designates
those achievements that are to be honored,
those acts that are to be shamed. And be-
cause these ideas and feelings carry values
about what is right or wrong in the way in
which id impulses are expressed and in
which the ego functions, cultural condition-
ing likewise influences superego develop-
ment.

If the individual is to assimilate the cul-
ture in which he is bom, knowledge con-
cerning these pattems for behavior must be
transmitted to him; the values must become
incorporated. The products of the culture
and its artifacts must be available for his
use.

Areas of Cultural Deprivation

Who, then, are the culturally deprived?
I should like to designate four types of chil-
dren who are culturally deprived. It will be
apparent that there is much overlapping of
these types. First, the child who is so ill-fed,
ill-clothed, and ill-housed that he and his
family live at a level below that which is
compatible with standards of health and
decency is culturally deprived. Second, as
indicated above, the pattems for behavior
must be transmitted by adults. Hence, there
is grave danger that a child will be culturally
deprived if within his family there is no ap-
propriate model for sexual identification and
when within the family and the neighborhood
there are few appropriate models after which
the child can pattem his concepts of a socially
productive adult role. Third, a child is cul-
turally deprived when the methods and ap-
proaches of the educational system alienate
him and make it impossible for him to as-
similate the knowledge needed to become a
socially productive person who is reasonably
able to comprehend the world in which he

66 February 1966 CHILD WELPARB

Culturally Deprived ChUdren

lives. Fourth, a child is culturally deprived
who comes to the conclusion—on the basis
of the behavior and attitudes expressed to-
ward him—that there will be no place for
him in the culture, and he will have no
valued role to play in the society of which
he will be a part as an adult. Why do these
four types of conditions constitute cultural
deprivation, and who are these children?

Physical Poverty

Why should living in poverty be equated
with cultural deprivation? Poverty means
hunger. The hungry child hurts; his belly
aches from the cramp of hunger. He cannot
grow and develop properly. The hungry child
camiot attend to learning those patterned
forms of behavior that constitute his cultural
heritage; nor, if the culture gives him so little,
is he likely to be motivated to adopt its
values. Moreover, when hunger exists in a
“land of plenty,” in an “aflBuent society” in
which high value is placed on material tilings
and on acquisitiveness as a personality trait,
then the contrast is sharp indeed between
what the child experiences and what the
culture symbols teU him he should be ex-
periencing. Dr. James, New York City Com-
missioner of Health, comments:

“It is not the point that the deserted mother
in the slum may have somewhat better nutri-
tion and less arthritis than an Asiatic rice
worker. What counts is that somehow she is
far adrift of what is expected in our society.” *

In the United States, one of the most re-
cent studies of the extent of poverty has been
reported by Orshansky. This report uses as
the standard for poverty any income that is
less than three times the cost of the economy
food allowance as computed by the Depart-
ment of Agriculture for families of three or
more persons (with adjustments of this for
families of two and for persons living alone).

On this basis, there are 15 million children
living with their families in poverty in the
United States. These children constitute one
in five of all the children in families. The
association between poverty and women
heading the household has long been pointed

out, as has the fact that public assistance
grants in all states are poverty-level grants.
It is, therefore, the more surprising to leam
that 10 million of the 15 million children
living in poverty are in families headed by a
man, and only one million of these are re-
ceiving aid to families with dependent chil-
dren.

Although unemployment is one cause of
impoverishment, it was found that for many
millions of persons poverty exists in families
in which the male head of the household is
fully employed—at low wages. This disad-
vantage falls more heavily upon nonwliite
families than upon white families. The con-
centration of nonwhite workers in these low-
paying jobs consigns their families to a life
of poverty—at three times the rate of white
citizens.”

Witmer points out that although the pro-
portion of poor nonwhite families (47 per-
cent) is more than three times that of poor
white families (14 percent), in terms of
numbers the poor white families are almost
three times as numerous as poor nonwhite
families. Similarly, although 63 percent of
the families headed by women are poor in
contrast with only 13 percent of those headed
by men, in numbers there are three million
poor families headed by men as contrasted
with one million headed by women.* Thus,
even though poverty is indeed associated with
being nonwhite and with female headship
of the family, there are more poor families
who are white than Negro and more with a
man at the head of the household than with
a woman.

I do not know whether Canadians have
been as busy counting their poor as Ameri-
can economists and govemment officials have
been in the last few years. But I do know
that years ago Canada’s govemment passed
the Family Allowance Act signifying that
it had concem for the material well-being of
its children, and it expressed this concern
by providing a monthly payment to parents
in behalf of each child. There is no similar
provision in the Unted States to signify our
social investment in children nor to safeguard

* George James, M.D., quoted in Children, XI
(1964), 213.

5 MoUie Orshansky, “Counting the Poor: Another
Look at the Poverty Profile,” Social Security Bulletin,
XXVIII, No. 7 (1965), 3-29.

8 Helen L. Witmer, “Children and Poverty,” Chil-
dren, XI (1964), 212.

CHILD WELFARE February 1966

67

MEIER

families against the economic hazard of hav-
ing a large family.

Inadequate Role Models

The second type of culturally deprived
child is the one who has no adequate role
models. The patterning of behavior, the
learning of behavior appropriate to social
roles, and the transmission of values do not
happen automatically. The child is intro-
duced to these through the hundreds of cues
he receives from adults in his environment.
The child in the fatheless home—particularly
the male child—has no ready reference for
establishing his sexual identification and for
learning in the myriad ways, day by day and
year by year, the kinds of behavior expected
from men in the home as husbands and
fathers, in the neighborhood and on the job
as citizens of the community. In this regard,
the Negro male child is particularly vulner-
able to cultural deprivation. (Witmer points
out that although only .06 percent of the
white families with children have a female
head of the family, this is true of 21 percent
of the nonwhite families.”)

The greater amount of marital instability
among Negroes is associated with the rel-
atively fewer economic opportunities for
Negro men as compared with Negro women.
This circumstance runs counter to the value
assumptions of the dominant white culture
that the father is the stable wager earner and
wiU be the primary support of the children.
This same circumstance also means that
within the range of acquaintances with men
of his own race, the Negro child is likely to
find fewer adult models who have achieved
success.

Inadequate Education

A third type of cultural deprivation exists
when a child does not learn those things
necessary to his becoming a socially produc-
tive adult who is adequately knowledgeable
about his surroundings and the infiuences

f Ibid., p. 209. These percentages were derived from
the table, which gives the following information: In
this country in 1960, there were 25,661,000 families
with own children. Of the 23,263,000 white families,
1,394,000 were headed by a female. Among the
2,398,000 nonwhite families, 497,000 had a female
head.

that affect his life. In our culture, the ability
to understand and to use words and numbers
are necessary tools. These are the symbols
through which the accumulated knowledge
of a culture is transmitted. More simply and
basically, these are necessary tools for the
individual’s earning a living, for finding out
where he is in a city, for being able to count
the money he has or does not have, for being
able to read a biU and to know how much
payment is expected, for knowing how much
he is really paying for something on an
“easy-payment plan,” for reading signs in
the supermarket, for filling in an application
for employment, and for reading the direc-
tions that tell him how he is to use the con-
tents of a package.

The child from a poverty-stricken home is
at a disadvantage when he first begins school.
He has not seen newspapers, magazines, or
books used either as sources of information
or as sources of pleasure. He has become
acquainted with fewer things that he can
identify by name. Moreover, the slum child
has had few organized conversations with
adults.^ He has not been listened to or talked
with; no one reads to him. For the eco-
nomically favored child, his experiences at
home and at school reinforce each other,
whereas this is not the case for the cul-
turally deprived child, for whom home and
school frequently seem to be at odds with
each other. Consequently, the gap between
his reading ability and that of his more
favored associate widens as the number of
school years increases.

Educators have become highly critical of
the effect that the educational system and its
teaching methods have upon culturally de-
prived children. There is increased urgency
for learning how to educate these chUdren,
since it is predicted that future jobs will re-
quire better education and higher levels of
skill.

Davis writes:

“The future of our Nation industrially and
socially depends upon the ability of the schools
to help large numbers of children from work-
ing class families leam the basic skills essential
both to social and economic life. The schools

8 Suzanne Keller, “The Social World of the Urban
Slum Child: Some Early Findings,” American Journal
of Orthopsychiatry, XXXIII (1963), 828.

68 February 1966 CHILD WELFARE

CulturaUy Deprived ChUdren

have not yet learned how to give this training
effectively.” »

Educators have identified some of the
factors that interfere with learning. Lack of
preschool acquaintance with the media for
leaming has already been cited. Learning
materials used in school are drawn from the
experiences of middle-class children, and the
stories in the readers are about children
quite strange to the slum child. When, in
addition, the child is Negro and aU the stories
are about white people, the difficulty is com-
pounded. When the older Negro child finds
in the history books and in the courses in
American literature that his forebears are
just not there—except as slaves—^his sense
of being a part of the culture is violated.
(Thus, some of us have heard Negro civil
rights workers exclaim with gleeful satis-
faction, “They see us now! Finally, they
know we are here!”)

Middle-class teachers often do not under-
stand the “style” of leaming among people
in lower classes and, therefore, are unable
to communicate with deprived children.
Moreover, the less-adequate teachers are
frequently assigned to the poor districts of
the city. Female domination of the school
often discourages the continued attendance
of the adolescent boy. And—^perhaps most
important of all—the pressures of immedi-
ate economic need, the repeated humiliations
of poor achievement in school, and the lack
of certainty that education will be useful
cause many boys and girls to drop out of
school. Thus, the cycle of cultural depriva-
tion continues for themselves as adults and
for their future children.

Inadequate Role Identification

A fourth type of cultural deprivation
exists when a child or young person comes
to the conclusion, on the basis of the be-
havior and attitudes expressed toward him,
that there will be no place for him in the
culture, and he will have no valued role to
play. Erikson has made it clear that the

8 Allison Davis, “Society, the School, and the Cul-
turally Deprived Student,” in Arno Jewett, et al., eds..
Improving English Skills of Culturally Different
Youth in Large Cities (Washington, D . C : Office of
Education, U.S. Department of Health, Education,
and Welfare, 1964), p . 12.

individual achieves his ego identity not only
by knowing who and what he is, but also by
being recognized and so identified by others:

“The community supports such development
to the extent to which it permits the child, at
each step, to orient himself toward a complete
‘life plan’ with a hierarchical order of roles as
represented by individuals of different age
grades. Family, neighborhood, and school pro-
vide contact and experimental identification
with younger and older children and with
young and old adults. A child, in the multi-
plicity of successive and tentative identifica-
tions, thus begins early to build up expectations
of what it will be like to be older and what it
will feel like to have been younger—expecta-
tions which become part of an identity as they
are, step by step, verified in decisive experi-
ences of psychosocial ‘fittedness.’ ” ̂ ^

It is not enough for the young person to
know that he has capacities, to want to make
use of them, and to have goals. If these per-
sonal qualities are to eventuate in social
productivity, the society must articulate its
readiness to permit the individual to make
use of his capacities.

The other three types or conditions of
cultural deprivation previously discussed
coalesce in their damaging impact upon the
young person’s capacity to establish an ef-
fective ego identity, and they tend to ex-
clude him from full participation in the cul-
ture. This, the adolescent knows—^before
he reaches adulthood—and his despair
sometimes leads to his assuming a negative
identity dedicated to the destruction of the
cultural structure from whose benefits he is
barred. Schorr has referred to the “three
D’s of alienation—drugs, delinquency, and
despair.” ^̂

Cultural Diversity

I tum again to the question of terminology
and to the question implied earlier. Are the
four specified conditions truly indicative of
“cultural deprivation,” or do they merely
refiect middle-class values? Some authors
have suggested that neither “culturally de-
prived” nor “culturally disadvantaged”

10 Erik H. Erikson, “The Problem of Ego Identity,”
Psychological Issues, I, No. 1 (1959), 114.

11 Alvin L. Schorr, “Policy Issues in Fighting
Poverty,” Children, XI (1964), 130.

CHILD WELFARE February 1966

MEIER

should be used, for both fail to take into
account the positive values within the cul-
turally determined attitudes and behaviors
among lower-class persons. Rather, they say,
the phrase “culturally different” should be
used, thus giving recognition to the fact that
differing values exist in different classes and
cultural groups. Related to this is the usage
of the phrase “the culture of poverty.”

Schorr has addressed himself to this
problem, pointing out that it is dangerous
to make assumptions about cultural at-
titudes without taking into account the
conditions out of which these attitudes arise.
He writes: “. . . the attitudes that are as-
sociated with the culture of poverty, viz.,
orientation to the present, passivity, cyni-
cism, are a realistic response to the facts of
poverty.” 12 “Because the attitudes persist,”
he continues, “we should not suppose that
they are an independent phenomenon. They
depend on material circumstances and
probably are functional in relation to
them.” ”

Cultural diversity—among the many
ethnic groups and the classes within—is and
should be a matter of national pride. Di-
versity, or difference, does not mean dep-
rivation. But certain minimum require-
ments must be met in order for the individual
to function effectively within any ethnic
group and any class therein. To refer to the
lack of these requirements as “differences,”
or as signifying a special “culture of poverty”
with an implication of choice on the part of
the individual, or as “transmitted traditional
values” obscures the fact that, when these
minimum conditions are not met, the in-
dividuals concerned are indeed deprived
and disadvantaged.

To expect that children will have enough
to eat is not a middle-class value—providing
one recognizes that their culture determines
whether the diet will include or exclude
enchiladas, hush puppies, gefiillte fish, or
orange juice. To expect that children will
be taught how to earn a living and how to
communicate with others is not a middle-
class value—^providing one recognizes that
their culture may infiuence the direction

12 Alvin L. Schorr, “The Nonculture of Poverty,”
American Journal of Orthopsychiatry, XXXIV (1964),
907.

IS Ibid., p. 911.

toward a vocation. To expect that boys and
girls will have models for sex-role identifica-
tion is not a middle-class value—providing
one recognizes that some differences in sex
roles are. class-determined. And certainly
middle-class value is not involved in the
expectation that the child, when grown, will
have an opportunity to find a place for him-
self in that society.

Implications for Child Welfare Practice

What implications do these four areas
of need have for child welfare practice? The
implications are many, both as to the way
in which services are structured and the
nature of the services to be rendered. But,
the nature and magnitude of this problem
are such that it is unlikely to be solved by
any one type of social agency or combina-
tion of agencies relying upon the method of
bringing about change case by case, person
by person, and family by family.

Social-structural changes are required to
change some of the conditions resulting
from discrimination and leading to poverty,
such as employment at substandard wages,
dead-end employment, inadequate educa-
tion, and excessive rents for poor housing.
Child welfare agencies should decide to use
some of their resources and infiuence to
educate the public concerning the need for
more adequate minimum-wage laws, fair
employment practices, adequate school
levies, vocational training geared to real job
opportunities, and the entering of unions
through apprentice training.

United States social workers have been
extraordinarily and unaccountably silent
concerning social security measures such as
the family-allowance systems that make
some provision for society’s sharing some
of the costs of child rearing and that take
into account the economic hazards of large
families. Recently, however, social workers
have begun to show somewhat more interest
in the idea of a minimum family income.

These types of measures that bring about
changes in the social structure are preventive
in nature, although some of them—even if
they were legislated immediately—might
not benefit the families who are currently
culturally deprived. Nevertheless, these long-
range measures are among the most impor-

70 February 1966 CHILD WELFARE

Culturally Deprived Children

tant in terms of their basic infiuence upon
the lives of large numbers of children, some
of them yet unborn.

There are however, other implications for
child welfare pertinent to the immediate
problems of today’s deprived children. As
noted earlier, although only a fraction of the
children living in poverty are receiving
public assistance, it is important that child
welfare agencies lend their infiuence in work-
ing toward the improvement of standards for
public assistance.

So far as the practices of child welfare
agencies are concemed, two of the most
important implications of cultural depriva-
tion (from my point of view) are these:
First, if the child welfare field intends to
have any impact upon a significant number
of the 15 million culturally deprived chil-
dren—1 child in every 5 in the United
States—it must concern itself increasingly
with children in their own homes. Second,
related to the first point is the inadequacy
of traditional agency alignments (accord-
ing to social work method and fields of
practice in welfare federation and councils)
and the specializations of services within
agencies themselves (according to social
work methods or t3^es of clientele and
services).

Flexibility of Services

Voluntary agencies have long claimed
fiexibility as one of the advantages of being
under voluntary auspices. It is time for them
to claim their heritage by actually being
fiexible, which means much more tiiian oc-
casionally being willing to take a difficult
child for placement when pressured to do so.
Flexibility must involve inaugurating ex-
perimental services or ranges of services
previously not undertaken. This would mean
taking their services to the culturally de-
prived children and families in the slums, in
the public housing developments, and in the
schools. But this also means taking only
those kinds of services that the families and
children are able to use.

The neighborhood-based multiservice
agency provides the opportunity for reach-
ing families who, from the despair of poverty,
would not be able to find or go to the dis-
tantly located specialized service. The neigh-

borhood service would be likely to use all
three of the social work methods—casework,
groupwork, and community organization—
but it would also use the talents of health
personnel, teachers, and home economists.

Expansion of Services

The neighborhood service proving most
useful to the residents of the neighborhood
would likely be one that, above all, helped
families to deal with practical realities. The
poorly educated person is ill-equipped to
deal with the intricacies of bureaucratic
structures such as the housing authority, the
employment agency, and the hospital. The
parents, like their culturally deprived chil-
dren, may have been alienated by the schools
and thus be unable to deal with numbers
and the written word, contrary to the as-
sumptions made by personnel in the bureau-
cratic structures. Literacy classes and help
with budgeting are practical measures.

There is ample evidence that when young
children in deprived areas are given pre-
school experiences in learning, they are
better able to make use of school experi-
ences. The day care center can prepare the
child to begin school on a more equitable
footing with his more fortunate peers. Not
only will he have learned more words (what
they mean, how to listen to them, and how
to use them), but he also will have learned
how to deal with things. The absence of
things with which to play and work has a
direct relationship to the development of
children in impoverished homes.

Riese has stated:

“Tactile perception and the manipulating of
objects which are sensed as distinct and out-
side the body limits are instrumental in the dis-
covery of one’s own body image; this is a basic
relation of man and matter.” i*

And again:

“Materials to work with are not purely a
matter for self-expression or a means for social
and economic liberation, important as these
functions obviously are or will become. For the
deprived youngster, materials for manipulation
are above all a vehicle and belated opportunity
for proprioceptive experience, for the sizing up

i^Hertha Riese, M.D., Heal the Hurt Child
(Chicago: University of Chicago Press, 1962), p. 293.

CHILD WELFARE February 1966 7 1

MEIER

of one’s strength and manipulative skill against
and in comparison with the surroundings and
its requirements.” ^̂

Furthermore, the child in a day care
center would necessarily receive some atten-
tion from health personnel prior to his ad-
mission. (Health services might well be a
key service in a neighborhood service cen-
ter.) And the child in the day care center
would get something to eat there.

For the older child, tutoring services might
be needed. The impoverishment of experi-
ences for the slum child and his parents
outside of the slum has been documented.
The adults as well as the children need
opportunities to do and see things that in-
terest them on the other side of the slum’s
poverty curtain. Group activities within the
neighborhood service can provide oppor-
tunities for recreation and leaming, and
groupwork can be directed toward helping
individuals improve their capacities for so-
cial relationships. It would be expected that
if the families in the neighborhood found
the services useful, this would lead to the for-
mation of self-help groups.

In commenting upon the alienation from
society that the poor feel, Schorr suggests
that “more aid and encouragement to poor
families to organize for their own pur-
poses” *̂ might help to achieve an integrated
society. He adds in this regard:

“The problem of self-organization among
poor white people is, in a way, more acute than
among poor Negroes. Poor white people have
no comparable [civil rights] movement and
they are losing even the advantage that a white
skin gave. If they are not reached in some other
manner first, they may be candidates for a
White Muslim movement.” ^”

I am aware of the fact that none of the
above suggestions concerning the neighbor-
hood services center are new. They have
been tried in experimental programs in
various parts of the country. My point is
that the field of child welfare and child wel-
fare agencies have not been notably eager
to experiment along these lines. In the com-
ments above, I have suggested that volun-

d., p. 299.
18 Schorr, “Policy Issues in Fighting Poverty,” op.

ctt., pp. 130-131.
iT/6/d., p. 131.

tary agencies have a particular responsibility
to make use of their right to be flexible; obvi-
ously, these experimentations are also ap-
propriate for public agencies. In fact, the
new “poverty programs” are using some of
these means.

I am also aware that in large urban com-
munities—^with highly organized systems of
social services—it is taken for granted that
medical social workers in hospitals deal with
problems of patients that affect their physical
condition and that school social workers
deal with problems of children that are re-
lated to the school. Perhaps, because a large
share of my child welfare experience was in
rural areas, I do not fully appreciate these
niceties in the organization of services. In
the rural areas and in smaller towns, when
there is a problem pertaining to the welfare
of children, there is a kind of naive assump-
tion that this has something to do with “child
welfare” and that the child welfare worker
in tum does something or ought to do some-
thing about it. In addition to my early con-
ditioning, I continue to have experiences
that cause me to surmise that even in big
cities, in this matter of organization of serv-
ices, there is sometimes more “organization”
than “services.”

A colleague of mine recently told me that
in a large city, which prides itself on its so-
cial work standards, the medical social work-
ers in a public hospital were finding it vir-
tually impossible to refer successfully to
child welfare agencies (either public or pri-
vate) the cases of young teenage unmarried
mothers who delivered their babies there.
Unless these girls absolutely refused to take
their babies home, they took them home
without any agency extending services to
them.

It would seem that if child welfare agen-
cies wish to be of service to culturally de-
prived children, a more effective liaison will
need to be worked out among schools, hos-
pitals, and other institutions that serve de-
prived families.

Expansion of Personnel

I am also aware of the fact that expansion
of services means, among other things, ex-
pansion of personnel. We are not graduating
enough social workers from schools of social

72 February 1966 CHILD WELFARE

Culturally Deprived Children

work to take care of present needs. We are
not even enrolling enough students. More-
over, we are not getting some of the young
people who might become interested in the
profession // they were to see evidence that
social work was responding wholeheartedly
to the new challenges.

In considering new approaches to proh-
lems, the profession also needs to reconsider
how best to use the present limited number
of professionally educated persons. Many
of the services suggested for the neighbor-
hood service center are not social work serv-
ices, although they are intended to further
the welfare of children. Some of the services
require professional personnel from other
professions; other services are semiprofes-
sional in nature and can be given by persons
trained on the job. The manpower shortage
in our profession may become increasingly
acute, thus making it necessary for the agen-
cies and the profession to distinguish be-
tween those activities that do indeed require
professional education and those that can be
done by persons with less education.

Some of the children who are culturally
deprived come into foster care. Because of
their previous experiences, these children
need the same kind of individual help needed
by culturally deprived children within their
own homes. The fact that they have been re-
moved from their own homes suggests, in
addition, that other problems of intrafamilial
relationships are present. (The culturally
deprived child placed in foster care is a
separate topic that has not been addressed
in this paper.)

Concluding Remarks

This paper has identified four of the con-
ditions signifying cultural deprivation. It has
further suggested that if the field of child
welfare and the child welfare agencies
therein are to have any impact on a signifi-
cant number of culturally deprived children,
then the field and the agencies will need to

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organization practice in all fields of social
work.

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A doctoral program offering the opportunity
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year of residence includes a field work place,
ment in administration, casework, community
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or teaching. Open to the experienced social
worker with a Master of Social Work degree.

Financial grants avaUabte.

Write: MARGARET E. BISHOP, D.S.W.
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School of Social Work
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direct more resources and energy into serv-
ices for children in their own homes. Fur-
thermore, if these services are to be helpful,
they must be geographically and psycho-
logically accessible to culturally deprived
children and their parents, and they have
to be offered in those forms that are re-
garded as valuable by the persons for whom
the services are intended. In addition, it is
suggested that our business is the welfare of
children, and our obligation is to reach chil-
dren when their welfare is in jeopardy; our
business is not the perpetuation of organiza-
tional structures labeled “child welfare”
when and // these structures are no longer
adequate to deal with new needs and new
challenges.
RECEIVED JULY 6, 1965

CHILD WELFARE February 1966 73

Maternal Childhood Abuse and Children’s Emotional-Behavioral
Difficulties: Intergenerational Transmission via Birth Outcomes and

Psychosocial Health

Rebecca Giallo and Deirdre Gartland
Murdoch Children’s Research Institute, Parkville, Victoria,

Australia, and The University of Melbourne

Monique Seymour and Laura Conway
Murdoch Children’s Research Institute, Parkville, Victoria,

Australia

Fiona Mensah
Murdoch Children’s Research Institute, Parkville, Victoria,

Australia, and The University of Melbourne

Lorraine Skinner and Ali Fogarty
Murdoch Children’s Research Institute, Parkville, Victoria,

Australia

Stephanie Brown
Murdoch Children’s Research Institute, Parkville, Victoria, Australia, and The University of Melbourne

Understanding the mechanisms and psychosocial pathways potentially underlying the association be-
tween maternal childhood abuse exposure and poor child health and wellbeing is important to inform
opportunities for support and intervention early in the period of becoming a parent. The aim of the study
was to investigate whether adverse birth outcomes and psychosocial health issues (maternal depressive
symptoms, exposure to intimate partner violence in the first postnatal year) are potential mechanisms
underlying the association between maternal childhood abuse and children’s emotional– behavioral
functioning at 10 years. Data were drawn from 1,507 first-time mothers and their 10-year-old children
participating in the Maternal Health Study, a prospective study of women’s health during pregnancy and
after birth. One in four women reported that they had experienced physical or sexual abuse in childhood.
Children whose mothers had experienced either of these types of childhood abuse had significantly
higher emotional– behavioral difficulties than children whose mothers had not. Psychosocial health
pathways via maternal depressive symptoms and exposure of mothers to intimate partner violence in the
first 12 months postpartum, but not adverse birth outcomes, mediated the association between maternal
childhood abuse and children’s emotional-behavioral difficulties. These findings underscore the need to
support mothers who have experienced childhood abuse and psychosocial health issues, both as a means
of promoting maternal health and mitigating the potential intergenerational risks for children’s emotional
and behavioral health.

Keywords: maternal childhood abuse, children, mental health, depression, intimate partner violence

This article was published Online First December 19, 2019.
Rebecca Giallo and Deirdre Gartland, Healthy Mothers Healthy Families

Research Group, Murdoch Children’s Research Institute, Parkville, Victo-
ria, Australia, and Department of Paediatrics, The University of Mel-
bourne; Monique Seymour and Laura Conway, Healthy Mothers Healthy
Families Research Group, Murdoch Children’s Research Institute; Fiona
Mensah, Healthy Mothers Healthy Families Research Group, Murdoch
Children’s Research Institute, and Department of Paediatrics, The Univer-
sity of Melbourne; Lorraine Skinner and Ali Fogarty, Healthy Mothers
Healthy Families Research Group, Murdoch Children’s Research Institute;
Stephanie Brown, Healthy Mothers Healthy Families Research Group,
Murdoch Children’s Research Institute, and Department of Paediatrics and
Department of General Practice and Primary Health Care Academic Cen-
tre, The University of Melbourne.

This study was approved by the following human research ethics com-
mittees: La Trobe University (2002/38); Royal Women’s Hospital, Mel-
bourne (2002/23); Southern Health, Melbourne (2002-099B); Angliss Hos-

pital, Melbourne (2002), Royal Children’s Hospital, Melbourne (27056A).
This research was supported by project grants from the Australian National
Health and Medical Research Council and from the Victorian Govern-
ment’s Operational Infrastructure Support Program. Stephanie Brown was
supported by a VicHealth Public Health Research Fellowship, a NHMRC
Career Development Award and Senior Research Fellowship, and an ARC
Future Fellowship; and Rebecca Giallo and Fiona Mensah were supported
by a NHMRC Career Development Fellowship. We are extremely grateful
to the women taking part in the study, to members of the Maternal Health
Study Collaborative Group, and to members of the Maternal Health Study
research team who have contributed to data collection and coding. The
ideas expressed and data appearing in this article have not been previously
disseminated.

Correspondence concerning this article should be addressed to
Rebecca Giallo, Healthy Mothers Healthy Families Research Group,
Murdoch Children’s Research Institute, 50 Flemington Road, Parkville,
VIC 3052, Australia. E-mail: rebecca.giallo@mcri.edu.au

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Journal of Family Psychology
© 2019 American Psychological Association 2020, Vol. 34, No. 1,

112

–121
ISSN: 0893-3200 http://dx.doi.org/10.1037/fam0000623

112

mailto:rebecca.giallo@mcri.edu.au

http://dx.doi.org/10.1037/fam0000623

Childhood physical and/or sexual abuse is associated with in-
creased risks of poor physical and psychosocial health across the
life span (Paolucci, Genuis, & Violato, 2001; Wegman & Stetler,
2009) and across generations (McDonnell & Valentino, 2016). A
better understanding of how the adverse effects of maternal child-
hood abuse are transmitted to the next generation is critical to
informing prevention and early intervention approaches to break
intergenerational cycles of poor health. Drawing upon Buss and
colleagues’ (2017) transdisciplinary model of the intergenerational
transmission of maternal childhood maltreatment exposure, the
present study investigated adverse birth outcomes (preterm birth,
low birth weight) and psychosocial pathways (maternal mental
health, mother exposure to intimate partner violence in first post-
natal year) as potential mechanisms underlying the association
between maternal childhood abuse and children’s emotional–
behavioral functioning at 10 years.

Prevalence and Potential Health Consequences of
Childhood Abuse Among Women and Their Children

Between 15– 40% of women in high income countries such as
Canada (MacMillan et al., 1997), the United States (Centers for
Disease Control and Prevention (CDCP), 2010), and Australia
(Gartland et al., 2016) have experienced childhood physical, emo-
tional, and/or sexual abuse. Child abuse often co-occurs with other
experiences such as neglect, parental mental health issues, sub-
stance use problems, family conflict, and violence (CDCP, 2010),
increasing risks for poor health in adulthood including headaches,
gastrointestinal symptoms and cardiovascular disease (Wegman &
Stetler, 2009), mental health problems such as depression, post-
traumatic stress symptoms, substance use and self-harm (Paolucci
et al., 2001; Wegman & Stetler, 2009), and the experience and/or
use of interpersonal violence (Widom, Czaja, & Dutton, 2008).

There is a growing body of evidence also pointing to potential
intergenerational effects of maternal childhood abuse on children’s
health and development (Bosquet Enlow, Englund, & Egeland,
2018; Collishaw, Dunn, O’Connor, & Golding, 2007; Madigan,
Wade, Plamondon, & Jenkins, 2015; Racine, Plamondon, Madi-
gan, McDonald, & Tough, 2018; Roberts, O’Connor, Dunn, Gold-
ing, & The ALSPAC team, 2004). For example, in a U.K.
population-based study (n � 5,619), maternal childhood abuse was
associated with children’s emotional-behavioral difficulties at ages
4 and 7 years (Collishaw et al., 2007). In a more recent study of
490 mother-child dyads, maternal childhood physical abuse (but
not sexual abuse) was associated with children’s internalizing
difficulties at age 3 (Madigan et al., 2015). Given this evidence,
there is increasing focus on understanding how the effects of
maternal childhood abuse are transmitted to the next generation.

Understanding the Potential Intergenerational
Pathways of Maternal Childhood Abuse on Children

A model of the intergenerational transmission of maternal child-
hood maltreatment exposure has been proposed by Buss and
colleagues (2017). Described as a transdisciplinary model, it draws
upon theory and research into (a) maternal neurobiological re-
sponses to stress across the life span to preconception, (b) the fetal
or developmental origins of health and disease, and (c) the psy-
chosocial sequelae of the postnatal environment. The first mech-

anism recognizes that child maltreatment can result in dysregula-
tion of the hypothalamic-pituitary-adrenal (HPA) axis, which can
threaten maternal health outcomes, and may also lead to epigenetic
alterations that are transmitted during the conception process.
These changes may predispose offspring to a range of health
problems in childhood and across the life span. This mechanism
was not investigated in the current paper.

The second mechanism focuses on the prenatal endocrine and
immune/inflammatory environment, highlighting that maternal bi-
ological and psychosocial stress in utero as well as poor maternal
health (i.e., diabetes, hypertension, chronic renal disease, mental
health problems; Racine, Madigan, Plamondon, McDonald, &
Tough, 2018) may compromise fetal neurodevelopment. They can
also increase risks for adverse birth outcomes, which can have
long-term consequences for children’s neurodevelopment (Saigal
& Doyle, 2008). Although a systematic review of six studies
revealed mixed findings (Wosu, Gelaye, & Williams, 2015), half
of the included studies found that mothers who had experienced
childhood sexual abuse had three to five times the odds of preterm
birth compared to women with no abuse history. In a more recent
study of 398 women and children in the US, maternal childhood
maltreatment was associated with lower birth weight, which in turn
was associated with higher infant social– emotional problems at 6
months old (McDonnell & Valentino, 2016). Further research is
still needed to better understand the mediating role of adverse birth
outcomes.

The final mechanism focuses on the influence of the postnatal
environment and the psychosocial sequelae often experienced by
women with a history of childhood abuse on children’s outcomes.
For example, in a large population-based study of 8,292 families in
the U.K., childhood sexual abuse was associated with increased
maternal mental health problems and parenting difficulties, which
in turn were associated with children’s emotional– behavioral dif-
ficulties (Roberts et al., 2004). In another study, childhood phys-
ical abuse was associated with postnatal depressive symptoms,
which were in turn associated with parenting difficulties and
children’s internalizing difficulties at age 3 (Madigan et al., 2015).
Maternal mental health in the first postnatal year was also of
particular interest in the current study, along with women’s expe-
rience of intimate partner abuse, which has also been associated
with poor outcomes for children (Bair-Merritt, Blackstone, &
Feudtner, 2006; Holt, Buckley, & Whelan, 2008).

Approximately one in four women experience violence in an
intimate relationship in the early years after having a baby (Gart-
land et al., 2016). This can include physical violence (i.e., beating,
pushing, choking), emotional or psychological abuse (i.e., humil-
iation, intimidation, and threats), and sexual violence (Hegarty,
Bush, & Sheehan, 2005). Although research into childhood abuse
as a risk factor for IPV has been mixed (Stith, Smith, Penn, Ward,
& Tritt, 2004), some studies have shown that child maltreatment
(including physical and sexual abuse) is associated with increased
risk of IPV in adulthood (Gartland et al., 2016; Widom et al.,
2008). It has been posited that child abuse can disrupt children’s
attachments to their caregivers, leading to insecure and disorga-
nized attachment styles and emotional regulation difficulties (Cyr,
Euser, Bakermans-Kranenburg, & Van Ijzendoorn, 2010). Such
difficulties may predispose women (and men) to difficulties in
forming and maintaining healthy adult relationships, making them
vulnerable to conflict and violence (Madigan, Bakermans-

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113MATERNAL CHILDHOOD ABUSE

Kranenburg, Van Ijzendoorn, Pederson, & Benoit, 2006). Al-
though children’s exposure to IPV is associated with adverse
health outcomes (Bair-Merritt et al., 2006; Holt et al., 2008), few
studies have explored IPV as a potential mechanism underlying the
associations between maternal childhood abuse and children’s
outcomes.

Recognizing the complex interplay between physical and psy-
chosocial health, two recent studies have explored these mecha-
nisms simultaneously in mediating models (Madigan, Wade, Pla-
mondon, Maguire, & Jenkins, 2017; Racine et al., 2018). In a US
study (n � 510), maternal health (e.g., gestational diabetes, hy-
pertension) and infant birth outcomes (e.g., low birth weight and
preterm birth) mediated the association between maternal adverse
childhood experiences and infant physical health, but not emo-
tional health, at 18 months old. In contrast, psychosocial factors
(e.g., maternal depression, interparental conflict, and single par-
enthood) mediated the relationship with infant emotional problems
but not physical health problems (Madigan et al., 2017). In con-
trast, a Canadian study (n � 1,994) reported that both maternal
physical health (e.g., diabetes, heart disease, hypertension) and
psychosocial factors (mental health and hostile parenting) medi-
ated the associations between maternal adverse childhood experi-
ences and infant gross and fine motor skills, problem-solving, and
personal–social domains at age one (Racine et al., 2018). These
studies underscore the value of investigating multiple mechanisms
simultaneously, reflecting the complexity of women’s and chil-
dren’s lives. They also highlight that there may be different path-
ways of effect depending upon the children’s health outcomes of
interest.

Aims of the Current Study

To address critical gaps in our understanding about how mater-
nal childhood abuse exposure can affect children in the next
generation, the current study investigated two potential mecha-
nisms embedded within Buss and colleagues’ (2017) model. Draw-
ing upon data from a large Australian prospective pregnancy
cohort study of women and their first-born children, we investi-
gated whether adverse birth outcomes (low birth weight and pre-
term birth) and exposure to maternal depressive symptoms and
IPV in the first postnatal year mediated the relationship between
maternal childhood abuse and children’s emotional-behavioral
functioning at 10 years. We focused on psychosocial pathways
during the first year of children’s lives as this is a time of signif-
icant infant neurodevelopment. It is also a time when women have
a high level of contact with health services for themselves and their
children, presenting opportunities for support and intervention
early in the period of becoming a parent.

The second aim of the study was to assess whether the strength
of the relationships between maternal childhood abuse, birth out-
comes, maternal depressive symptoms and IPV, and children’s
outcomes differed for boys and girls. Given some evidence that
boys can be more sensitive to adversity in the family environment
(Mensah & Kiernan, 2010), and that boys exposed to IPV are more
likely to experience behavioral difficulties than girls (Evans, Da-
vies, & DiLillo, 2008), we hypothesized that the strength of the
model relationships would be stronger for boys than girls. A more
nuanced approach to understanding how these mechanisms operate

for boys and girls may inform the monitoring and tailoring of
interventions for families at risk.

Method

Study Design

Data were drawn from the Maternal Health Study, a prospective
longitudinal study of women’s health during pregnancy and after
childbirth, with follow-ups of their children’s health at 4 and 10
years of age. Research ethics committee approvals for the Maternal
Health Study were obtained from La Trobe University (2002/38),
Royal Women’s Hospital (2002/23), Southern Health (2002-099B),
Angliss Hospital, and the Royal Children’s Hospital (27056A,
27056B, 33127A/B, 34058A-D, 36189A/B). Study design and sam-
pling are detailed in the study protocol (Brown, Lumley, McDon-
ald, Krastev, & the Maternal Health Study collaborative group,
2006). Briefly, women registered to give birth at six public hos-
pitals in metropolitan Melbourne, Australia between April 2003
and December 2005 were invited to participate. Eligibility criteria
were: (a) 18 years or older, (b) nulliparity, (c) gestation of up to 24
weeks at time of enrolment, and (d) proficiency in English to
complete written questionnaires. Approximately 6,000 invitation
packages were distributed to women attending the six study hos-
pitals for maternity care, shortly after their first (booking) visit
between 10 and 20 weeks’ gestation. Invitation packs were dis-
tributed to women during clinic visits and at antenatal education
classes and were mailed to women at their home address. It is not
possible to determine precisely how many women received more
than one invitation or how many ineligible women received an
invitation. We conservatively estimate that around a third of eli-
gible women enrolled in the study. Women completed self-
administered questionnaires at 10 –24 weeks’ gestation; at 3, 6, 12
and 18 months postpartum; and at 4 and 10 years postpartum.

Participants

There were 1,507 women who met the eligibility criteria and
returned a baseline questionnaire. Mothers’ demographic charac-
teristics at enrolment were compared with routinely collected
Victorian data for nulliparous women giving birth as public pa-
tients in Victoria during the recruitment period (see Table 1). The
majority of women were aged between 30 and 34 years, born in
Australia, university educated, in paid employment, and married or
living with a partner.

The number of surveys returned at the 3, 6, 12, 18 months and
4 and 10 year follow-ups were 1,431, 1,400, 1,357, 1,327, 1,102,
and 950, respectively. Selective attrition was observed. Using data
collected in early pregnancy or in the first year postpartum, women
who did not participate in the 10-year follow-up were significantly
more likely to be: of non-English speaking background, younger at
birth of first baby, in the lowest income brackets, reporting sec-
ondary school education or less, and having reported depression
and/or IPV in the first year postpartum.

Measures

Maternal childhood abuse. Maternal childhood abuse was
retrospectively reported in the 4-year follow-up questionnaire us-

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114 GIALLO ET AL.

ing the Child Maltreatment History Self Report (MacMillan,
Tanaka, Duku, Vaillancourt, & Boyle, 2013). Women were asked
six questions about how often an adult may have physically abused
them (e.g., “Pushed, grabbed or shoved you”, “Kicked, bit or
punched you”, “Physically attacked you in some way”) when
growing up on a 3-point scale ranging from 0 � Never to 3 �
Often. Women were also asked four questions about whether an
adult or someone older than them had performed sexual acts (e.g.,
“Touched sex parts of your body”, “Tried to have sex with you or
sexually attacked you”) when growing up. Scores for the physical
and sexual abuse items were summed to create subscale scores.
Physical and sexual abuse were defined as a positive response to
any of the items. The scale has excellent reliability and validity
(MacMillan et al., 2013). Cronbach’s alpha for the physical and
sexual abuse subscales was .85 and .83, respectively.

Children’s emotional-behavioral functioning. Children’s
emotional– behavioral functioning at 10 years of age was assessed
using the parent-report of the Strengths and Difficulties Question-
naire (SDQ; Goodman, 2001). The SDQ is comprised of 25 items
assessing a range of emotional and behavioral symptoms such as
sadness, worries, attention difficulties, fighting, and problems with
peers on a 3-point scale (0 � Not True to 2 � Certainly True).
There are 4 subscales representing emotional symptoms, conduct
problems, hyperactivity/inattention, and peer problems. There is
also a Total Difficulties score where higher scores indicate more
emotional and behavioral difficulties. Cut-off scores for the “nor-
mal” (0 –13), “at risk/borderline” (14 –16), and “clinical” (17�)
ranges based on Australian norms are available. The categorical
variable based on the Total Scale cut-off scores was used to
describe the proportion of the children exposed and not exposed to
IPV experiencing clinically significant emotional– behavioral dif-

ficulties. The continuous scores for the subscales were used in the
modeling. The SDQ has had extensive psychometric evaluation
with Australian samples, with moderate to strong internal consis-
tency and test–retest reliability reported (Hawes & Dadds, 2004).
Cronbach’s alpha for the Total Difficulties scale for the current
sample was .79.

Maternal depressive symptoms. Maternal depressive symp-
toms were assessed using the 10-item self-report Edinburgh Post-
natal Depression Scale (EPDS; Murray & Cox, 1990) at 12 months
postpartum. Women reported on the extent to which they had
experienced a range of symptoms such as depressed mood, feeling
anxious, crying, and thoughts of self-harm in the previous week on
a 4-point scale. A cut-off of �13 is recommended when screening
for probable major depression in community samples (Murray &
Cox, 1990). Cronbach’s alpha for the current sample was .88.

Intimate partner violence. Intimate partner violence (12
month period prevalence) was assessed using the short 18 item
version of the Composite Abuse Scale (CAS; Hegarty, Bush, &
Sheehan, 2005). The 18 items measure how often emotional (e.g.,
“My partner told me I was crazy”) and physical violence (e.g.,
“My partner threw me”) from an intimate partner occurred in the
last 12 months, rated on a six-point scale ranging from 0 � Never
to 5 � Daily. Women were identified as experiencing physical IPV
if they scored 1 or more on any of the physical violence items, and
emotional IPV if they scored three or more on the emotional
violence items. Any IPV (physical and/or emotional) was coded as
1 � Yes, and no abuse as 0 � No. The CAS has excellent
reliability and is well-validated with clinical and general popula-
tions (Hegarty et al., 2005). Cronbach’s alpha for the current
sample was .73.

Table 1
Characteristics of Study Participants at Enrollment and Nulliparous Women Giving Birth in
Victoria as Public Patients During the Study Recruitment Period

Participants Victorian Patientsa

(N � 1,507) (N � 40,905)
Characteristics n (%) n (%)

Maternal age (in years)
�24 years 190 (12.6) 12,216 (29.9)
�25 years 1246 (82.4) 28,679 (70.1)
Not reported 76 (5.0)

Maternal country of birth
Australia 1,074 (71.3) 29,791 (73.3)
Overseas—English speaking background 138 (9.7) 2330 (5.7)
Overseas—Non-English speaking background 212 (14.1) 8,517 (21.0)
Not reported 83 (5.5)

Relationship status
Married 876 (58.1) 22,790 (55.9)
Living with partner 490 (32.5) n/ab

Divorced/separated/not partnered 65 (4.3) n/ab

Not reported 76 (5.0)
Highest educational attainment n/ab

Post-high school qualification 1,036 (68.7)
High school completion (Year 12) or less 387 (25.7)
Not reported 84 (5.6)

In paid employment 1,172 (77.8) n/ab

Low income (recipient of health care card) 366 (24.3) n/ab

a Victorian Perinatal Data Collection Unit (was provided upon request). b n/a indicates that this information
was not routinely collected by Victorian hospitals and therefore not available.

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115MATERNAL CHILDHOOD ABUSE

Birth outcomes. Birth outcomes including number of weeks’
gestation and infant birth weight were reported by mothers. Pre-
term birth was defined as being born less than 37 weeks gestation,
and low birth weight was defined as being born less than 2500 g.
A composite variable was derived where either preterm birth
and/or low birth weight were identified as an adverse birth out-
come.

Demographic information. Demographic information re-
ported in this paper included maternal age, country of birth,
education, employment status, and household income, along with
child age and gender.

Data Analysis

Exploratory data analysis, descriptive statistics, and correlations
using Pearson’s r(phi for pairs of dichotomous variables; point-
biserial for pairs of continuous and dichotomous variables) were
conducted in SPSS V22. Logistic regression analysis was also
conducted to assess the relationships between maternal childhood
abuse and children’s emotional– behavioral difficulties using the
clinical cut points on the SDQ Total Difficulties scale.

A series of models: (a) direct effects model of maternal child-
hood abuse on children’s emotional– behavioral functioning, (b) a
partially mediating model where both the direct effect of maternal
child abuse on children’s emotional– behavioral functioning (latent
construct with the SDQ subscales for emotional, conduct, hyper-
activity/inattention, and peer problems as indicators) and the indi-
rect effects via the intervening variables (adverse birth outcomes,
maternal depressive symptoms and IPV) were estimated, and (c)
the hypothesized model where the effect of maternal child abuse
on children’s emotional– behavioral functioning is fully mediated
by the intervening variables (adverse birth outcomes, maternal
depressive symptoms and IPV). Each model was adjusted for
maternal age and education, and the association between the in-
tervening variables was accounted for by correlating the error
terms. Please note that the covariates and correlations have not
been drawn in the figures for ease of interpretation.

The models were estimated in Mplus V7.4 (Muthen & Muthen,
1998-2011) using both maximum likelihood estimation with ro-
bust standard errors (MLR) and maximum likelihood estimation
(ML) with bootstrapping to obtain bootstrap confidence intervals.
The results yielded similar estimates and only the ML results are
presented. Model fit of the hypothesized model was assessed using
a range of model fit statistics (Satorra-Bentler chi-square test,
Tucker Lewis Index (TLI), Comparative Fit Index (CFI), and Root
Mean Square Error Approximation (RMSEA)). While a nonsig-
nificant chi-square indicates good model fit, this is generally
unexpected for large samples. Therefore, given our sample size,
greater attention was given to other fit indices. TLI and CFI should
exceed .90 for an acceptable fit, and values closer to or below .05
for the RMSEA are acceptable. Missing data in all models were
managed using Full Information Maximum Likelihood (FIML).

To assess for evidence of mediation, we assessed for changes in
the magnitude and significance of the direct path between maternal
childhood abuse and children’s emotional– behavioral functioning
after the introduction of the intervening variables (adverse birth
outcomes, IPV, maternal depression). If the direct path decreases
and becomes nonsignificant, this provides evidence of full medi-
ation, but if the direct path decreases and remains significant, this

provides evidence of partial mediation. We also assessed the
specific indirect pathways between maternal childhood abuse and
children’s emotional– behavioral functioning via each of the inter-
vening variables. The indirect effects were estimated using the
product of coefficients approach with bootstrapping to obtain
bootstrap confidence intervals in MPlus (MacKinnon, Lockwood,
Hoffman, West, & Sheets, 2002). Evidence of mediation (i.e., an
intervening variable transmits the effect of an independent variable
to a dependent variable) was provided if the confidence interval for
the estimate for the indirect effect did not cross zero and was
significant.

Finally, multigroup analyses were conducted to assess for mod-
eration by child gender. This involved testing a model with all
parameters freely estimated (unconstrained model) and comparing
it to a model where the path estimates for relationships between the
model variables were constrained to be equal (constrained model)
among boys and girls using the chi-square difference test. As
above, MLR and ML with bootstrapping to obtain bootstrap con-
fidence intervals were used to estimate the models. They yielded
similar results, and the ML results are presented.

Results

Descriptive Statistics and Missing Data

Missing data was approximately 20% across all variables, and
highest for the SDQ Total Difficulties at 10 years (�30%), which
is to be expected given attrition associated with an 11-year cohort
study. These missing data were managed using FIML when esti-
mating the models. Descriptive statistics for the key model vari-
ables are presented in Table 2. Statistical (see Table 2) and
graphical measures of normality indicated that the maternal de-

Table 2
Descriptive Statistics for the Study Variables

Study variable Statistic

Children’s emotional-behavioral difficulties (10yrs)
Range 0–28
M (SD) 6.85 (5.39)
Skewness 1.13
At risk/Borderline and Clinical range, n (%)a 108 (7.2)

Maternal depressive symptoms (1yr pp)
Range 0–27
M (SD) 4.81 (4.74)
Skewness 1.23
Clinical range, n (%)b 109 (7.2)

Maternal childhood sexual abuse, n (%)c 241 (16.0)
Maternal childhood physical abuse, n (%)c 294 (19.5)
Any maternal childhood abuse, n (%) 428 (28.4)
Preterm birth (�37 weeks gestation), n (%) 96 (6.4)
Low birthweight (�2500g), n (%) 80 (5.3)
Adverse birth outcomes (pre-term birth and/or low

birthweight), n (%) 119 (7.9)
Intimate partner violence (first 12mths pp), n (%)d 234 (15.5)

Note. pp � postpartum; sample size ranged from N � 877–1325 due to
missing data.
a Strengths and Difficulties Questionnaire Total Difficulties �
14�. b Edinburgh Postnatal Depression Scale Clinical Range �
13�. c Child Maltreatment History Self-report. d Composite Abuse
Scale.

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116 GIALLO ET AL.

pression scores on the EPDS and children’s emotional– behavioral
scores on the SDQ Total Difficulties scale were positively skewed.
Therefore, maximum likelihood estimation with robust standard
errors was used to estimate the models.

Table 3 presents the Pearson’s r correlations among all key
analysis variables in the hypothesized model and potential medi-
ator variables. While most associations between the model vari-
ables were significant, adverse birth outcomes were not associated
with the independent (maternal childhood abuse) or dependent
(children’s emotional– behavioral difficulties) variables. Despite
this, we proceeded with testing our theoretically/conceptually
driven research aims and hypotheses.

Maternal Childhood Abuse and Children’s Emotional-
Behavioral Difficulties

Table 4 reveals that compared to children of mothers who had not
experienced childhood abuse, children of mothers who had experi-
enced abuse had 1.6 times higher odds of emotional– behavioral
difficulties in the At-risk/Borderline and Clinical ranges.

Testing the Intergenerational Pathways Models

Prior to testing the hypothesized model, the latent construct of
children’s emotional– behavioral difficulties represented by the
observed SDQ subscales was tested and found to be a good fit to
the data, �2(2, N � 1507) � 16.29 p � .001; CFI � .98; TLI �
.94; RMSEA � .09 (90% CI [.05, .13]); and SRMR � .02. This
was used in subsequent modeling. The direct effects model of the
relationship between maternal childhood abuse and the latent
construct of children’s emotional– behavioral functioning was es-
timated. The model was a reasonable fit to the data, �2(11, N �
1507) � 32.17, p � .001; CFI � .97; TLI � .95; RMSEA � .04
(90% CI [.02, .05]); and SRMR � .03. The standardized estimate
for the direct path was significant (.12, p � .003). This model
accounted for 3% of the variance in children’s emotional–
behavioral functioning, (R2 � .03, p � .074). Next, the partially
mediated model including the mediators (IPV, depressive symp-
toms, adverse birth outcomes) was tested and found to be a

reasonable fit to the data, �2(20, N � 1507) � 48.34, p � .001;
CFI � .97; TLI � .94; RMSEA � .03 (90% CI [.02, .04]); and
SRMR � .02. The standardized estimate between children’s
emotional– behavioral difficulties and maternal childhood abuse
decreased but remained statistically significant (.09, p � .031),
providing evidence of partial mediation by one or more of the
intervening variables. This model accounted for 6% of the variance
in children’s emotional– behavioral functioning, (R2 � .06, p �
.006). Finally, the hypothesized fully mediated model (without the
direct effect of maternal childhood abuse on children’s emotional–
behavioral difficulties) was tested and found to be a reasonable fit
to the data, �2(21, N � 1507) � 53.33 p � .001; CFI � .97; TLI �
.93; RMSEA � .03 (90% CI [.02, .04]); and SRMR � .03. This
model also accounted for 5% of the variance in children’s
emotional– behavioral functioning, (R2 � .05, p � .013). A chi-
square difference test revealed that the fully mediated model was
a better fit to the data than the partially mediated model, �diff2 (1,
N � 1507) � 6.99, p � .008, and therefore was accepted as the
final model.

The standardized parameter estimates for the mediated model
are presented in Figure 1. Maternal childhood abuse was signifi-
cantly associated with IPV and higher maternal depressive symp-

Table 3
Correlations Among All Model Variables

Study variables 1 2 3 4 5 6 7 8 5 6 7

1. SDQ Total Scale scorea —
2. SDQ emotional problems .69��� —
3. SDQ conduct problems .73��� .34��� —
4. SDQ hyperactivity/inattention .81��� .30��� .53��� —
5. SDQ peer problems .69��� .35��� .41��� .39��� —
6. Maternal childhood abuse (0 � no; 1 � yes)c .11�� .06 .08� .10�� .08�� —
7. Adverse birth outcomes (1 � no; 2 � yes) �.01 �.02 �.06 .03 .01 .04 —
8. Intimate partner violence (first 1yr pp) (1 � no; 2 � yes)d .12��� .04 .12��� .11�� .09� .14��� .05 —
9. Maternal depressive symptoms (1yr pp)b .15��� .13��� .11�� .11�� .07� .14��� .04 .29��� —

10. Child gender (1 � girl; 2 � boy) .12��� �.08� .11�� .22��� .09�� �.03 .02 .02 �.001 —
11. Maternal age at first birth (1 � 24yrs; 2 � 25yrs) �.03 .05 �.08� �.05 �.004 �.03 .01 �.11��� �.06� .01 —
12. Maternal education (1 � tertiary, 2 � high school or less) .06 �.02 .06 .06 .07 .06 .05 .09�� .02 .04 �.23���

Note. SDQ � Strengths and Difficulties Questionnaire; pp � postpartum; sample size ranged from N � 877–1325 due to missing data.
a Strengths and Difficulties Questionnaire Total Difficulties. b Edinburgh Postnatal Depression Scale. c Child Maltreatment History Self-
report. d Composite Abuse Scale.
� p � .05. �� p � .01. ��� p � .001.

Table 4
Logistic Regression Analyses Estimating the Relationship
Between Maternal Childhood Abuse and Child Emotional-
Behavioral Difficulties at 10 Years (N � 877)

SDQ Total Difficulties Clinical Rangea

Maternal
childhood

abuseb
Normal Borderline/Clinical
n (%) n (%) OR [95% CI], p

No 497 (90.7) 51 (9.3) Ref.
Yes 282 (85.7) 47 (14.3) 1.62 [1.07, 2.48], .024

Note. SDQ � Strengths and Difficulties Questionnaire.
a Score of 14 � reflects classification into the Borderline/Clinical Range on
the SDQ Total Difficulties Scale. b Child Maltreatment History Self-
report.

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117MATERNAL CHILDHOOD ABUSE

toms at 12 months postpartum, but not with adverse birth out-
comes. Maternal childhood abuse, IPV, and higher maternal
depressive symptoms were associated with higher children’s
emotional– behavioral difficulties at 10 years, while adverse birth
outcomes was not.

The indirect effects of maternal childhood abuse on children’s
emotional– behavioral difficulties were also assessed. The total
indirect effect via the intervening variables was also significant,
standardized estimate � .04 (95% CI [.02, .06]), p � .001. The
specific indirect effects are provided in Table 5. The indirect
pathways via maternal depressive symptoms and IPV were signif-
icant, providing evidence of mediation. There was no evidence of
mediation via adverse birth outcomes given the nonsignificant
indirect effects.

Testing for Moderating Effects by Child Gender

Multigroup analysis was conducted to assess moderation by
child gender. The unconstrained model where all parameters were
freely estimated among boys and girls (�2(49, N � 1507) �
139.97) was compared to the constrained model where the path
estimates between the model variables were constrained to be
equal among boys and girls (�2(55, N � 1507) � 145.30). The
chi-square difference test was not significant (�diff2 (6, N � 1507) �
5.33, p � .502), providing little evidence of moderation by child
gender.

Discussion

Findings from this population-based study of first-time Austra-
lian mothers provide support for the intergenerational association
between maternal childhood abuse and their children’s emotional–
behavioral difficulties. Children of mothers with a history of
childhood abuse had higher odds of experiencing emotional–
behavioral difficulties than children of mothers who had not ex-
perienced childhood abuse. One in four mothers had a history of
childhood abuse into parenthood, heightening their risk of poor
mental health and exposure to IPV.

Our findings also provided support for several mechanisms
proposed in Buss and colleagues’ model (2017) of the intergen-
erational transmission of maternal childhood maltreatment expo-
sure to children. In addition to the direct risk of maternal childhood
abuse to children’s emotional– behavioral functioning, we found
evidence for mediation via the psychosocial health pathways of
exposure to IPV and maternal depressive symptoms in the first
year postpartum but not for adverse birth outcomes (low birth
weight, preterm birth). Although the model accounted for a small
proportion of the variance in the outcome, this highlights how the
sequalae of psychosocial issues for women who have experienced
childhood abuse can contribute to their children’s emotional–
behavioral difficulties. There are several ways in which the psy-
chosocial pathways may work to influence children’s mental
health. For example, exposure to IPV and maternal mental health

Figure 1. Standardized parameter estimates for the mediated model of the relationship between maternal
childhood abuse and children’s emotional-behavioral difficulties at age 10 years. Covariates (maternal age and
education) and correlated error terms for the mediator variables are not shown; dotted lines indicate nonsignif-
icant pathways. �� p � .01. ��� p � .001.

Table 5
Standardized Estimates for Specific Indirect Pathways for the Overall Sample and by Child Gender (N � 1,507)

Overall sample

Specific direct and indirect pathways
Standardized estimate

[95% CI] p

Maternal childhood abuse ¡ Adverse birth outcomes ¡ Children’s emotional-behavioral difficulties �.001 [�.006, .002] .513
Maternal childhood abuse ¡ Intimate partner abuse ¡ Children’s emotional-behavioral difficulties .02 [.004, .03] .025
Maternal childhood abuse ¡ Maternal depressive symptoms ¡ Children’s emotional-behavioral difficulties .02 [.01, .04] .015

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118 GIALLO ET AL.

problems in the first years of life can contribute to marked stress
and physiological arousal among infants (Levendosky et al., 2016).
When the biological systems responsible for regulating stress (i.e.,
HPA axis) are overactivated and become dysregulated, the devel-
opment of the neural systems responsible for emotional regulation
may be threatened (De Bellis & Zisk, 2014). Therefore, these
children may find it harder to manage strong emotions and their
behavior, particularly in stressful situations.

Although parenting behavior was not investigated in the current
study, these findings can also be considered within the broader
context of parent– child relationships. In a meta-analysis of 55
studies, childhood maltreatment was found to be associated with
insecure and disorganized attachment styles (Cyr et al., 2010).
These styles can lead to challenges in adulthood, including mental
health difficulties, problems managing stress, and parenting diffi-
culties (Madigan et al., 2006). Mothers who have significant
trauma histories of abuse, IPV, and poor mental health may find it
harder to be sensitive and responsive to their children’s emotional
experiences (Howell, Graham-Bermann, Czyz, & Lilly, 2010).
Mothers who find it difficult to regulate their own emotions may
find it hard to role-model effective coping strategies to their
children. Furthermore, compared to women who have not experi-
enced childhood abuse, women with a history of childhood sexual
abuse are more likely to use harsh parenting practices (DiLillo &
Damashek, 2003) and have anxious, overprotective attachment
styles (Kwako, Noll, Putnam, & Trickett, 2010), which are both
risk factors for children’s emotional– behavioral difficulties.

Our study contributes to the research effort focused on biomed-
ical impacts on children’s outcomes, where there is still inconclu-
sive evidence. We found little evidence for adverse birth outcomes
underlying the associations between maternal childhood abuse and
children’s emotional-behavioral difficulties, which is consistent
with Madigan et al. (2017), who found that infant birth outcomes
(e.g., low birth weight, preterm birth, loss of fetal movements
during pregnancy) did not mediate the association between mater-
nal childhood abuse and children’s emotional health at 18 months
old. These findings are reassuring and positive for children who
have had a difficult start to early life.

The final aim of the study was to assess for model differences by
child gender. No evidence of moderation was found, suggesting
that the pathways from maternal childhood abuse to children’s
emotional– behavioral difficulties via IPV and maternal depression
are similar for boys and girls. This is somewhat in contrast with
research indicating that IPV may differentially affect boys and
girls, with stronger negative impacts on externalizing behavior for
boys (Evans et al., 2008). In addition to understanding risks for
boys and girls, another area for future research is to identify and
deepen our understanding of whether there are differences in
protective factors or mechanisms by child gender.

Study Strengths, Limitations and Future Research
Directions

The availability of intergenerational data drawn from a preg-
nancy cohort of more than 1,500 women and their children was a
key strength of the study. Our conceptually driven approach and
sophisticated longitudinal analyses enabled the simultaneous mod-
eling of three potential mechanisms by which maternal childhood
abuse can have a long-term impact on children. A well validated

multidimensional measure of IPV was used, and a nuanced inves-
tigation into the effects of maternal childhood abuse and potential
mechanisms on boys and girls was conducted.

There are also several limitations to note. The majority of
women were Australian-born, over 25 years of age, had a tertiary
education, were in paid employment, and were partnered. More-
over, selective attrition was observed among younger women,
those with lower educational attainment, and those with higher
levels of depressive symptoms during pregnancy, which may limit
generalizability of the findings to women who were underrepre-
sented in this study. It is noted, however, that while low initial
response fractions and selective attrition are likely to result in
biased prevalence estimates, measures of association are unlikely
to be affected (Mealing et al., 2010).

All measures were self-reported by mothers, and it is possible
that reporter bias could have influenced the associations be-
tween the study variables. Mothers reported on their children’s
emotional– behavioral functioning, and ratings may have been
influenced by mental health difficulties or heightened concern for
their children who may have been exposed to IPV. The retrospec-
tive assessment of maternal childhood abuse was limited to in-
stances of physical and sexual abuse by an adult, which did not
capture details about the relationship of the perpetrator to the
mother or the frequency and duration of the abuse. The items
pertaining to sexual abuse also reflected a broad range of sexual
abuse experiences, from potentially protracted experiences of
abuse within the child’s immediate caregiving environment to
infrequent or isolated experiences outside the caregiving context. It
is possible that associations with maternal depression, IPV, and
children’s emotional– behavioral functioning may be stronger for
repeated experiences of childhood sexual abuse by a family mem-
ber or family friend than for isolated experiences outside the
family environment. We also did not ask about other forms of
childhood maltreatment such as emotional abuse or neglect. Fur-
thermore, we only asked about women’s experience of IPV toward
them and did not ask about other forms of violence that children
might be exposed to, such as the women’s use of violent or abusive
behaviors toward their partner or child maltreatment by a parent.

Finally, it is important to acknowledge alternative models ex-
ploring different pathways as areas for future research. For in-
stance, we did not examine other aspects of maternal mental health
such as anxiety or posttraumatic stress symptoms that are common
among women who have experienced abuse and trauma in child-
hood (Paolucci et al., 2001). Similarly, other aspects of child
development and functioning might be affected by maternal his-
tory of childhood abuse, including physical health (i.e., asthma,
allergy), language, and cognitive functioning. For example, Madi-
gan et al. (2017) found that adverse birth outcomes (e.g., low birth
weight, preterm birth, loss of fetal movements during pregnancy)
did mediate the association between maternal childhood abuse and
children’s physical health. Therefore, a key area for future research
is to investigate poor birth outcomes as mechanisms underlying the
association between maternal childhood abuse and children’s
physical health. It is also worth noting that the prevalence of
adverse birth outcomes in our study was �10% and may have
lacked power to detect small associations between the variables.
Another area for research is to investigate pathways via an accu-
mulation of physical health risks for both mothers (e.g., high and
low BMI, gestational diabetes, hypertension) and children (e.g.,

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119MATERNAL CHILDHOOD ABUSE

very preterm birth, small for gestational age, low birth weight).
The impacts of maternal childhood abuse on children’s emotional–
behavioral functioning may be greater for those infants and moth-
ers with a greater accumulation or specific pattern of health risk
factors during pregnancy and at time of birth. Moreover, there are
likely to be other pathways involved in the processes of intergen-
erational transmission that were not investigated in this study. For
example, genetics and epigenetic mechanisms and pathways via
maternal physical health and poor health behaviors (i.e., smoking,
substance use, poor nutrition). It is also likely that there are
protective mechanisms that may disrupt the intergenerational
transmission processes such as access to professional and social
support, positive parenting behaviors, and children’s engagement
in school.

Implications and Conclusions

Improving maternal and child health is a key priority of the
United Nation’s Sustainable Development Goals. Childhood abuse
is a serious threat to the health and wellbeing of women and their
children across the life course. Importantly, our findings show that
a history of childhood abuse is associated with maternal depressive
symptoms and IPV in the first year after having a baby, and these
are associated with emotional– behavioral difficulties for children
at 10 years. This underscores the importance of early intervention
to disrupt the potential for intergenerational impacts and cycles of
abuse and poor health within families.

Pregnancy and the early years of parenting when women have a
high level of contact with maternal health and early childhood
services provide multiple and sustained opportunities for early
identification and intervention to disrupt cycles of intergenera-
tional trauma. For some women, this might be the first time that
they have ever been asked about experiences of childhood abuse,
encouraged to share their experiences, and explore options for
support. For women who have accessed professional support in the
past, the transition to parenthood might be another pivotal time in
their lives when accessing support could be beneficial. Access to
intervention and support can provide opportunities to promote the
health of women in the early years of their children’s lives, as well
as identify and support women experiencing relationships difficul-
ties, partner conflict, and IPV.

Given that the psychosocial health pathways of maternal child-
hood abuse have the potential to affect children, efforts to promote
children’s health and wellbeing are critical. Maternal and early
childhood services are in an ideal position to facilitate timely
referral pathways for children showing early signs of emotional
and behavioral regulation difficulties. Building the capacity of
mothers and other caregivers to recognize and respond to these
early signs of emotional– behavioral dysregulation and difficulties
is also important. Several studies have shown that children who are
exposed to IPV are more likely to display positive emotional–
behavioral functioning when their mother or another caregiver is
able to provide emotion coaching to help children manage distress,
regulate emotions, and use positive coping skills (Manning, Da-
vies, & Cicchetti, 2014). The effectiveness of mother– child dyadic
interventions such as Child-Parent Psychotherapy (CPP) and Fo-
cused Cognitive Behavioral Therapy to support healing and recov-
ery and promote maternal and child health has been demonstrated

(Cohen, Mannarino, & Iyengar, 2011; Lieberman, Ghosh Ippen, &
Van Horn, 2006).

Finally, our results have implications for all professionals work-
ing with children in the middle years of childhood. Intergenera-
tional trauma is common, and many children presenting with
emotional– behavioral difficulties in schools, hospitals, and pri-
mary care settings may have been exposed to a range of psycho-
social stressors in their caregiving environment, including parental
depression, IPV, and other adversities. The earliest possible iden-
tification and support in these settings has the potential to change
the trajectories of children and families who have been affected by
intergenerational cycles of abuse and poor health.

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Received May 1, 2019
Revision received October 25, 2019

Accepted November 8, 2019 �

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121MATERNAL CHILDHOOD ABUSE

http://dx.doi.org/10.1007/s00737-016-0659-8

http://dx.doi.org/10.1007/s00737-016-0659-8

http://dx.doi.org/10.1097/00004583-200111000-00015

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http://dx.doi.org/10.1186/s12884-015-0606-0

http://dx.doi.org/10.1186/s12884-015-0606-0

• Maternal Childhood Abuse and Children’s Emotional-Behavioral Difficulties: Intergeneratio …

Prevalence and Potential Health Consequences of Childhood Abuse Among Women and Their Children
Understanding the Potential Intergenerational Pathways of Maternal Childhood Abuse on Children
Aims of the Current Study
Method
Study Design
Participants
Measures
Maternal childhood abuse
Children’s emotional-behavioral functioning
Maternal depressive symptoms
Intimate partner violence
Birth outcomes
Demographic information
Data Analysis
Results
Descriptive Statistics and Missing Data
Maternal Childhood Abuse and Children’s Emotional-Behavioral Difficulties
Testing the Intergenerational Pathways Models
Testing for Moderating Effects by Child Gender
Discussion
Study Strengths, Limitations and Future Research Directions
Implications and Conclusions
References

International Journal of

Environmental Research

and Public Health

Article

Transnational Child Sexual Abuse: Outcomes from
a Roundtable Discussion

Hannah L. Merdian 1,* , Derek E. Perkins 2, Stephen D. Webster 3 and Darragh McCashin

4

1 School of Psychology, University of Lincoln, Lincoln LN6 7TS, UK
2 School of Law, Royal Holloway University of London, Egham, Surrey TW20 OEX, UK;

Derek.Perkins@rhul.ac.uk
3 Independent Research Psychologist, London SM6 9AA, UK; stephenwebster@pivotalresearchservices.com
4 School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland; mccashid@tcd.ie
* Correspondence: hmerdian@lincoln.ac.uk

Received: 24 October 2018; Accepted: 28 December 2018; Published: 16 January 2019
����������
�������

Abstract: The phenomenon of men who travel across international borders to engage in child sexual
abuse presents significant public health, legal, diplomatic, cultural, and research challenges. Briefed
in the current scope of this issue by relevant stakeholders across legislation, research, and social
policy, a roundtable discussion held in London aimed to synthesise plenary discussions from
multidisciplinary attendees across law enforcement, academia, non-profit, and industry sectors
with direct relevance to the UK. Specifically, the roundtable discussions aimed to gather the central
themes relating to attendee discussions on the key challenges, affected countries, response strategies,
and knowledge gaps. Four key themes were identified from the data, relating to the definition of
Transnational Child Sexual Abuse (TCSA), criminal justice, geographical considerations, and issues
surrounding tourism/hospitality. The data highlighted four priorities for future development and
research, namely developing offender typologies, victim-centric investigative practice, prevalence
and definitions, and collaborations. These themes provide insight into the issue of transnational
child sexual abuse from the perspective of different disciplines and offer a strategy to prioritise,
and collaborate, in the efforts against transnational child sexual abuse.

Keywords: child sexual abuse; child sexual exploitation; transnational child sexual abuse; travelling
offender

1. Introduction

The role of offenders travelling within and across national borders to plan, prepare, and carry out
sexual offences against children is a significant public protection concern [1,2]. Transnational Child
Sexual Abuse (TCSA) can refer to: (a) offenders, including those with a criminal history, travelling to
a different jurisdiction and engaging in the sexual abuse of children; (b) offenders who intentionally
reside abroad for offending purposes (semi-permanent or permanent residence); and (c) offenders who
engage in Internet-enabled sex offences, utilising technologies such as webcams and live-streaming.
It is impossible to be precise about the extent of child sexual abuse as a result of offenders networking
and then travelling within the UK and/or internationally due to the hidden and under-reported nature
of this offending ([3], para 51). In 2012, the UK Child Exploitation and Online Protection Centre
(CEOP) [4] received 1,145 reports of online child sexual exploitation, with the offender looking to
travel physically within the UK to meet a child to commit contact sexual abuse. A review of sexual
offence prevention orders [5] showed that between 2008 and 2012, 303 British sex offenders had been
arrested abroad for child sexual offences. CEOP’s [4] analysis of online chat forums pointed to the
dynamic nature of the geographical locations within organised commercial child sexual exploitation,

Int. J. Environ. Res. Public Health 2019, 16, 243; doi:10.3390/ijerph16020243 www.mdpi.com/journal/ijerph

http://www.mdpi.com/journal/ijerph

http://www.mdpi.com

https://orcid.org/0000-0003-2030-7694

http://www.mdpi.com/1660-4601/16/2/243?type=check_update&version=1

http://dx.doi.org/10.3390/ijerph16020243

http://www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2019, 16, 243 2 of 14

because of increased awareness in destination countries, and offenders moving towards countries that
have suffered environmental or political upheaval, leading to displacement of children from their
families and a differential focus of local authorities. Given the risk presented by offenders (and groups)
networking and travelling within the UK and/or internationally to sexually offend, CEOP listed TCSA,
and the role of technology in its conduct, as a key threat in their strategic action plan.

There is a significant dearth of empirical literature on the issue of TCSA. The majority of published
material relates to organised child abuse networks and child trafficking, and focuses on conceptual
considerations [6–9] and policing/legal issues [10–14], resulting in a lack of empirical data on the
offenders or the networks they use. However, there is an emerging body of research on the use of
cyberspace for the sexual grooming of minors and the adaption of sexual crime theory for online
sexual behaviour that can be organised under four broad themes: offender characteristics, types of
networks, the role of cyberspace as an enabler and mode of child sexual exploitation, and national and
international policy responses.

1.1. Offender Characteristics

The online solicitation of children for sexually-oriented interactions can occur through various
methods, with the most prominent being direct engagement with a potential victim through online
channels (e.g., chat rooms, instant messaging, email, mobile phones). The National Centre for Missing
and Exploited Children [15] survey of online child victimization showed that nearly a quarter of minors
who reported having received an unwanted sexual contact online were also asked by the offender to
meet in person. Consequently, the research to date has mainly focused on the use and function of
online networking in the victim grooming process [16–18], offender characteristics [19,20], the role of
sexual arousal, emotion regulation, shame, and deception in the online solicitation of a minor [21,22],
or the “personas” adopted by offenders in the grooming process [23,24], without a specific focus on
transnational child sex offending. While previous research, including Harkins and Dixon [1], identified
some behavioural characteristics of child sexual abuse networks, to date, there is no detailed account of
the demographic characteristics of offenders, and the role these networks play in the normalization and
facilitation of child sexual abuse, given that these provide users with an environment to explore their
sexual interests [25–27]. Studies investigating organised transnational child sexual exploitation [28,29]
have focused on victim identification, victim characteristics, and their engagement rather than on
the perpetrators. What is known is that almost all of the offenders reported to CEOP as suspected or
convicted transnational child sex abusers were reportedly male (99%), with a median age of above
40 years [4].

Based on descriptive analysis of their case information, CEOP suggested a continuum of
transnational offending behaviour: Transient offending describes the sexual abuse of children, potentially
facilitated by the commercial sexual exploitation of children, where the offender will be in short-term
contact with the victim(s) (also referred to as “child sex tourism”). Embedded offending is the repeated
victimisation of a child by the same offender, often accompanied by extended grooming of the victim,
significant others, and the community; here, perpetrators may be more likely to reside long-term
in the overseas destination. While this describes a topological crime classification, Briggs et al. [30]
suggested a motivational typology of online solicitation offenders, based on the analysis of chat
logs between offenders and their victims. According to Briggs et al., fantasy-driven users tend to
maintain their engagement with the minor solely in the online space, whereas contact-driven users are
focused on transferring the online engagement into a real-life encounter. In keeping with advancing
evidence regarding offender typologies, a recent law enforcement perspective document published by
Europol [31] recommended different strategies for the prevention and management of online sexual
coercion and extortion of children to reflect the differences in perpetrators’ motivation and profiles.

Int. J. Environ. Res. Public Health 2019, 16, 243 3 of 14

1.2. Types of Networks

Online communities have established themselves as an important networking and exchange
platform for users with a sexual interest in children [32]. There are some paedophile online organisations
such as the North American Man-Boy Love Association, Girlchat, Boywiki [16,27,33]; Cherry-Popping Daddies,
or Young Petals [24] who advocate legalising sexual behaviour with minors and the liberalisation of
existing child protection laws. These communities play an important role in normalising and validating
paedophile intentions, and facilitate the establishment of contacts to other users with deviant sexual
interests [34]. As Tate [35] described, many paedophile groups present themselves as suppressed
minorities, which serves as a sustainable coherence factor for their participants. These fora often
function as a validating source for offence-supportive cognitions [25,26,33,36].

While research on online sexual grooming of minors has increased in recent years [17,30],
organised child abuse networks remain significantly under-researched. These groups can be defined
as a set of offenders who cooperate to recruit children to be abused, pass victims between them,
and may be involved in group abuse sessions with children [37]. There is evidence of these rings
abusing children offline in contexts such as residential care homes [38], “child sex tourism” in South
East Asia [39], as well as delivering abuse in online settings, for example the Orchid Club in North
America [34]. Burgess [40] distinguished between transitional (unorganised) and syndicated (highly
organised) sex-rings; however, his theory precedes the introduction of the Internet, and thus may not
(fully) apply to cyberspace-enabled offending. In a more recent paper on groups that sexually abuse
children, Cockbain, Brayley, and Laycock [10] described pathways to group involvement, the perceived
benefits derived from group involvement, and the evolution of the group. However, this study is
based on analysis of three offenders, limiting the extent to which these findings can be generalised.
Generalisation could potentially occur based on the psychological processes supporting and enabling
the offending behaviour, for example, the normalizing context of the online group [26,41] and the role
of conformity in groups [1]. There has, however, been little work applying these theories to child
sexual abuse networks [1,24].

1.3. The Role of Cyberspace as an Enabler and Mode of Child Sexual Exploitation

A body of work is emerging about the role of cyberspace and the associated behaviours it may
encourage as facilitators of child sexual exploitation [1,42,43]. In the context of child sex tourism,
Panko and George [8] described websites that covertly or overtly advertise child abuse as a tourism
experience. The proliferation of peer-to-peer networks is argued to make the exchange of information
easier for offenders and more difficult for law enforcement to intervene [4,24,44]. An emerging risk is
the organised online abuse by British nationals of children living abroad [4], but to date no published
research on this behaviour was identified.

A high proportion of online abuse and exploitation crimes involve children, and their own activities
concerning peer-related sexual content has meant that young people are also creating potentially illegal
materials [45]. Whilst guidelines published by the National Institute for Health and Care Excellence [46]
have differentiated between sexually abusive behaviour and those behaviours that are detrimental to a
child’s development, the links between harmful sexual behaviours, pornography, grooming, sexting,
and contact sexual offending are poorly understood and conceptualised [45]. The online behaviours of
young people, illustrated by large-scale studies such as EU Kids Online, n = 18,709 [47], have highlighted
the risk of receiving sexual messages; about one quarter of those receiving such messages self-reported
that they had experienced negative emotions resulting from them. Whilst this study showed a range of
positive outcomes relating to the digital lives of young people, it also highlighted some of the risks
linked to online behaviours. For example, 30% of European children (aged 9 to 16 years) reported
having communicated with someone they have not met face-to-face, 9% of children have met them in
person, and 1% felt negatively affected by it. It is within these data trends that the concerns about
transnational sexual offending (abetted by technology) becomes further amplified.

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1.4. National and International Policy—Current Response Frameworks

Concern about people networking and travelling within or outside the UK to sexually abuse
children has moved higher up the political agenda [2]. In the UK, Sexual Harm Prevention Orders
and Sexual Risk Orders were introduced in order to restrict the movement of people who present
a risk of harm to children in the UK and abroad [48]. Alongside legislation, the UK Government
has prioritised to investigate and prevent child sexual abuse. In order to tackle the issue of British
registered sex offenders targeting child-focused organisations abroad, CEOP’s and the Association of
Chief Police Officers’ Criminal Records Office launched the International Child Protection Certificate,
which allows organisations to check the criminal record of those seeking work with children abroad
(https://www.acro.police.uk/icpc/). However, the certificate will not detect offenders without a criminal
record in the UK. In addition, there is no mechanism to mandate organisations abroad to use the
certificate. On an international level, travel for the purpose of offending behaviour and online grooming
have been considered within the Directive 2011/93/EU of the European Parliament and of the Council
of 13 December 2011 on combating the sexual abuse and sexual exploitation of children and child
pornography [49].

Sexual exploitation of children occurs within more general social, economic, and cultural
considerations [50]. Thus it is important to develop comprehensive and pro-active prevention
measures that target a number of potential risk factors, such as low levels of education, poverty,
ignorance, official corruption, apathy, and a lack of law enforcement and government policy [39,51].
Increased international and local police collaboration has had a positive impact on reducing commercial
child sexual exploitation in at-risk countries; for example, Thailand reported reduced crime rates
for 2011/2 [4]. In addition, the international non-governmental organisation network ECPAT (Every
Child Protected Against Trafficking) has played a significant role in developing measures to reduce
the vulnerability of children abroad and has mobilised the tourism industry to take an active part in
countering the risk of sexual offending [51]. In 1998, the Code of Conduct for the Protection of Children
from Sexual Exploitation in Travel and Tourism (the Child Protection Code) was launched to establish
an ethical policy against the commercial sexual exploitation of children, to train tourism personnel,
and to provide information to travelers [52]. However, there is very little empirical evidence to inform
tourism personnel about the characteristics of networks and offenders therein, how they operate online
and offline, and the key touch points of risk in the UK and abroad. Particularly under-researched areas
are the social and cultural factors affecting transnational organised child sexual exploitation. The Model
National Response (MNR) of the WePROTECT Global Alliance [53] has provided an overview of how
nations can establish and deliver a coordinated response to online child sexual abuse and enhance
international cooperation, irrespective of the starting point of current policies. Within the MNR, it is
recognised that cooperation is needed between law enforcement, the tourism industry, technology
sectors, academia, the non-profit sector, charities, global governance bodies, the public, and indeed
young people themselves. However, as documented by ECPAT research [54], despite advancing child
protection policies, there remains a growth of sexual exploitation of children in travel and tourism
across the globe. There are key challenges pertaining to multi-stakeholder engagement at a global
level, in addition to resourcing limitations that necessitate prioritisation of law enforcement objectives.
Consequently, it is likely that a significant portion of TCSA remains unaddressed.

2. Method

2.1. Study Design

Given the limited knowledge surrounding the issues of TCSA, the aim of this roundtable discussion
was to collate information from an international, multi-disciplinary, multi-agency perspective that will
be of practical value and assistance to those working to combat this particular offending behaviour.
The agenda for the roundtable discussion was: (1) to hear an overview of current research findings on
transnational child sexual exploitation/abuse, (2) to share an update on current, related transnational

https://www.acro.police.uk/icpc/

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law enforcement issues, and (3) to take part in small-group and roundtable scoping and discussion
sessions on current issues facing law enforcement, policy makers, offender managers, and treatment
providers. The choice of a roundtable discussion format using the procedural details outlined in
McCartan et al. [55] was to allow participants to engage in exploratory in-depth interactions with
different professionals in order to elicit a rich qualitative dataset.

2.2. Participants/Discussants

Thirteen discussants attended the roundtable discussion, representing three sectors: (1) criminal
justice and policy-making, (2) child protection/children’s rights organisations, and (3) academia
including criminology, psychology, marketing, hospitality/tourism, and childhood development.
All participants were directly involved with the topic of online or transnational child sexual abuse in
their respective sector; and were either mid-career or senior within their present roles. Participants
were recruited via snowball sampling [56], by targeting relevant organisations and lead contributors in
the field. In order to facilitate free exploration of this challenging topic, participants were assured of
confidentiality by having their identifying organisation removed from the data.

2.3. Procedure and Materials

The roundtable discussion lasted four hours, including breaks, and was facilitated by two
independent facilitators from the host institution’s Research and Enterprise Department. Participants
were seated at three tables consisting of five attendees and completed an information sheet, highlighting
issues of current concern. Following an introductory address from policing and academia lasting
approximately 40 minutes each (with a short question and answer period), a first round of small-group
discussions followed on the current challenges and issues in addressing TCSA, including affected
countries. Using their notes, a representative from each table then communicated back to the full
participant group the key points from the discussions at their table. Emerging issues were collected
and displayed on large posters across the room, which were then anonymously rated by participants in
order to identify the most pressing concerns. Participants used stickers to select the issues they believed
to be of highest priority, and assigned them to the respective poster during the interval. These set the
agenda for the second part of the group discussions, including the identification of specific strategies
to address the identified issues, to deal with at-risk countries, and to highlight further knowledge gaps.
For these initial discussions, participants selected the next group discussion that was of most interest
to them.

All discussions were recorded using an encrypted voice-recorder, and additional note-takers were
present on each table. All discussions were facilitated to be unstructured in nature to allow participants
to explore the topics that were of highest priority to them, based on the developing themes of the event.
The independent facilitators acted as a neutral point of contact to mediate any potentially different
ideological or power dynamics.

2.4. Data Analysis

All data were initially transcribed. Using an inductive approach, data were analysed using
qualitative thematic analysis [57] on the recorded data and notes taken during the discussion.
This approach was chosen due to its flexibility and interpretivist epistemology [55]. The posters, post-it
notes, and information sheets generated during the course of the day were used to contextualise
the primary data from the recordings and notes. Following the familiarisation process of re-reading
the data, an initial set of codes was produced by the fourth author. A sample transcript was coded
by the first author researcher to ensure inter-rater reliability. Any disagreement or lack of clarity
was discussed between researchers until consensus was reached. All codes were then grouped into
potential themes and reviewed by the third author. The overall themes were then defined and named.

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3. Results

The information sheets showed that the majority of participants were mainly interested in,
and advocating for, inter-agency and inter-professional information exchange. Desired outcomes were
linked to the development of more insight, new ideas to tackle TCSA in their respective roles, and to
make new contacts.

3.1. Roundtable Discussion

In the first part of the roundtable discussion, attendees were asked to identify the key challenges
and issues of TCSA in their respective discussion groups. Four key themes were identified, concerning
issues with the definition of TCSA, criminal justice, geographical considerations, and issues surrounding
tourism/hospitality.

3.1.1. TCSA Definition

Participants wondered how TCSA compares to trafficking and online child sexual abuse:

“I think there’s a more fundamental question to be asked—what do we mean by location and distribution
channels? What is being distributed via what channel? ( . . . ) It can be online or offline, it can be
abroad, or being streamed.”

“There’s a burning question about motivation there, isn’t there? Because there will be people that will
have a sort of prima facie motivation to go to a different country or location—regardless of whether
its online/offline—to abuse a child. And so will therefore proactively seek out information that will
allow them to do this. But then ( . . . ) you have situational offenders who may just be, for example,
engaging with CSEM [Child Sexual Exploitation Material] in a network ( . . . ) where there’s some
on-going conversations, and then all of a sudden, the opportunity presented itself.”

In this context, participants also highlighted that definitional clarity is needed for travelling offender
and victim. In addition, participants wondered about the wider context of TCSA:

“[We need to consider] economic discrepancies or poverty in the countries where this happens and the
cultural acceptability of the exploitation happening. It’s not just a question of demand—but children
coming round hotels offering services . . . so that parameter of wealth, poverty and social inequality in
these locations seemed to be a key factor in our discussions.”

Following on from these discussions, participants also wondered if there are vulnerable occupations
(such as pilots, truck drivers, global event facilitators) that could be targeted for prevention work.

3.1.2. Criminal Justice Issues

Under this second theme, four sub-themes could be defined:

Management of Travelling Offenders

Participants raised the issue of managing travel applications of registered sex offenders, and those
who travel without travel application; and who holds responsibility for incidents of sexual abuse where
such travelers access countries with no border control or without monitoring systems. Participants
also shared knowledge about specific hotspot countries worthy of more focus:

“If we’re concerned about UK offenders travelling abroad, there’s places like Kenya, Philippines,
and older countries like Thailand and Cambodia that continue to be areas of concern.”

Investigative Methods

Participants highlighted difficulties in identifying victims (“Many victims are not showing red flags.”)
and how to extricate relevant information from databases (“Categorisation of database information does

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not generate new knowledge.”). There was also a call to collaborate with other counties in on-going or
future investigations:

“One of the issues we raised was prevention. In the UK, we haven’t got a bottomless pit of resources of
money. Let’s deal with our offenders going abroad and deal with them at source. They may be men,
and they may be coming from here, but let’s deal with our own offenders first and see what works,
and then spread that. Deal with the root cause.”

Enhancing Knowledge about the Offending

Participants acknowledged that there is still limited knowledge about transnational offending
pathways: Is it individual offenders or is it organised? Who do you pick up? How are groups accessed?
One participant stated:

“We were recognising that CSEM is all over, but why do people travel to do it? There are various
hypotheses—high-risk sex offenders who carefully monitor might choose to do that. Respected
individuals who might not do it in this country would go abroad—a process of normalisation might
reinforce that. We were looking at could we understand the pathways by which people ended up doing
that. Part of that would be what would come out of investigations leading to convictions, but part
of it might come from interviewing people about how their pathways developed. It could be that it’s
through sharing exploitative material, networking—building up to it from that. Or it might be that
there’s knowledge of certain places to go to—how do people get that knowledge? From an intervention
viewpoint, those processes might have points that could be disrupted.”

Maintaining a Victim-Centric Stance

Participants wondered how they can implement a victim-centric policing model when managing
cases of transnational offenders, especially when providing for the needs of victims in, or from
other jurisdictions:

“It is very difficult when you’ve got different levels of victim support and training—what exactly are
we looking to prevent? Because a lot of these problems on the ground are not exactly preventable.”

3.1.3. Geographical Issues

Participants highlighted the need to identify and share knowledge on geographical areas of concern,
as well as considering event-specific offending (such as surrounding the World Cup). Key markers of
target areas were poverty and corruption:

“We were saying corruption is a real problem—it leads on from poverty. The reverse is: the offenders
are rich, they can buy people off. They can buy the family off, they can groom the family. They can pay
police officers off. Families will take any amount of money for a child. So poverty, corruption and
richness together is the perfect triangle of abuse, isn’t it?”

Participants also highlighted how such markers could be used to identify areas of future concern.
A second issue that arose here was how Western culture might be perceived abroad:

“Maybe it’s not just people travelling abroad . . . maybe they are more sexualised here? Is this a cultural
phenomenon? Is [TCSA] actually a specific issue or is it just sexual abuse in general happening in
different fora with new technology?”

“We had a presentation at a hotel recently, there was a person from serious crime office talking about
CSE [child sexual exploitation]—1.3 million children were abused in this country [UK]. ( . . . ) Why
don’t we talk about this country? We have 10,000 refugee children missing in Europe. It’s much
easier to talk about what’s happening in Vietnam—it makes us feel more comfortable, but that’s the
way it is.”

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Finally, participants were considering the “borderless role” of technology and the dark web:

“It depends on the level of sophistication of the offender you see. The newbies will go in social
media—which are controlled by the police. We’re talking now about the dark social (not necessarily
dark web), but those that can’t be encrypted such as Snapchat, where there’s no potential of looking.
So if I’m an offender and I start a network with others who bring other people, then I can organise my
own network.”

3.1.4. Tourism/Hospitality Issues

Interestingly, issues surrounding the tourism and hospitality sector emerged as a separate
sub-theme. Participants explored the role of hotels (mainly, hotel receptions), and how they can
play a part in the prevention of TCSA, and highlighted initiatives such as a “Hotel Watch” (e.g.,
https://sussex.police.uk/advice/protect-your-business/hotel-watch/). Participants also reflected on
novel tourism developments, such as AirBnB, which emerged as both a “digital disruptor” to how
safety, accountability, and regulation operates within the industry, but also as a new challenge to
understanding how people use informal space via transactions [58].

3.2. Priority Ranking

Participants were asked to record any additional factors for consideration on post-it notes.
These highlighted nine separate research questions that could be summarised into three key themes:
Offending Behaviour; Victim Safeguarding; and Culturally-Sensitive Responding. Participants were
asked to rate these in terms of their priority, highlighting the need for systematic information gathering
and victim safeguarding as key priorities (see Table 1).

Table 1. Identified research questions, prioritised by the group (frequency rating).

Theme Research Question Priority Ranking

Offending Behaviour How do offenders know to go to certain locations/distribution channels? 7

Victim Safeguarding
What support is available to children/victims in affected countries (e.g.,

safe housing, psychological support, compensation)?
6

Victim Safeguarding
In cases of compensation, how can we ensure there is no meta-abuse of

the victim, and how can policy ensure such accountability?

5

Victim Safeguarding
In some countries, victims of child sexual abuse may be seen as

criminally liable (differences in legislation between countries); issue of
victim blaming/stigma surrounding victimisation, and power

5

Offending Behaviour What types of transnational child sexual abuse exists? 5

Offending Behaviour
What are the profiles of perpetrators in-country vs. foreign visitors
(travelling sex offenders)? How do live-streaming offences fit in?

5

Culturally-Sensitive
Responding

Western way of thinking in a non-Western problem—how can we
think/act globally?

4

Offending Behaviour
What is the impact of online child sexual abuse, networking, and

travelling on contact sex offending?
4

Victim Safeguarding
Can you do research with the child victim? What are the consequences

to the child? What are their perceptions of the help provided?
3

4. Discussion

This study investigated the issues related to TCSA from a multi-agency and multi-professional
stakeholder perspective. Data were collected during a roundtable discussion event in London with
stakeholder representatives from academia, law enforcement, tourist industry and non-profit child
protection sectors. Participants discussed issues related to the key challenges of TCSA, the affected
countries, response strategies, and knowledge gaps. The breadth of responses from attendees
underscores the scale of the TCSA problem, and the challenges in responding to it. The discussions
highlight four key themes as future priority areas (see Figure 1).

https://sussex.police.uk/advice/protect-your-business/hotel-watch/

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Int. J. Environ. Res. Public Health 2019, 16, x FOR PEER REVIEW 9 of 14

Victim

Safeguarding

Can you do research with the child victim? What are the

consequences to the child? What are their perceptions of the

help provided?

3

4.

Discussion

This study investigated the issues related to TCSA from a multi-agency and multi-professional

stakeholder perspective. Data were collected during a roundtable discussion event in London with

stakeholder representatives from academia, law enforcement, tourist industry and non-profit child

protection sectors. Participants discussed issues related to the key challenges of TCSA, the affected

countries, response strategies, and knowledge gaps. The breadth of responses from attendees

underscores the scale of the TCSA problem, and the challenges in responding to it. The discussions

highlight four key themes as future priority areas (see Figure 1).

Figure 1. Thematic summary of overall priorities identified at the roundtable discussion.

4.1. Key Theme 1: Offender Typologies

A recurring theme from attendees’ discussions was the extent to which the field is encountering

a new type of offender, or a new pathway to child sexual abuse behaviour. Key information required

here is the analysis of features of geographical target areas as well as the role of technology and

Internet access in target countries, to inform preventative strategies. A sub-question that emerged

was the appropriate selection and analysis of information collected in relevant databases. Overall,

participants acknowledged that the vast majority of known TCSA offenders are male (see also [4])

but were less clear on their psychological characteristics and how the pathway to TCSA was initiated

(“there’s a burning question about motivation there”). Participants discussed their experiences and

professional knowledge about the motivations of TCSA offenders and connected this to potential

pathways to TCSA offending behaviour, with the view to identifying gateways for interrupting it

and to further explore the role of the dark web in facilitating TCSA. Given the role of the Internet in

facilitating TCSA, participants provided nuanced discussions related to the motivational continuum

of (potential) offenders, and the overall function that the Internet has: “How do people [offenders] get

that knowledge [of TCSA destinations]? From an intervention viewpoint, those processes might have points

that could be disrupted.”

Figure 1. Thematic summary of overall priorities identified at the roundtable discussion.

4.1. Key Theme 1: Offender Typologies

A recurring theme from attendees’ discussions was the extent to which the field is encountering a
new type of offender, or a new pathway to child sexual abuse behaviour. Key information required
here is the analysis of features of geographical target areas as well as the role of technology and Internet
access in target countries, to inform preventative strategies. A sub-question that emerged was the
appropriate selection and analysis of information collected in relevant databases. Overall, participants
acknowledged that the vast majority of known TCSA offenders are male (see also [4]) but were less clear
on their psychological characteristics and how the pathway to TCSA was initiated (“there’s a burning
question about motivation there”). Participants discussed their experiences and professional knowledge
about the motivations of TCSA offenders and connected this to potential pathways to TCSA offending
behaviour, with the view to identifying gateways for interrupting it and to further explore the role of the
dark web in facilitating TCSA. Given the role of the Internet in facilitating TCSA, participants provided
nuanced discussions related to the motivational continuum of (potential) offenders, and the overall
function that the Internet has: “How do people [offenders] get that knowledge [of TCSA destinations]?
From an intervention viewpoint, those processes might have points that could be disrupted.”

4.2. Key Theme 2: Victim-Centric Investigative Practice

In keeping with best practice procedures of investigative practice advocated by many stakeholders
such as ECPAT [59] and the Declaration of Rome [60], attendees recognised the need to hold to account
the multi-agency partners responsible for preventing re-victimisation (e.g., during investigation
proceedings) and the provision of support services provided for the victims (and their families).
Participants highlighted the need for good investigative practice to be shared across jurisdictions,
and for greater clarity in terms of accountability and responsibility. Indeed, there was also the call
to develop a shared definition of what constitutes effective support for victims, and for it to be then
embedded in a culturally responsive framework. This connects with the victim-centred approach that
has come to be prioritised across multi-agency responses to all forms of sexual offending. However,
there was also recognition that this may not always be possible across jurisdictions where accountability
of victim follow-up and support is unavailable.

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4.3. Key Theme 3: Prevalence and Definitions

There was a detailed discussion regarding the “hotspot countries” of TCSA, and the need to
identify key markers of such countries to be able to foresee future vulnerable countries. Whilst law
enforcement can locate regions with high levels of recorded TCSA, that is not to rule out other potential
hotspot regions that are as yet unknown. Connected with the offender typologies theme, further data
is required to critically evaluate where certain offender-types travel, why, and in what numbers. Other
definitional issues arose with broad terms such as culture or poverty, and a suggestion to develop a
shared language that does not overemphasise cultural differences. A final definitional and conceptual
issue was the distinction of victim vs. perpetrator in light of the challenges from self-generated illegal
content [45]. Whilst this analysis clearly argues for a victim-centric approach, there is much complexity
underlying how we approach the concept of victimhood and perpetration within TCSA when there are
significant mediating factors at play (“ . . . a lot of these problems on the ground are not exactly preventable”).

4.4. Key Theme 4: Collaboration

It was evident that collaborative work from all stakeholders was seen as the route to the most
effective responses. This necessitates strategically targeted information-sharing to be able to cultivate
a feasible strategy, a level of collaboration between partners abroad, and the establishment and
strengthening of such links. Participants challenged the assumptions made about where, how and why
TCSA occurs, with respect to the social, economic, political, and cultural considerations [39]. Equally,
there was acknowledgement of the work of agencies such as ECPAT [51] and parts of the tourist
industry [52] in establishing ethical policies against TCSA. However, there was also acknowledgement
of the underestimation of TCSA and its likely global increase [4]. Consequently, there were interesting
discussions between participants regarding the design of the most appropriate ethical framework
when proposing to intervene at any level abroad. A separate but related issue concerned how best to
intervene given limited resources; for example, there is a need for a more coordinated international
response to address ‘at risk’ offenders journeying into the pathways to TCSA. This final theme connects
all other themes by way of establishing a solution-focused response to the issues raised—namely,
collaborative approaches to prevention and interruption of the preparatory stages to (re-)offending.

Finally, perhaps one surprising outcome of this study was the lack of any detailed discussion
regarding the specific role of the technology industry and government in moderating content, detecting
and eradicating TCSA networks, and collaborating with stakeholders. This is perhaps partly attributable
to the absence of any technology industry or government representation at the roundtable event.
Nonetheless, it is somewhat surprising that specific technological interventions were not explored
given the frequency at which cyberspace was implicated in TCSA. Enhancing the role of this industry in
the challenge to eradicate TCSA is regarded as a fundamental component within the literature [61,62].

4.5. Limitations

This study comprised of a self-selected sample of participants that was not fully representative
of all stakeholders. Notably, there was no representation of victims or perpetrators, nor was there
any technology industry or political representation. Further limitations were the small number of
participants, and any potential biases arising from their different ideological views, differential power,
and any related consequences of these differences. In addition, while this type of data collection
generated a wide-ranging set of data, their variability affects the overall strength and generalisability
of the data collected. However, this approach was justified given the exploratory nature of this study,
with the aim for future research to investigate each issue in-depth and develop clear action plans.

5. Conclusions

The findings in this study lend support to further exploring how stakeholder collaboration could
assist primary, secondary, and tertiary prevention approaches [63] to TCSA. Specifically, the participants’

Int. J. Environ. Res. Public Health 2019, 16, 243 11 of 14

prioritisation of the research questions identified throughout the day offers a potential starting point
for future collaborations. It followed that offending behaviour (how offenders know where to go) and
victim safeguarding (ensuring support and accountability for responses to victims) should be seen as
the primary areas for multi-agency collaboration.

To that end, this roundtable discussion highlighted the scope and motivation for collaboration
between academia, front-line operations and charities. This research emphasised the need for
investment in further resources that can address the knowledge gaps that are currently limiting the
ability of stakeholders to tackle TCSA. For example, the sharing of data between academia, industry,
charities, and law enforcement across jurisdictions can enhance knowledge regarding the psychology
of the continuum of TCSA offender motivations and the respective offending behaviours, in both
online and offline environments. In the next steps, the key themes identified need to be translated into
clear action plans to be addressed in work going forward.

Author Contributions: Conceptualization, S.D.W., H.L.M., and D.E.P.; Methodology, H.M and D.M.; Formal
Analysis, H.M and D.M.; Investigation, H.L.M., D.E.P., and D.M.; Resources, H.L.M. and D.E.P.; Writing—Original
Draft Preparation, H.L.M. and S.D.W.; Writing—Review and Editing, D.M., D.E.P., and H.L.M.; Visualization,
D.M., and H.L.M.; Supervision, D.E.P.; Project Administration, H.L.M.; Funding Acquisition, H.L.M., and D.E.P.

Funding: This research was funded through the College Research Fund of the University of Lincoln, UK.

Conflicts of Interest: The authors declare no conflict of interest.

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• Introduction

Offender Characteristics
Types of Networks
The Role of Cyberspace as an Enabler and Mode of Child Sexual Exploitation
National and International Policy—Current Response Frameworks

• Method

Study Design
Participants/Discussants
Procedure and Materials
Data Analysis

• Results

Roundtable Discussion
TCSA Definition
Criminal Justice Issues
Geographical Issues
Tourism/Hospitality Issues
Priority Ranking
Discussion
Key Theme 1: Offender Typologies
Key Theme 2: Victim-Centric Investigative Practice
Key Theme 3: Prevalence and Definitions
Key Theme 4: Collaboration
Limitations

• Conclusions

References