Stress regulation in maltreating parents

Recently it was estimated that in the Netherlands annually 30 out of 1,000
children suffer from child maltreatment. Previous research has indicated that
mothers at risk for maltreating their children show increased physiological
responses to infant crying sounds, as well as increased arousal levels in
response to infant smiling. In addition, excessive use of force in handgrip
tasks was reported for parents at risk for maltreatment. A major limitation for
the interpretation of these findings is that most of the studies focus on
parents at risk for child maltreatment instead of actually maltreating parents.
In order to draw firm conclusions about physiological risk factors for child
maltreatment, it is important to investigate parents who have been reported for
substantiated child maltreatment.

Research has also shown that own experiences with maltreatment in their youth
and the attachment representation that parents have regarding the relationship
with their own parents can play a role in physiological stress reactions as
well as the risk for child maltreatment. Therefore, in the current study we
will also focus on the effect of own experiences with maltreatment and the
attachment representation of the parents on the fysiological stress reactions
that in turn are risk factors for child maltreatment.

The aim of the current study is to gain more insight in the physiological
mechanisms that are involved in child maltreatment by studying heart rate, skin
conductance, alpha-amylase, cortisol, and hand grip strength responses to
infant crying and laughter sounds during various paradigms in a sample of
maltreating mothers and a control group of nonmaltreating mothers. We
hypothesize that maltreating mothers show hyperreactivity in response to
infants* socio-emotional signals as compared to nonmaltreating mothers.
We also expect that an insecure or unresolved attachment representation and the
experience of childhood trauma will partly explain the differences between the
maltreating and nonmaltreating groups.

Heart rate, skin conductance, alpha-amylase, cortisol, and hand grip strength
will be assessed in maltreating and nonmaltreating mothers during different
paradigms. We will include 50 mothers in the maltreatment group and 50 in the
nonmaltreating control group. The physiological responses of these mothers will
be assessed during the Cry Paradigm of Zeskind (Zeskind & Shingler, 1991),
which will be combined with paradigms of infant crying and laughter by Groh and
Roisman (2009) and a visual mother-child comforting paradigm (Johnson, Dweck, &
Chen, 2007). Finally, we will use the Adult Attachment Interview to assess the
mother*s attachment representation (George, Kaplan, & Main, 1985).

Subjects in the study will be asked to participate in three computer tasks and
an interview. The computerized assessment and the interview will each take
approximately one hour, and will be scheduled during two separate appointments.
Mothers in the full-time and part-time treatment program will be assessed at
the location of their treatment, in a separate quiet room. Mothers in the
control group will be asked to come to the location where their child is
receiving treatment. We aim to schedule the assessments for them during child
treatment appointments.
For all participants an individual assessment by a child- and adolescent
psychiatrist on their family background and childhood experiences is added
(Dutch Childhood Trauma Questionnaire-Short Form; Thombs, Bernstein,
Lobbestael, & Arntz, 2009). This psychiatric assessment involves questions on
their own childhood experiences of maltreatment. For the mothers* emotional
welfare, this assessment will take place in a treatment context. If
participants become emotionally disturbed by the questions about their
childhood experiences, the psychiatrist will terminate the assessment and
provide intervention if necessary. In addition, participants will be asked to
fill out a questionnaire on their parenting styles, in order to verify their
nonmaltreatment status. Again, for the case group, the child- and adolescent
psychiatrist will be present to provide a psychologically safe environment.
All research procedures will be discussed with the child-and family
psychiatrist responsible for the treatment of the participating families to
ascertain that no assessment will interfere with treatment programs.