Child Abuse & Neglect 31 (2007) 393415

Differential correlates of multi-type maltreatment

among urban youth,
Catalina M. Arata a, , Jennifer Langhinrichsen-Rohling b ,
David Bowers c , Natalie OBrien b
a
Neurology: Child and Adult, PC, University of South Alabama, Mobile, AL, USA
b
Department of Psychology, University of South Alabama, Mobile, AL, USA
c
Department of Political Science and Criminal Justice, University of South Alabama,
Mobile, AL, USA
Received 10 November 2003; received in revised form 28 September 2006; accepted 30 September 2006
Available online 6 April 2007

Abstract

Objective: The aim of this study was to examine the differential effects of multi-types of maltreatment in an
adolescent sample. Different combinations of maltreatment (emotional, sexual, physical, neglect) were examined
in relation to both negative affect and externalizing symptoms in male and female youth.
Method: One thousand four hundred fifty-two middle and high school youth were recruited from urban schools and
a mandated early warning truancy program. Youth completed an anonymous survey that included measures of child
maltreatment, depression, suicide proneness, hopelessness, delinquency, hostility, substance use, and promiscuity.
Respondents were categorized into groups of different combinations of maltreatment by their reports of sexual
abuse, physical abuse, neglect (emotional and physical), and emotional abuse.
Results: Nearly two-thirds of boys and girls reported some form of maltreatment, and multi-type maltreatment was
common (e.g., 13% reported experiencing both physical and sexual abuse and neglect). Individuals with maltreatment
histories were more depressed (F = 52.78, p < .0001), suicide prone (F = 24.29, p < .001), and hopeless (F = 32.07,
p < .0001) than non-abused individuals. Maltreated adolescents were also more hostile (F = 35.03, p < .0001), and
they engaged in more delinquent behavior (F = 26.76, p < .0001), promiscuity (F = 8.54, p < .0001), and drug and
alcohol use (F = 9.61, p < .0001). Individuals experiencing multi-type maltreatment were the most symptomatic,

This study was funded by grant #2001-SI-FX-0006, entitled USA Youth Violence Initiative, from the Office of Juvenile
Justice and Delinquency Prevention.

This paper was presented at the 11th annual meeting of the American Professional Society on the Abuse of Children.

Corresponding author address: 100 Memorial Hospital Drive, Suite 2A, Mobile, AL 36608, USA.

0145-2134/$ see front matter 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2006.09.006
394 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

particularly youth with histories of physical abuse, sexual abuse, and neglect. In general, gender differences in
effects were not observed.
Conclusions: The results highlight the importance of studying combined types of maltreatment, as well as under-
standing the particularly deleterious effects of neglect and emotional abuse. The results are generally consistent
with an additive model of maltreatment effects.
2007 Elsevier Ltd. All rights reserved.

Keywords: Physical abuse; Sexual abuse; Emotional abuse; Neglect; Maltreatment; Gender

Introduction

The negative effects of child maltreatment have been well documented over the past 20 years (Finkelhor,
Hotaling, Lewis, & Smith, 1990; Higgins & McCabe, 2000); however, researchers within the field
have typically examined the effects of only one specific type of maltreatment at a time. More recently,
researchers have begun to measure the concurrence rates of different types of maltreatment. For example,
Ney, Fung, and Wickett (1994) reported that more than 95% of victims experience more than one type
of maltreatment. Similarly, in a study of college students, Arata, Langhinrichsen-Rohling, Bowers, and
OFarrill-Swails (2005) found that 60% of individuals reporting a history of childhood maltreatment also
reported more than one type of maltreatment.
Given the high co-occurrence of multi-type maltreatment, research is needed to examine the effects
of multiple types of maltreatment. Higgins and McCabe (2001) conducted a literature review and found
only 29 studies that measured the effects of multiple types of maltreatment. These authors concluded
that particular forms of maltreatment were highly correlated. Specifically, physical abuse and psy-
chological maltreatment, and physical abuse and sexual abuse were highly likely to co-occur in the
same individuals. In general, physical abuse was strongly correlated with other maltreatment types.
On the other hand, sexual abuse was not always found to be highly co-existent with other types of
maltreatment.
In studies where multiple forms of maltreatment have been measured, the maltreatment effects
have been shown to vary depending upon the samples used, the number and types of maltreatment
assessed, and the outcome variables utilized (see Table 1 for a summary of some of the primary studies).
Some researchers have found evidence that supports the existence of differential effects (e.g., Paivio
& McCulloch, 2004). For example, neglect has been found to be associated with internalizing types of
symptoms, such as low self-esteem and loneliness (Loos & Alexander, 1997). Childhood neglect has also
been associated with a lack of positive gender-related self beliefs (Rosen & Martin, 1998). In contrast,
physical abuse and verbal abuse have been found to be particularly associated with anger and aggression,
while sexual abuse has been specifically associated with sexual problems (Loos & Alexander, 1997). Fur-
ther, suicidality has been linked more with sexual abuse than with other types of maltreatment (Bryant &
Range, 1997). Conversely, other researchers have found few differential effects of abuse (Mullen, Martin,
Anderson, Romans, & Herbison, 1996; Silverman, Reinherz, & Giaconia, 1996).
Studies with child and adolescent samples are important for identifying effects of abuse, because they
do not rely so extensively on retrospective reporting. Researchers who have studied abuse among child
and adolescent samples have generally found some evidence of differential effects of maltreatment, with
findings similar to those observed in adult samples. Physically abused children are more likely to display
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 395

Table 1
Studies examining the effects of multiple types of maltreatment on adolescent and young adults
Authors Types of maltreatment Sample Results
assessed
Arata et al. (2005) Physical abuse 382 college males Sexual abuse > internalizing
and females behaviors
Sexual abuse Physical abuse >
Emotional abuse externalizing behaviors
Neglect
Bensley et al. (1999) Abuse 4,790 adolescents Combined abuse +
Sexual abuse in general school molestation > antisocial
Molestation population behavior and suicidal
ideation
Brown, Cohen, Johnson, and Smailes (1999) Neglect 639 adolescents Sexual abuse > depression
and young adults in and suicide attempts
general community
Physical abuse
Sexual abuse
Bryant and Range (1995) Sexual abuse 114 college females Sexual
abuse + other > suicidality
Physical abuse Sexual abuse + other and
physical + psychological
abuse < reasons for living
and responsibility to family
Bryant and Range (1997) Physical abuse 486 college males Sexual abuse and/or
and females physical abuse > suicidality
Sexual abuse
Buckle et al. (2005) Sexual abuse 81 adolescent Physical neglect
psychiatric (only) > lower IQ
Emotional abuse inpatients Sexual abuse > parental
overprotection
Physical abuse Sexual abuse + externalizing
behaviors > low academic
achievement
Physical and emotional Sexual abuse + internalizing
neglect behaviors > low academic
achievement
Cavaiola and Schiff (1988) Physical abuse 150 abused and Sexual abuse > sexual acting
chemically out
dependent
adolescents
Sexual abuse 60 nonabused Physical abuse > legal
chemically problems
dependent
adolescents
396 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415
Table 1 (Continued )
Authors
Clemmons et al. (2003)
Green et al. (1999)
Holt and Espelage (2005)
Kinard (2004)
Koss et al. (2003)
Types of maltreatment Sample Results
assessed
Incest 60 nonabused and
nonchemically
dependent
adolescents
Sexual abuse 112 Latina One type of abuse did not
undergraduates differ in trauma symptoms
from no maltreatment
Physical abuse Any two types of
Emotional abuse maltreatment > trauma
Witnessing violence symptoms
Physical abuse 49 clinic referred Physical abuse with or
adolescent females without sexual
abuse > Conduct Disorder
Sexual abuse Physical abuse and sexual
abuse > Major Depressive
Disorder and Somatoform
Disorder
Dating violence 681 adolescents in Child sexual abuse >
middle school and physical and emotional
high school victimization dating
Dating emotional abuse Child sexual abuse > anxiety
and depression
Childhood sexual abuse Maternal support
(perceived) + dating
violence > less anxiety and
depression-(African-
Americans)
Dating violence > anxiety
and depression
Physical dating
violence > anxiety and
depression (Caucasians)
Physical abuse 198 maltreated Neglect > higher teacher
school age children ratings of behavior
in state child problems, depression, lower
protective service self-worth, suicidal ideation
agency
Sexual abuse Sexual abuse > teacher
ratings of behavior
problems, lower self worth
Neglect
Physical abuse 1,660 individuals For men, combined physical
from seven Native and sexual abuse, physical
American Tribes abuse, or physical neglect
were interviewed > alcohol dependence
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 397

Table 1 (Continued )
Authors
Loos and Alexander (1997)
McGee et al. (1997)
Moran et al. (2004)
Mullen et al. (1996)
Ney et al. (1994)
Types of maltreatment Sample Results
assessed
Physical neglect For women, all types of
Sexual abuse childhood abuse > alcohol
Emotional abuse dependence
Emotional neglect
Physical abuse 401 college males Physical abuse or verbal
Verbal abuse and females abuse > anger and
Emotional neglect aggression
Physical abuse 160 adolescents Psychological abuse
from Child > internalizing and
Protective Services externalizing problems
Sexual abuse Females > internalizing
Psychological abuse Males > externalizing
Neglect
Exposure to family
violence
Physical abuse 2,187 10th to 12th Emotional abuse > substance
graders from six abuse
Sexual abuse public schools in Physical abuse > substance
Oregon abuse
Emotional Abuse Sexual abuse > substance
abuse
Physical abuse and sexual
abuse > greater risk for
substance abuse
Physical abuse 596 adult Physical abuse > marital
community females problems
Sexual abuse Sexual abuse > sexual
problems
Emotional abuse Emotional
abuse < self-esteem
Physical abuse 167 children Physical abuse, physical
(outpatient, neglect, and verbal
inpatient, youth abuse > problems than other
offenders, and high combinations of abuse
school) from 7 to
18 years
Sexual abuse
Physical neglect
Verbal abuse
Emotional neglect
398 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

Table 1 (Continued )
Authors Types of maltreatment Sample Results
assessed
Prino and Peyrot (1994) Physical abuse 21 physically Physically
abused children abused > aggressive and
hostile
Neglect 26 neglected Neglected > withdrawn and
children submissive
21 non-maltreated
children
Rosen and Martin (1998) Sexual abuse 1,365 US Army Physical and emotional
soldiers abuse > negative masculinity
(both genders)
Physical and emotional Sexual abuse > negative
abuse (combined) femininity(males)
Physical neglect Emotional neglect > positive
femininity (males)
Emotional neglect More Sexual
abuse > positive femininity
(females)
Silverman et al. (1996) Physical abuse 375 community Physical abuse or sexual
sample of young abuse > suicidality, major
adults depressive disorder, PTSD,
and antisocial behavior
Sexual abuse Males: physically
abused > drug
abuse/dependence
Widom and Kuhns (1996) Physical abuse 1,196 adults with Females: sexual
documented cases abuse > alcohol
of child abuse abuse/dependence
Sexual abuse and/or neglect Sexual abuse or
neglect > prostitution
Neglect Abuse or neglect > running
away
Wolfe et al. (2001) Physical abuse 1,419 community Abused females > anger,
adolescents depression, anxiety, PTSD
symptoms, dating violence
victimization, delinquency
and carrying concealed
weapons
Sexual abuse 93 adolescents Abused males > depression,
from Child PTSD symptoms, overt
Protective Services dissociation, and abuse
perpetration and
victimization in dating
relationships
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 399

Table 1 (Continued )
Authors Types of maltreatment Sample Results
assessed
Emotional abuse
Emotional neglect
Physical neglect
Note. (>) Indicates the sample was more symptomatic; (<) indicates the sample was less symptomatic on the specific constructs.

aggressive, acting-out types of behaviors, whereas neglect has been more associated with internalization
of symptoms, such as being withdrawn or submissive. Moreover, sexual abuse has often been associated
with sexual acting out (Cavaiola & Schiff, 1988; Prino & Peyrot, 1994). At the same time, studies with
adolescents also find that experiencing more than one type of maltreatment may be more predictive of
emotional and behavior problems, than the effects of any particular type of abuse experienced alone (e.g.,
Bensley, Van Eenwyk, Spieker, & Schoder, 1999; Green, Russo, Navratil, & Loeber, 1999).
While differential effects of physical and sexual abuse have been observed in adolescent samples, only a
few researchers have included measures of neglect or psychological abuse in their studies of maltreatment.
When neglect and psychological abuse have been included, they have been found to be significant factors
in explaining the negative emotional effects associated with other types of maltreatment. For example,
McGee, Wolfe, and Wilson (1997) found that physical abuse was not associated with externalizing
behaviors, unless psychological maltreatment was also present. Likewise, neglect was associated with
internalizing behaviors, but only if psychological maltreatment was also present.
Gender differences in the effects of maltreatment among adolescents have also received some research
attention. McGee et al. (1997) found that physical abuse was a better predictor of self-rated internalizing
problems for girls than for boys, with boys evidencing higher rates of externalizing or aggressive behavior
in association with their abuse. Wolfe, Scott, Wekerle, and Pittman (2001) reported that while abuse
was associated with more symptoms for male than female adolescents, females had a broader range of
negative outcomes associated with maltreatment history than did males. Wolfe and colleagues indicated
that maltreatment was a significant risk factor for males to become perpetrators or victims of physical
violence and threats, whereas female abuse victims were significantly more likely to be recipients of
violence rather than perpetrators.
The purpose of the present study was to expand the literature on differential effects of maltreatment,
by addressing some of the gaps in the existing literature. Most notably, relatively few researchers have
included neglect and psychological abuse in their studies of differential effects. Further, there is a con-
tinuing need for research using adolescent samples, as issues of retrospective reporting are minimized
and opportunities for early intervention may be present for youth. Therefore, the present study exam-
ines the differential and additive effects of four different types of child maltreatment in an adolescent
sample. They are: physical abuse, sexual abuse, emotional abuse, and neglect. Consistent with previous
literature, it was hypothesized that sexual abuse would be associated with more symptoms of negative
affect (e.g., depression, hopelessness, suicide proneness), whereas physical abuse would be more associ-
ated with externalizing types of symptoms (e.g., delinquency, substance use, promiscuity, and hostility).
Neglect was hypothesized to be associated with both externalizing symptoms and negative affect. It was
also hypothesized that maltreatment effects would be additive, with more types of maltreatment being
associated with greater symptoms.
400 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

An additional goal of the study was to examine gender differences in the effects of different types of
maltreatment. Consistent with prior research, it was expected that male and female adolescents would
differ in the types of effects associated with maltreatment, with males maltreatment being more associated
with externalizing symptoms and females maltreatment have a weaker association with externalizing
symptoms but a greater association with symptoms of negative affect.

Method

Participants

From January 2002 to May 2003, 1,959 urban middle school and high school youth in Mobile, Alabama,
were recruited for participation in a study on youth behavior. Of all the youth recruited, 1,553 (79%)
participated. The participation rate was 93% in the high school, with 67% of students at an early warning
school truancy program participating, and 62% in the middle school. After removing 101 invalid (e.g.,
all questions answered the same) and/or grossly incomplete surveys, or surveys that did not meet age
criteria for inclusion (age < 13 or age > 18, or they were in the 12th grade and did not give age) or
surveys that were incomplete for the participants gender, the final dataset consisted of surveys from
1,452 youth. The majority of the youth came from the high school sample (876, 60.3%), 189 (13.0%)
were from the middle school sample, and 387 (26.7%) were from the early warning truancy program
sample. In the final dataset, 35.5% of the sample were Caucasian, with 50.7% African American, 2%
Hispanic, 2.7% Asian American, 2.7% Native American, and 6.3% Other. There were 774 (53.3%) female
participants. The mean age was 15.6 years (range 1318). The sample consisted of a high percentage of
low-income participants based on responses to a question regarding free lunch status. Forty-two percent
of the sample reported receiving a free lunch, and 9.6% reported that they received a reduced price
lunch.

Procedure

IRB approval. The University of South Alabama Institutional Review Board approval was secured for
all aspects of this study.

School samples. After obtaining permission from each school principal and school board, parents were
sent a letter describing the study. For the high school sample, a passive consent procedure was used.
The letter described the study to the parents and invited them to several meetings to provide further
information about the project. Parents were also given information so they could contact the investigators
by telephone. The letter instructed parents that they should tell their offspring not to fill out the survey
if they did not want them to participate. In addition, assent was obtained from each youth. The middle
school parents received a similar letter, but these parents had to return a signed consent form in order
for their child to participate. In both school samples, responses to the survey were anonymous. Each
school received $1.00 for each possible participant. Research assistants handed out the surveys in indi-
vidual classrooms and were available to assist students who needed help completing the questionnaire.
In addition, all students were given a referral list for mental health services at the conclusion of the
project.
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 401

Truancy program participants. In order to include high-risk youth who may not be in school, youth
were also recruited from a district-wide Early Warning Truancy program. This is a 1-hour long program
jointly held by the school system and the District Attorneys office. Its purpose is to intervene with youth
with excessive school absences (>5 unexcused) and/or tardies (>15). Each youth identified as truant by
the school district receives a letter from the DAs office mandating their appearance at the Early Warn-
ing Truancy program. For this study, an additional letter was attached to the DAs correspondence that
informed both the adolescent and their parents of the opportunity to participate in this research. Ado-
lescents who were interested in participating were asked to stay after the truancy program in order to
complete the survey. In all cases, a parent was required to accompany the child to the Early Warning Tru-
ancy program. Thus, by parents allowing their child to remain after the program, they were demonstrating
passive parental consent. In addition, active assent was obtained from each participant. The survey was
administered in a group setting. Either the survey was read aloud or the participants listened to a tape
recording of the survey if they had reading difficulties. Research assistants handed out the surveys and
were available to assist students who needed help completing the questionnaires. Each youth received
$10 for their time and participation. In addition, all students were given a referral list for mental health
services at the conclusion of the project.

Measures

Demographic information sheet. A demographic information sheet was used to obtain general informa-
tion such as gender, ethnicity, current living situation, grade in school, and family background.

Maltreatment history. The Childhood Trauma Questionnaire-Short Form (Fink, Bernstein, Handelsman,
& Foote, 1995, CTQ-SF) is a 34-item, self-report questionnaire that was used to assess five types of child
maltreatment: sexual abuse, physical abuse, emotional neglect, emotional abuse, and physical neglect.
Each item begins with the anchor, When I was growing up and respondents indicate on a five-point
Likert scale the frequency of a particular incident (1 = never true; 5 = very often true). The five subscales
have reported coefficient alphas ranging from .71 to .93 (Bernstein & Fink, 1998). The subscale alphas
ranged from .62 to .85 in the current sample. Convergent validity with interviews on child maltreatment
history has been demonstrated for the CTQ-SF and it is designed for use with adolescents (aged 12
and over) and adults (Bernstein, Fink, Handelsman, & Foote, 1994). The CTQ has separate scales for
emotional neglect and physical neglect; however, for this study, these two scales were combined to form
one neglect scale.
Scores on the CTQ-SF were used in two ways. First, they were used as quantitative ratings of the
severity of each type of maltreatment. Second, they were used to categorize individuals based on their
reported maltreatment history. Guidelines for classification of maltreatment scores are available for a
later version of the CTQ (Bernstein & Fink, 1998). According to the CTQ manual, respondents can be
classified into four categories: None (or Minimal), Low (to Moderate), Moderate (to Severe), and Severe
(to Extreme). A comparison of the published CTQ with the CTQ-SF indicated significant overlap in
items. Specifically, the CTQ-SF had one less item on the emotional abuse scale, one less item on the
physical abuse scale, and one less item on the physical neglect scale than was on the final CTQ. Thus, it
was decided to use the published scores for classifying individuals into maltreatment groups. Since there
was an item missing from some scales, the criteria used in this study for categorizing maltreatment may
be more conservative (i.e., individuals had to report more maltreatment to be categorized into a particular
402 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

level) than that used with the current CTQ (Bernstein & Fink, 1998). Cutoff scores for four categories of
maltreatment classification are provided for each scale. Bernstein and Fink (1998) recommend using the
lowest cut score if the purpose is to maximize the chances of detecting maltreatment, as this score has
the highest sensitivity, with acceptable specificity. We followed this recommendation.
Using this classification guide, participants were divided into groups based on reported maltreatment
history on the CTQ-SF. To divide the sample into all possible combinations of maltreatment would have
resulted in 16 different groups, with some groups having extremely low ns. For example, in examining
the classification data, it was observed that few individuals reported only experiencing emotional abuse,
(n = 15 youth reporting emotional abuse without any other type of concurrent maltreatment) and that
emotional abuse was almost a universal correlate of every other type of reported abuse. Thus, it was
decided to divide the sample into nine groups, with emotional abuse only being separated out when it
occurred alone. The nine groups were as follows. Individuals who scored below the cutoff for Low (to
Moderate) abuse on all five scales were categorized as No Maltreatment (n = 528). Individuals who
scored above the cutoff on only Emotional abuse (n = 15), were categorized as Emotional Abuse Only.
Emotional abuse included items such as, People in my family called me things like stupid or lazy
or ugly. However, analyses that were conducted by group did not include the Emotional Abuse Only
group due to the small n for this subgroup.
Individuals who scored above the cutoff on either Emotional Neglect or Physical Neglect, but did
not score above the cutoff on Sexual Abuse or Physical Abuse, were categorized as, Neglect Only
(n = 267). Emotional neglect included items such as, I felt loved (reverse scored), while physical
neglect included items such as, I didnt have enough to eat. The fourth group, Physical Abuse Only
(n = 62), consisted of individuals who scored above the cutoff for Physical Abuse, but not above the
cutoff for Sexual Abuse or Neglect. Physical abuse included items such as, People in my family hit
me so hard that it left me with bruises or marks. The fifth group, Sexual Abuse Only (n = 123),
consisted of individuals who scored above the cutoff for Sexual Abuse, but not for Physical Abuse or
Neglect. Sexual abuse items included questions such as, Someone threatened to hurt me or tell lies
about me unless I did something sexual with them. The sixth group, Physical Abuse and Neglect
(n = 92), consisted of individuals scoring above the cutoff for physical abuse and one or both types of
neglect. Sexual Abuse and Neglect (n = 124) included individuals scoring above the cutoff for neglect
and sexual abuse, but not physical abuse. Physical and Sexual Abuse (n = 47) included individuals
scoring above the cutoff for these types of abuse, but not neglect. Finally, Physical Abuse, Sexual
Abuse, and Neglect (n = 194) consisted of individuals scoring above the cutoff for all three types of
maltreatment.

Negative affect measures

Depression. The Center for Epidemiological Studies-Depression Scale (Radloff, 1977; CES-D) is
a 10-item, self-report scale that was used to assess current levels of depressive symptomatology.
Respondents rate how frequently over the past week they have experienced a variety of symptoms
of depression. Items are rated on a scale from zero to three, with zero meaning rarely and three
indicating most of the time. Items were summed for a total score with a range from 0 to 30.
The scale has been shown to have good reliability and internal consistency and has a cutoff score
for classifying individuals as significantly depressed. The scale had a coefficient alpha of .83 in this
sample.
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 403

Hopelessness. Five true/false items from Kazdins Hopelessness Scale for Children (HSC) (Kazdin,
French, Unis, Esveldt-Dawson, & Sherick, 1983) and one-item (I do not expect to live a very long life)
developed by Bolland, McCallum, Lian, and the Mobile Summer Research Team (1998), were used to
assess the youths negative expectations about themselves and their future. The full HSC has been shown
to have an internal consistency of .71. In the current sample, the coefficient alpha for the six-item total
score was .74.

Suicide proneness. The Life Attitudes Schedule-Short Form (Rohde, Lewinsohn, Seeley, &
Langhinrichsen-Rohling, 1996; LAS-SF) was used to assess risk-taking and suicide prone behaviors.
The LAS-SF consists of 24 true/false items. Four subscale scores can be derived: death and suicide-
related behaviors, health related behaviors, risk and injury related behaviors, and self-related behaviors.
Higher scores suggest more involvement in high risk, self-destructive, and suicide prone types of behavior
and less involvement in life-extending types of behavior. In the current sample, only the total score was
used and it had a coefficient alpha of .75.

Negative affect. Scores on the CES-D, the LAS-SF, and the Hopelessness scale were summed to produce
a Negative Affect summary score for use in the regression analyses. The newly constructed Negative
Affect symptom scale had a coefficient alpha of .86 in this sample.

Externalizing measures

Hostility. Hostility was measured by using the Hostility subscale of the Symptom Checklist 90-Revised
(Derogatis, 1994). The SCL-90-R is a measure that assesses symptoms of overall psychological problems
as expressed at the current time. The Hostility subscale consists of six items that include feelings of
irritability as well as aggressive behavior (e.g., I shouted or threw things). Respondents were asked to
rate on a five-point Likert scale how often (0 = Not at all; 4 = Extremely) they felt or behaved during the
past week, with higher scores indicating greater hostility. In the current sample, the coefficient alpha for
the Hostility subscale score was .85.

Self-reported delinquency scale (SRDS). The SRDS (Elliot, Huizinga, & Ageton, 1985) is an instrument
that measures an adolescents degree of participation in delinquent behaviors. The SRDS evaluates fight-
ing, theft, vandalism, alcohol, and drug use. The SRDS includes questions regarding delinquent behaviors
engaged in by the individual and by their peers. For this study, only the 17 items regarding the respondents
own behaviors were included. Respondents were asked to indicate how frequently (0Never; 1Once;
2More than once) they had engaged in each activity over the past 12 months. Items include a broad
spectrum of delinquent behaviors, ranging from lying about your age to purchase something, to stealing
a motor vehicle, selling drugs, and/or shooting at someone. Scores are summed with possible range of
054. In the current sample, the coefficient alpha for these items was .86.

Sexual experiences. The number of consensual sexual partners the participant had was assessed by the
following question: With how many people have you had sexual intercourse when you wanted to?
Participants responded by choosing one of the following responses: Zero; One; Two or Three; Four or
more people. Past research has shown this item to be a useful measure of promiscuity and also to be a
strong correlate of sexual abuse history (Arata, 2000).
404 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

Substance use. Substance use, specifically use of alcohol, marijuana, and other drugs (crack/cocaine,
Ecstasy, LSD, Shrooms, etc.) was assessed by the three following questions: (1) This past year, how
often have you drank alcoholic beverages (beer, wine, etc.); (2) This past year, how often have you used
marijuana (weed, blunts); and (3) This past year, how often have you used drugs other than marijuana?
Respondents rated their substance use on a scale from never (0) to nearly everyday (6). Responses to
these three items were summed to produce a Substance use scale, with an internal consistency of .70 in
the current sample. These questions were adapted from other research on high school substance use and
have been found to produce good estimates of substance use (Arata, Stafford, & Tims, 2003; Oullette,
Gerrard, Gibbons, & Reis-Bergan, 1999).

Externalizing symptoms. Scores on the SRDS, the Hostility subscale of the SCL90-R, the Substance use
scale, and the sexual behavior item were summed to produce an Externalizing symptoms summary score
for use in the regression analyses. The Externalizing symptom scale had a coefficient alpha of .89 in this
sample.

Order of administration. The measures were administered to all individuals in the same order. The
order of measures was as follows: Demographic information, Life Attitudes Schedule Short Form,
Hopelessness scale, Self-Reported Delinquency Scale, Hostility subscale of the Symptom Checklist 90-
Revised, Childhood Trauma Questionnaire-Short Form, Center for Epidemiological Studies-Depression
scale, Substance Use Scale, and Sexual Behavior item.

Data analysis. Frequency data were computed to identify rates of different types of maltreatment, includ-
ing rates of single versus multi-type maltreatment. Chi-square analyses were used to examine gender
differences in rates of different maltreatment types. In order to examine the effects of maltreatment,
MANOVAs were conducted to examine levels of symptoms for each maltreatment group. Symptoms
of negative affect were examined in one MANOVA and externalizing symptoms were examined in a
separate MANOVA. Planned post-hoc Tukey tests were used to determine group differences in spe-
cific symptoms. Gender was also included as an independent variable and as an interaction term in the
MANOVA to determine if there were gender differences in symptoms associated with different types of
maltreatment.
Because all combinations of maltreatment could not be included in the MANOVA and to account
for variation in severity of maltreatment within a group, multiple regression was used to estimate the
contribution of different types of maltreatment to different types of symptoms. By conducting separate
analyses for males and females, we were also able to examine gender differences in effects of maltreatment.
The Enter method was used for the multiple regressions via the SPSS Statistical package.

Results

Rates of maltreatment by gender

Overall, there were no significant gender differences in the rates of classification into the nine mal-
treatment groups (p = .298). For both male and female adolescents (Table 2), slightly more than one third
of the sample did not report any type of maltreatment (35.5 and 37.1%, respectively). Likewise, for both
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 405

Table 2
Frequency of different types of abuse
Types of abuse Males Female
No abuse 241 (35.5%) 287 (37.1%)
Emotional abuse 8 (1.2%) 7 (.9%)
Neglect 134 (19.8%) 133 (17.2%)
Physical abuse 34 (5.0%) 28 (3.6%)
Sexual abuse 50 (7.4%) 73 (9.4%)
Physical abuse and neglect 49 (7.2%) 43 (5.6%)
Sexual abuse and neglect 49 (7.2%) 75 (9.7%)
Physical and sexual abuse 21 (3.1%) 26 (3.4%)
Physical, sexual abuse, and neglect 92 (13.6%) 102 (13.2%)
Total 678 774
Note. Emotional abuse may be present in all of the abuse groups.

genders, emotional abuse alone was very rare (1.2% for males and .9% for females). Neglect was the most
common single type of maltreatment experienced (19.8% of males were in the Neglect Only group and
17.2% of females). Surprisingly, the combination of physical abuse, sexual abuse, and neglect was the
next most frequent maltreatment group classification for both genders (13.6% of male adolescents and
13.2% of female adolescents). All the rest of the maltreatment classification groups contained between
3 and 10 percent of the sample (e.g., 3.1% of males and 3.4% of females were placed into the combined
Physical and Sexual Abuse category; 7.2% of males and 9.7% of females were placed into the Sexual
Abuse and Neglect category).

Differential effects of maltreatment

Negative affect. A MANOVA was used to examine the associations between maltreatment group and gen-
der and symptoms of depression, hopelessness, and suicide proneness. As expected, there was a significant
main effect for maltreatment group, Wilks Lambda = .72, p < .0001, and for gender, Wilks Lambda = .98,
p < .0001. The interaction effect was not significant. Follow-up univariate ANOVAs revealed significant
maltreatment group main effects for all three types of negative affect symptoms.
For gender, there was a significant effect for depression, with females reporting significantly more
symptoms of depression than males (Table 3). As shown in Table 3, planned post-hoc Tukey compar-
isons among the maltreatment groups indicated that individuals in the No Maltreatment group reported
significantly fewer depressive symptoms than individuals in all other maltreatment groups, except the
Physical Abuse Only group. The Physical Abuse Only group did not have significantly greater depression
scores than the Neglect Only, the Sexual Abuse Only, or the Physical and Sexual Abuse maltreatment
groups. Conversely, the Physical Abuse, Sexual Abuse, and Neglect group reported more symptoms of
depression than all the other abuse groups, except the Physical Abuse and Neglect maltreatment group
which also had a high mean depression score.
For Hopelessness, the No Maltreatment group scored significantly lower than any of the groups con-
taining individuals reporting neglect (i.e., Neglect Only, Physical Abuse and Neglect, Sexual Abuse and
Neglect, or Physical Abuse, Sexual Abuse, and Neglect). Conversely, individuals reporting the com-
bination of all three types of maltreatment (Physical Abuse, Sexual Abuse, and Neglect) had greater
406 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

Table 3
Gender differences in negative affect or externalizing symptoms
Variable Male adolescents M (SD) Female adolescents M (SD) F p
Depression 7.31 (5.79) 8.62 (6.63) 14.26 <.001
Hopelessness 0.73 (1.27) 0.68 (1.26) 0.56 .456
Suicide proneness 6.24 (3.85) 5.71 (3.87) 6.79 .009
Delinquency 7.81 (6.99) 5.01 (5.14) 73.76 <.001
Substance use 3.00 (3.85) 2.34 (3.27) 11.50 .001
Hostility 5.53 (5.38) 5.52 (5.71) .002 .961
Promiscuity 1.34 (1.47) 0.99 (1.29) 21.28 <.001
Note. Ns vary slightly across analyses due to missing data.

Hopelessness scores than individuals from all other groups that did not self-report experiences of neglect
(i.e., No Maltreatment, Physical Abuse Only, Sexual Abuse Only, Physical Abuse and Sexual Abuse).
Similarly, for suicide proneness, the No Maltreatment group scored significantly lower than any of the
groups containing neglect experiences (i.e., Neglect Only, Physical Abuse and Neglect, Sexual Abuse
and Neglect, or Physical Abuse, Sexual Abuse, and Neglect). Maltreatment groups not including Neglect
(Physical Abuse only, Sexual Abuse only, Physical and Sexual Abuse) did not differ significantly from
the No Maltreatment group on their reports of suicide proneness. Finally, individuals from the Physical
Abuse, Sexual Abuse, and Neglect group reported higher levels of suicide proneness than individu-
als from all other groups except the Physical Abuse and Neglect, and the Sexual Abuse and Neglect
groups.

Externalizing symptoms. A MANOVA was used to examine the effects of maltreatment group and gender
on externalizing symptoms (delinquency, substance use, hostility, and promiscuity). The Multivariate test
revealed a significant main effect for maltreatment group, Wilks Lambda = .77, p < .0001, and for gender,
Wilks Lambda = .95, p < .0001. Follow-up univariate ANOVAs revealed significant maltreatment group
main effects for all four externalizing variables included in the MANOVA. Significant gender effects
were found for self-reported delinquency, substance use, and promiscuity. As shown in Table 3, male
adolescents reported greater delinquency, substance use and promiscuity than did female adolescents.
As shown in Table 4, planned Post-hoc Tukey comparisons revealed that the No Maltreatment group
self-reported significantly less delinquent behavior than any of the Neglect groups (Neglect Only, Physical
Abuse and Neglect, Sexual Abuse and Neglect, Physical Abuse, Sexual Abuse, and Neglect). In contrast,
individuals reporting all three types of maltreatment (Physical Abuse, Sexual Abuse and Neglect) self-
reported significantly more delinquent behavior than individuals from all other maltreatment groups
except the Physical Abuse and Neglect group.
With regard to substance use, a different pattern was obtained. Post-hoc Tukey comparisons indicated
that the No Maltreatment group reported similar levels of substance abuse to individuals from all other
groups, except they reported less substance use than individuals from the Physical Abuse and Neglect
group and the Physical Abuse, Sexual Abuse, and Neglect group. Conversely, the Physical Abuse, Sexual
Abuse, and Neglect group reportedly significantly more substance use than all the one abuse type groups.
However, their substance use scores did not differ significantly from any of the two-maltreatment type
groups (i.e., Sexual Abuse and Neglect, Physical Abuse and Neglect, and Physical Abuse and Sexual
Abuse).
Table 4
Negative affect and externalizing symptoms associated with different types of maltreatment groups

C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

Maltreatment groups F p

No maltreatment Neglect only Physical abuse Sexual abuse Physical abuse Sexual abuse Physical and Physical, sexual,
only only and neglect and neglect sexual abuse and neglect
(N = 415) (N = 247) (N = 60) (N = 115) (N = 90) (N = 114) (N = 45) (N = 178)
Means (SD) Means (SD) Means (SD) Means (SD) Means (SD) Means (SD) Means (SD) Means (SD)
Depression 4.84A 7.80B 5.89AB 7.16B 12.06CE 10.48CD 8.35BD 13.05E 52.78 .000
(4.45) (6.00) (4.64) (5.63) (7.01) (5.92) (5.92) (6.17)

Hopelessness .23A .75B .17A .37AB 1.35C 1.20C .47AB 1.55C 32.07 .000
(.70) (1.27) (.46) (.80) (1.60) (1.49) (.76) (1.77)

Suicide proneness 4.54A 6.50BC 4.44A 5.18A 8.27CD 7.45CD 5.26AB 7.78D 24.29 .000
(3.19) (3.84) (2.98) (3.28) (5.13) (3.87) (2.94) (4.16)

Delinquency 4.18A 6.07BC 5.06ABC 4.75AB 9.08DE 7.36CD 6.41ABD 10.58E 26.76 .000
(4.90) (6.15) (4.92) (4.80) (7.19) (6.24) (4.48) (7.37)

Substance use 2.12A 2.66A 1.48A 2.07A 4.20B .86AB 2.42AB 4.11B 9.61 .000
(3.13) (3.63) (2.18) (3.04) (4.37) (3.65) (3.68) (4.26)

Hostility 3.36A 5.11BD 3.46AB 4.56AB 7.93C 6.29CD 7.18CD 9.96E 35.03 .000
(4.39) (5.20) (3.43) (4.68) (6.42) (5.06) (5.56) (6.20)

Promiscuity .84A 1.08AB 1.10AB 1.21AB 1.13AB 1.44BC 1.04AB 1.77C 8.54 .000
(1.26) (1.30) (1.35) (1.36) (1.46) (1.51) (1.31) (1.49)
Note. Groups that have a common superscript are not significantly different from one another; Tukeys t tests for group differences were significant at p < .05. Ns vary slightly across analyses due to missing
data.

407
408 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

For hostility, planned comparisons indicated that the No Maltreatment group reported significantly
less hostility than the neglect groups (Neglect Only, Physical Abuse and Neglect, Sexual Abuse and
Neglect, Physical Abuse, Sexual Abuse, and Neglect) and the Physical Abuse and Sexual Abuse group.
The Physical Abuse Only and the Sexual Abuse Only groups did not report significantly different levels
of hostility than the No Maltreatment group. Conversely, the three types of abuse group (Physical Abuse,
Sexual Abuse and Neglect) reported significantly more hostility than members of all groups.
With regards to the number of sexual partners variable, planned comparisons of the abuse groups indi-
cated that the No Maltreatment group reported significantly fewer sexual partners than the Sexual Abuse
and Neglect group and the Physical Abuse, Sexual Abuse, and Neglect group. In contrast, the Physical
Abuse, Sexual Abuse and Neglect group reported significantly more sexual partners than members of all
groups except the Sexual Abuse and Neglect group.

Contribution of maltreatment types

Because the effects of emotional abuse were not able to be separated from the other types of abuse and
maltreatment in the previous analyses, multiple regression analyses were conducted to examine how the
different types of maltreatment contributed to the expression of negative affect and externalizing symptoms
(see Table 5 for a correlation matrix of variables included in the regression equations). Separate multiple

Table 5
Correlations among types of maltreatment and negative affect and externalizing measures for male and female adolescents
Variable 1 2 3 4 5 6 7
(1) Emotional abuse
Males
Females
(2) Physical abuse
Males .63***
Females .62***
(3) Sexual abuse
Males .45*** .48***
Females .40*** .41***
(4) Emotional neglect
Males .50*** .41*** .27***
Females .55*** .37*** .23***
(5) Physical neglect
Males .45*** .46*** .58*** .52***
Females .48*** .41*** .29*** .54***
(6) Negative affect
Males .53*** .40*** .31*** .48*** .39***
Females .59*** .38*** .33*** .52*** .45***
(7) Externalizing
Males .41*** .40*** .32*** .36*** .32*** .61***
Females .50*** .35*** .32*** .39*** .38*** .63***
Note. *** p < .001. Ns vary slightly across analyses due to missing data.
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 409

Table 6
Predicting externalizing symptoms and negative affect with male adolescents (n = 593) reports of four types of maltreatment
Independent variable B SE Beta Beta p
Externalizing*** R2 = .24
Emotional abuse .70 .19 .185 .0001
Physical abuse .65 .21 .151 .002
Sexual abuse .27 .16 .071 .101
Neglect .40 .09 .194 .0001
Negative affect*** R2 = .36
Emotional abuse .83 .11 .334 .0001
Physical abuse .07 .13 .025 .585
Sexual abuse .03 .10 .011 .783
Neglect .44 .06 .320 .0001
Note. *** Indicates the multiple regression model was significant at the p < .001 level.

regressions were conducted by gender for the combination of negative affect symptoms (depression,
suicide proneness, hopelessness) and the combination of externalizing symptoms (delinquency, substance
use, hostility, promiscuity), with scores on the four subscales of the CTQ-SF (emotional abuse, neglect,
physical abuse, sexual abuse) as the independent variables (Tables 6 and 7).

Externalizing symptoms. For males, the model including all four subscales of the CTQ-SF was significant,
F(4, 593) = 45.58, p < .0001, with an R2 = .24. Of the four subscales, emotional abuse, physical abuse, and
neglect each made significant independent contributions to male adolescents externalizing symptoms. For
females, the model was also significant, F(4, 720) = 73.33, p < .0001, with an R2 = .29. Emotional abuse,
sexual abuse, and neglect all made significant contributions to female adolescents increased expression
of externalizing symptoms.

Negative affect. When symptoms of negative affect were examined, the model for males was significant,
F(4, 592) = 81.78, p < .0001, with an R2 = .36. Of the four maltreatment subscales, emotional abuse and

Table 7
Predicting externalizing symptoms and negative affect with female adolescents (n = 720) reports of four types of maltreatment
Independent variable Beta SE Beta B p
*** 2
Externalizing R = .29
Emotional abuse .91 .14 .298 .0001
Physical abuse .06 .15 .017 .679
Sexual abuse .37 .10 .132 .0001
Neglect .39 .07 .218 .0001
Negative affect*** R2 = .42
Emotional abuse .90 .11 .349 .0001
Physical abuse .08 .12 .026 .500
Sexual abuse .26 .08 .107 .001
Neglect .52 .05 .342 .0001
Note. *** Indicates the multiple regression model was significant at the p < .001 level.
410 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

neglect emerged as the only significant predictors of increased negative affect for male adolescents.
For females, the model was also significant, F(4, 720) = 131.29, p < .0001, with an R2 = .42. Emotional
abuse, sexual abuse, and neglect all made significant contributions to female adolescents expressions of
increased negative affect.

Discussion

The current study was designed to explore the occurrence and correlates of different types of maltreat-
ment, including emotional abuse, neglect, physical abuse, and sexual abuse. The results indicate that the
majority of adolescents in this diverse, urban sample reported experiencing some type of maltreatment
(approximately two-thirds of the sample of both male and female adolescents). While this prevalence
rate is high, it is consistent with victimization results obtained from other studies focused on African
American and Caucasian adolescents. For example, in a study by Holt and Espelage (2005), 62% of their
diverse sample of adolescents reported experiencing emotional abuse in their dating relationships.
In addition, consistent with previous research, our results indicated that single types of maltreatment
were not common; instead, co-occurring maltreatment experiences predominated. Of the different types
of maltreatment, neglect was the one type of maltreatment that was most often experienced alone. Physical
and sexual abuse occurred alone infrequently, with the combination of physical, sexual abuse, and neglect
being nearly twice as likely than the occurrence of either type of maltreatment alone. These findings
are consistent with Higgins and McCabe (2001) conclusions that when a child is identified as having
experiencing one type of maltreatment, the likelihood of other types of maltreatment co-occurring is very
high (see also Arata et al., 2005; Ney et al., 1994). Understanding the complex interchange of factors
underlying a variety of types of maltreatment is likely to advance the field and further inform interventions
(Buckle, Lancaster, Powell, & Higgins, 2005).
Contrary to some previous research (i.e., Bryant & Range, 1997; Loos & Alexander, 1997), there
was little evidence in the present study for differential effects associated with experiencing sexual ver-
sus physical abuse. Victims of sexual abuse only did not differ from victims of physical abuse only in
their mean levels of any of the seven dependent variables examined in the current study (i.e., depres-
sion, hopelessness, suicide proneness, delinquency, substance use, hostility, and promiscuity). However,
there were some differential effects associated with experiencing neglect, in comparison to experiencing
either physical or sexual abuse only. Specifically, individuals reporting neglect only had higher levels of
suicide proneness than individuals reporting either physical abuse alone or sexual abuse alone. In addi-
tion, individuals reporting neglect alone had significantly greater hopelessness than individuals reporting
physical abuse alone; hopelessness scores did not differ between the neglect only and the sexual abuse
only groups. Given the research that suggests that hopelessness, as opposed to depression per se, is a par-
ticularly important pathway to suicidality (e.g., Dixon, Heppner, & Rudd, 1994); these findings suggest
that family neglect may play a important role in the suicidal behavior of adolescents. Future research will
be needed in this area.
Generally, the results obtained in the current study were consistent with an additive model of the effects
of maltreatment, with greater symptoms associated with three versus two, and two versus one type of
maltreatment (e.g., Clemmons, Dilillo, Martinez, DeGue, & Jeffcott, 2003; Lang, Stein, Kennedy, &
Foy, 2004). Conversely, in the current study, youth reporting no types of maltreatment also reported the
lowest mean scores on depression, self-reported delinquency, hostility and promiscuity. They reported the
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 411

second lowest mean scores on suicide proneness and hopelessness; although, they did not significantly
differ from the physical abuse only group on any of the measured dependent variables. One possible
interpretation of these findings is that the experience of physical maltreatment only does not convey the
expected negative psychological consequences in this diverse, low-income adolescent sample from the
South, because the culture partially conveys that this type of parent-child experience is normative and, in
some cases, is warranted as a discipline strategy. Future research should consider adolescents attributions
about their various types of maltreatment experiences (e.g., do they subjectively perceive themselves to
be abused rather than disciplined?).
Interestingly, higher rates of self-reported substance abuse were only found for youth reporting a
combination of both physical abuse and neglect (with or without sexual abuse), with other maltreatment
groups reporting the same rates of substance abuse as youth with no history of maltreatment. Similarly,
Moran, Vuchinich, & Hall (2004) found that Oregon youth experiencing both physical and sexual abuse
are at especially high risk for substance use. Our finding suggest that adolescent substance abuse may be
related to a combination of risk factors, with neglect being a factor which may increase substance abuse
risk, when other risk factors are present (e.g., maltreatment).
There was a trend for the youth reporting all three types of maltreatment to have the highest levels
of symptoms, although individuals experiencing neglect in combination with either physical or sexual
abuse were often as symptomatic as individuals experiencing all three measured types of maltreatment
(physical, sexual and neglect). These results are consistent both with an additive model and with Ney et
al. (1994) findings which demonstrated that the most severe psychological conflicts are associated with
neglect, rather than with the experience of abuse. Specifically, Ney and colleagues suggested that not
having ones basic biological needs met may make other types of maltreatment even more devastating
when they occur. They also theorized that neglect may precede maltreatment, with individuals who are
neglected being at greater risk of incurring a variety of abusive experiences. The potential for abuse
may increase with the absence of parental monitoring or it may be related to increased acting out by
a child whose basic needs are unfulfilled. Another possibility may be that neglect is more likely to be
interpreted as a lack of parental care and love to a child (e.g., no attention is more harmful than receiving
negative, aversive, or inconsistent attention) and that some of the deleterious effects that are associated
with maltreatment are related to how the maltreatment is understood by the child, rather than by the
behavior per se.
Another goal of this study was to examine gender differences in maltreatment effects. While there were
overall gender differences on a variety of measures (depression, delinquency, substance use, promiscuity),
there were no significant interactions between gender and maltreatment group, suggesting that negative
outcomes were not related to how these gender differences interacted with maltreatment. A few gender
differences were obtained in the regression analyses. First, according to the multiple regression findings, it
appears that maltreatment history, in general, explains a slightly greater portion of the variance in symptom
patterns for female than for male adolescents (e.g., 42% of the variance in females negative affect
symptoms vs. 36% of the variance in males negative affect symptoms). Second, for male adolescents,
sexual abuse was not a significant predictor of either externalizing or negative affect symptoms, while for
female adolescents, sexual abuse contributed significantly to greater expression of both types of symptoms.
Conversely, physical abuse was not a significant predictor of symptoms for female adolescents, while
it was a significant predictor of externalizing symptoms (but not negative affect symptoms) for male
adolescents. Sexual abuse appears to be a particular component of acting out for female adolescents;
perhaps because the sexual abuse experienced by most females is qualitatively different in severity,
412 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415

chronicity, or impact from that experienced by most males. Furthermore, future research will be needed
to understand the direction of these findings (e.g., does sexual abuse cause greater acting out, or are acting
out female adolescents at greater risk of sexual victimization?).
Overall, there are several potential implications that can be derived from the findings obtained in the
current study. First, researchers need to define and assess various types of maltreatment, as they are highly
likely to co-occur. In the current study, high numbers of individuals were classified into maltreatment
groups. Greater identification of maltreated youth may have masked some of the differential effects
associated with severe or chronic victimization (Ethier, Lemelin, & Lacharite, 2004). Our finding that
sexual abuse was more associated with symptom levels for girls versus boys suggests that practitioners
should note the diverse effects associated with females sexual abuse (i.e., greater levels of externalizing
and negative affect symptoms). Understanding the expression of these symptoms over time in relation to
the sexual abuse experience may enhance intervention efforts. Additionally, these findings highlight that
practitioners should be more attuned to the negative emotional impact that is associated with experiences
of neglect and/or emotional abuse. Finally, results from this study indicate that researcher should consider
not only the differential effects associated with specific types of maltreatment, but should also begin to
consider the co-morbidity of maltreatment and the context in which various types of maltreatment take
place (Higgins, 2004).
While this study had the advantage of a large sample of diverse youth, there are a number of limitations.
First, the measurement of maltreatment history was based entirely on self-report and thus was subject to
reporting biases in either direction (e.g., under or over reporting of maltreatment experiences). Further, the
CTQ does not provide details regarding specific aspects of the maltreatment. Thus, individuals reporting
one type of maltreatment may vary tremendously in terms of the recency and duration of that maltreatment,
the identity of the perpetrator, and other details of the abuse (e.g., whether an injury was sustained). For
example, two youth could describe physical abuse, but one youth could be experiencing ongoing abuse,
whereas the other youth could have been abused by a stepparent who is no longer in the home. Similarly,
the comorbidity of maltreatment types could also reflect time issues; maltreatment of one type may lead
to an increased risk of other types of maltreatment in the future. For instance, a child who is neglected
may incur sexual abuse at a later point in time. In a self-report measure, reporting these experiences
would result in the appearance of comorbid or co-occurring maltreatment, when in fact they occurred
sequentially. Future research will also need to understand both the context of the abuse and the adolescents
attributions about their maltreatment experiences.
Another limitation of the current study was that there were not enough individuals who had experienced
emotional abuse only to consider the differential effects associated with this type of experience in isolation.
Moreover, because emotional abuse was a common correlate of all other types of reported abuse, it was
not separated out as a particular type of maltreatment in any of the groups that were formed. In an effort
to understand the effect associated with its occurrence, emotional abuse was considered separately in the
regression analyses. In these analyses, for both male and female adolescents, emotional abuse and neglect
were both found to make significant independent contributions to the occurrence of externalizing and
negative affect symptoms. This finding is consistent with current research highlighting the deleterious
effects of psychological abuse, above and beyond those associated with physical abuse and other types
of maltreatment (Iwaniec, 1997; OLeary, 1999).
In conclusion, five points are highlighted in the current findings: (1) Maltreatment is common in this
type of sample. Among adolescents, experiencing different types of maltreatment is more common than
experiencing only one type of maltreatment. (2) There appear to be few differential effects between the
 C.M. Arata et al. / Child Abuse & Neglect 31 (2007) 393415 413

experience of physical and sexual abuse. Both types of abuse are associated with greater externalizing
and negative affect symptoms among adolescents. (3) The most symptomatic youth were those who had
experienced neglect in combination with sexual and/or physical abuse. Generally, youth experiencing all
three types of maltreatment had the most psychological symptoms. (4) Emotional abuse rarely occurs in
isolation and is a unique and significant contributor to the symptoms observed in relation to maltreatment.
(5) Gender differences in the effects of maltreatment are modest; maltreatment is associated with greater
negative affect and externalizing symptoms for both male and female adolescents. However, gender dif-
ferences in the expression of these symptoms were obtained in a manner consistent with the literature
(male adolescents reported greater externalizing symptoms; female adolescents reported greater symp-
toms of negative affect). Sexual abuse was particularly associated with negative psychological symptoms
for female adolescents. In summary, these results highlight the importance of independently measuring
emotional abuse and neglect and considering their co-morbidity with other types of maltreatment (e.g.,
physical and sexual abuse), when conducting research on the effects of maltreatment.

Acknowledgments

The authors wish to thank Laura OFarrill-Swails, Allen Morgan, Jeff Kilbert, and Jim Dineen for their
work on this project.

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