TUESDAY, April 16, 2013 (MedPage Today) —An expectant mother's beliefs about her infant's negative intentions, such as soiling diapers on purpose, were associated with child abuse, researchers found.

Moms who said their children had negative intentions were more likely to maltreat their child by the time the baby was 26 months old, according to Lisa Berlin, PhD, of the University of Maryland School of Social Work in Baltimore, and colleagues.

In addition, more hostile attributions were significantly associated with harsher parenting behaviors, they wrote online in JAMA Pediatrics.

The authors noted that parental maltreatment is an increasing problem as abuse in childhood has been associated with abusive behaviors in adulthood.

The study analyzed pregnant women's attributions to children as a predictor of maltreatment and harsh parenting during an infant's first and second years, they wrote, as well as offering healthcare professionals methods of assessing hostile attributions through a community-based sample of 499 pregnant women.

Participants were mostly non-Hispanic black (34 percent) and white (35 percent) women with a mean age of 27. Most had a college degree (23 percent) or greater (18 percent) and did not report notable social isolation during pregnancy.

Almost all of the children (92 percent) were born at a gestational age of 37 weeks or more and 54 percent were boys.

Researchers interviewed mothers during the second half of their pregnancy about attributions of infant behavior, family demographics, mental health, and social isolation. Interviews were conducted again at follow-up during their child's second year about the child's date of birth and sex, as well as mother's self-reported parenting behaviors.

Attributions were recorded in questions such as "Do babies seek praise when they do something clever?" and "Do babies ignore their mothers to be annoying?" and were measured on a five-point scale.

Maltreatment outcomes were measured through county records and included 79 incidents of abuse among 40 children, including 62 allegations and 18 substantiations.

Harsh parenting was measured through a four-item, five-point scale of "hostile-reactive" behaviors, such as responding to periods where the infant was particularly fussy with anger directed at the child, spanking, shouting at, or shaking the child.

Hostile attributions were significantly associated with child maltreatment.

On the five-point scale, children of mothers who received the minimum score of one for hostile attributions had a 4 percent chance of being maltreated.

Children of mothers who received the maximum score of five for hostile attributions had a 15 percent chance of being maltreated.

"Almost one-quarter of the children in this sample (113 of 499 [23 percent]) had mothers who received the maximum score of 5 for hostile attributions," the authors said.

Maternal age, income, race, education, mental health status, and social isolation were not significantly associated with child maltreatment, though there were "significant bivariate correlations between mothers' hostile attributions and their mental health problems and social isolation."

The authors also found that "mothers' hostile attributions increased the likelihood that their child would be maltreated," adding that "for every one-point increase in mothers' hostile attributions, their children had a 26 percent greater odds of being maltreated."

The authors said their research was limited by lack of rigorous analysis of maltreatment data and missing diagnostic mental health information. In addition, the patient population was a small, homogeneous sample and the study relied on self-report for assessing maternal attributions and parenting behaviors.

They added that "our study highlights the value of practitioners attending to mothers' and expectant mothers' attributions about infants' intentions. This practice can be accomplished on informal and formal bases."

For instance, if a new mother reports that the baby is repeatedly waking her up during the night because the child is "spoiled" or "naughty," a practitioner could immediately discuss the mother's attributions and responses, they said.

In an accompanying editorial, Joel Milner, PhD, and Julie Crouch, PhD, both of the Northern Illinois University in DeKalb, pointed out that "cognitive models of aggression propose that when an individual attributes hostile intent to another person's behavior, these attributions increase the likelihood of aggression toward that person."

They noted that practitioners need to be able to make a distinction between changing attributions of hostile intent or focusing on helping the parent "develop a clearer understanding of intentionality as it relates to young children."

"There remains a need for additional research on the methods that might have the greatest efficacy in changing the maternal belief-based attributions, especially hostile attributions related to children's behaviors," they wrote.

Source: Child Abuse More Likely if Mom Sees Baby as Bad