ORIGINAL ARTICLE
Maltreatment Chronicity Defined with Reference
to Development: Extension of the Social Adaptation
Outcomes Findings to Peer Relations
James Christopher Graham & Diana J. English &
Alan J. Litrownik & Richard Thompson &
Ernestine C. Briggs & Shrikant I. Bangdiwala
Published online: 9 December 2009
# Springer Science+Business Media, LLC 2009
Abstract The purpose of this study was to extend work
seeking to improve research definitions of chronic mal-
treatment by contrasting a definition based on patterns of
CPS reports across childhood developmental stages to a
previously used definition based upon duration of the
period including reports, using teacher-estimated peer
relations to represent an extrafamilial outcome domain of
social adaptation. The sample includes 387 children who
are participating in a multi-site longitudinal study and had
been reported for abuse or neglect to CPS between birth
and age 8. CPS records from this time period provided the
basis of two chronicity constructs: 1) an ordinal categories
(OC) definition based upon four Eriksonian stages, and 2) a
durational definition (time between first and last reports).
Block-wise regression analyses were conducted to examine
the relative degree to which the two chronicity definitions
contributed to prediction of teacher-estimated peer relations
at the age 8 interview. Chronicity characterized with
reference to developmental stages significantly predicted
troubled peer relations, with child age, sex, and minority
status, family income, geographic location, and time of first
report taken into account. The effect was pronounced with
regard to aggressive peer relations. Duration of maltreat-
ment reports also predicted aggressive peer relations, but
significantly less so than did the OC definition. The
findings support the view that maltreatment chronicity is
usefully defined by taking children’s development into
consideration to characterize patterns of maltreatment
across developmental stages. Practice and research impli-
cations are suggested.
Keywords Maltreatment . Chronicity . Child development .
Maltreatment definitions . Peer relations . Aggression
Substantial evidence has accumulated documenting the
deleterious effects of child maltreatment on later function-
ing. Indeed, the dimension of chronicity appears to be
critical to understanding how maltreatment may lead to
psychosocial and behavioral problems and affect child
development. Specifically, the extant research has demon-
strated many effects of maltreatment, especially persistent
maltreatment, including externalizing behavioral problems
(e.g., aggression, conduct problems, delinquency) (Bolger
This research was made possible by grants from the Department of
Health and Human Services Administration on Children, Youth and
Families.
J. C. Graham : D. J. English
School of Social Work, University of Washington,
Seattle, WA, USA
A. J. Litrownik
Department of Psychology, San Diego State University,
San Diego, CA, USA
R. Thompson
Juvenile Protective Association,
Chicago, IL, USA
E. C. Briggs
Department of Psychiatry and Behavioral Sciences,
Duke University School of Medicine,
Durham, NC, USA
S. I. Bangdiwala
Department of Biostatistics, University of North Carolina,
Chapel Hill, NC, USA
J. C. Graham (*)
Child Welfare Research Group,
4045 Delridge Way SW, Suite 400, N17-2,
Seattle, WA 98106, USA
e-mail: jcgraham@u.washington.edu
J Fam Viol (2010) 25:311–324
DOI 10.1007/s10896-009-9293-9

and Patterson 2001; Dodge et al. 1990; Eckenrode et al.
1993; Éthier et al. 2004b; Thornberry et al. 2001),
internalizing behavioral problems (e.g., depression, anxiety,
social withdrawal) (Éthier et al. 2004b; Hanson et al. 2001;
Manly et al. 2001; Thornberry et al. 2001), poor academic
performance (Eckenrode et al. 1993; Thornberry et al.
2001), social skills deficits (Rogosch and Cicchetti 1994),
and peer rejection (Bolger and Patterson 2001; Rogosch
and Cicchetti 1994). The dimension of chronicity appears
to be critical to understanding how maltreatment may lead
to psychosocial and behavioral problems and affect child
development, and it is particularly important because a
disproportionately high number of children experience
repeated, rather than single, incidents of abuse and neglect
(Barnett et al. 1993; Éthier et al. 2004a; Lau et al. 2005;
McGee et al. 1995). Yet, exactly how to define chronicity
for research purposes remains an open question. A shared
general sense of the meaning of “chronicity” seems clear;
however, deciding how to operationalize it when conduct-
ing research is more of a challenge, and decisions about
how to do so have varied.
There are many ways in which chronicity could be
defined; the field agreeing on one ultimate definition is not
likely, and probably is not desirable, considering that
various specific topics of research may require tailored,
specialized, and nuanced definitions. That said, a broad
issue has been raised regarding how developing such
definitions should be approached (English et al. 2005c).
These authors have suggested that, as well as researchers
taking children’s development into account by looking at
the consequences of specific developmental timing of
maltreatment, even single-variable representations of mal-
treatment chronicity (i.e., variables used to characterize a
single pattern of maltreatment over time) should be
formulated with explicit reference to children’s develop-
mental stages. This is not how chronicity variables typically
have been approached in the field of child welfare to date.
Most commonly, if anything is done beyond researchers’
indicating if there have been multiple reports or not, counts
of the number of maltreatment reports or, at best, estimates
of the duration of the period of maltreatment are the types of
definitions that have been utilized.
Definitions of Chronicity
Chronicity of maltreatment, according to Éthier and
colleagues (2004a, b), generally refers to the persistence
of abuse and/or neglect over an extended period of time.
Although many researchers would agree with this definition
of chronic maltreatment, there has been considerable
variation in how this term is operationalized (Friedman and
Chase-Lansdale 2002). The more sophisticated definitions
of chronicity used in earlier research were developed based
upon measures of duration, though what is measured varies,
even when administrative data are used. For example,
Barnett et al. (1993) developed the Maltreatment Classifi-
cation System (MCS) in which chronicity is defined by the
length of time a case remains open in Child Protective
Services (CPS). In a subsequent study, Manly et al. (1994)
similarly defined chronicity as the total number of months
that the family received services from (CPS). Alternatively,
Bolger and Patterson (2001) operationalized maltreatment
chronicity as the time period from when the child’s
maltreatment had begun to when it ended, determined as
specifically as possible based on a review of each child’s
local case record.
Some researchers have distinguished between “transitory”
and “persistent” (chronic) maltreatment based not only on
whether CPS had an open case, but, additionally, if there was
a score on the Child Abuse Potential Inventory (CAPI;
Milner 1994) above the recommended cut-point (>166, or
95th percentile). Éthier and colleagues started with open
cases and examined them to determine if they persisted over
6 years (CPS case still open or CAPI score >166) or were
transitory (case closed and CAPI score <166), in order to
examine the relationship between maltreatment and behavior
problem outcomes (Éthier et al. 2004a, 2004b).
Significant methodological issues associated with these
divergent definitions of maltreatment chronicity warrant
attention. Most notably, the reliance on receipt of CPS
services to define whether maltreatment is actually occur-
ring is problematic, because opening a case for services
most often is based on the ability to substantiate maltreat-
ment, and/or voluntary engagement of families in services.
Neither of these factors is necessarily related to whether or
not maltreatment actually occurred, or predictive of child
outcomes. Moreover, as English et al. (2005c) suggest, the
length of time a CPS case remains open may not be the
most sensitive measure of maltreatment experiences over
time. In particular, services may cease for a range of
administrative or logistical reasons though maltreatment
continues (Éthier et al. 2004b), and services also may
continue though maltreatment has stopped. To compensate
for these shortcomings, more recent studies have added
additional criteria, including parental abuse potential scores
(Éthier et al. 2004a, b, as described above), supplementary
information on other maltreatment dimensions (English et
al. 2005d), or alternative developmental factors (Éthier et
al. 2004b).
In contrast to other types of approaches that have been
used to define chronicity, English et al. (2005c), utilized a
developmental stages framework to construct several
categories of increasing chronicity. Broadly, this approach
distinguished chronic maltreatment from “situational”
abuse and/or neglect, but it also incorporated the extent
312 J Fam Viol (2010) 25:311–324