RISK FACTORS AND DETERMINANTS OF CHILD MALTREATMENT

1. Child maltreatment can be viewed on a continuum of child-rearing practices, practices which are culturally defined.
2. Child development is a result of a complex process of interplays and shifting influences on physical, emotional, sexual, social and cognitive development
3. Child maltreatment is a multifaceted phenomenon which cannot be explained by one or two factors.

The findings from empirical research which exist today, can be organized and conceptualized into an ecological model suggested by Belsky and others. According to such a model there are four dimensions of risk factors which constitute the interplay pre-conditions for child maltreatment. It is the interplay, the dynamics between them which will determine whether child maltreatment will occur. They are 1) parental pre-disposition, 2) sources of stress, 3) characteristics of child and 4) social and cultural environmental milieu.

1. Parental Predispositions. 
Several characteristics of parents, both mothers and fathers, were found to be linked to child maltreatment.

• Psychological disturbance and psychopathology among parents. While the parent's psychopathology was evidence across all the various stages of family life cycle, it was most pronounced in the postpartum, infancy and early adolescence periods. · Parents developmental history. There is no doubt today about the association between experiences of mistreatment in one's own childhood and the potentiality for mistreatment of one's children. I emphasize the potentiality element, for we do not know the rate of those who were maltreated as children and became later on adequate parents.
• Mother's early age. Research suggests that parenting during adolescence may be a risk factor for child maltreatment. Teenage mothers were found to express undesirable child-rearing attitudes, to have unrealistic expectations for their child's development, and tend to be unresponsive to their young infants. However, we should not treat age of the mother as a categorical risk factor when it is part of the social and cultural milieu in a given society.
• Lack of education. Parental low education level and particularly lack of general knowledge regarding child development account for parental unrealistic expectations with regards to child's changing behavior, and constitute a potential risk for child maltreatment.

2. Sources of Stress Associated with Child Maltreatment
The accumulated work in the field of child abuse and neglect highlights several sources of stress which are likely to undermine parental functioning and lead to child maltreatment.

• Relationship between the parents. The relationship between the parents, either married or not, is a strong indication of the quality of parenting. Conflicts and tensions between them were found to be negatively correlated with the quality of parenting by both mothers and fathers.
• Social network. Social isolation was mentioned in the literature as a risk factor. The lack of support – emotionally as well as in concrete goods – from friends, neighbors and relatives has a heavy weight as a risk factor, especially when relationship between the parents are difficult, violent or non-existent.
• Unemployment. The linkage between total unemployment or underemployment and child maltreatment was established long ago. Decline in paternal authority, increase of arbitrary and punitive behavior toward children without the balance of supportiveness, were found to be common.
• Immigration. There isn't enough empirical evidence about child maltreatment among immigrant families, and it is difficult to sift out acceptable child-rearing practices among immigrant groups from child maltreatment. What can be said is that immigration may cause social isolation, unemployment and the lowering of social status as compared to the one held in the country of origin.
• Crises in family life. Sudden change in family life and family organization due to death, acute illness or divorce may also constitute a risk factor, when combined with other sources of stress and personal predisposition.

3. Characteristics of Child
Child maltreatment occurs in a framework of parent-child relationship and one has to consider the influence of the child on parental behavior. This is not to say that children are responsible for their abuse at the hands of their parents, but that there are perhaps certain characteristics which place the child at risk for being maltreated.

• Prematurity. There are ample sets of data which illustrate the effects of prematurity on parental behavior. Premature infants are usually weaker, less alert, harder to quiet if distressed than full term babies. Their parents do not tend, therefore, to be active and stimulating with them. Even later on in their lives it is difficult for the parents to find the right balance between over-stimulation and under-stimulation.
• Temperament of the child. Child's temperament is a characteristic which has a potential to elicit child abuse or neglect in as much as it clashes, or does not fit the parent's temperament.
• Retardation, emotional disturbance and physical handicap.These characteristics may also constitute risk factors for child maltreatment. Evolving data suggest that these particular characteristics negatively influence parental behavior, especially an aggressive behavior and difficulties in impulse control.

4. Social and Cultural Context
Our discussion of risk factors and determinants of child maltreatment, focused on abuse and neglect within the family. But, in addition we have to consider to what extent a particular child-rearing behavior is acceptable or deviant within one group, common or different between groups. Furthermore, we have to relate to parental behavior against the backdrop of the general social and cultural context.

• Social attitude toward children. We refer here to the ways in which children are viewed in a given culture. Are they considered to be the property of the parents? Till what age according to cultural norms they require the protection and nurturance of their parents? To what extent physical abuse is considered educational thus acceptable? And to what extent child labor is acceptable?
• Social attitude toward family. The main question here is to what extent the family is viewed as a unit which should not be tampered with. What are the social sanctions (formal, legal and informal) which exist and the ways they can be and are enforced in cases of families which deviate from the norms.
• Social attitude toward violent behavior. Is there a general acceptance of violence as a legitimate way to solve conflicts and disputes? Clearly when this is generally accepted, physical abuse of children will not be seen as a deviant parental behavior. Common sense tells us that certain social and cultural attitudes, like the ones mentioned, are conducive to child maltreatment within the family.

Interplay between Risk Factors 
As was mentioned earlier, child maltreatment is a result of a complex process, perhaps even several processes, of interplays and influences of various risk factors, across the dimensions described. Several questions come to mind and demand a very careful consideration. First, what is the specific weight or contribution of each factor in a given time, in the process of turning a potential into actual child maltreatment? Second, it is thought today that the potential for child maltreatment increases when there is an accumulation of risk factors (the dose theory). Are there specific combinations of risk factors within one dimension or across the four dimensions, that should alert us? Third, in addition to the above we need to ask whether there are unique and differential combinations of risk factors which are linked to and perhaps predictive of the different forms of child maltreatment. Fourth, we have also to consider whether an existing risk factor is transient and short-term stress, or is it of a long-term, chronic nature. What does this mean in terms of the potentials for child maltreatment? Fifth, our assessment of a specific family in a specific family in a given situation should not be focused only on risk factors. Rather, we need to look for strength, resiliency and existing support, which may serve as a balance, even a buffer against abuse. And the last point relates to our assessment and ways of prevention and intervention with high risk families. The processes of professional trainings of the various disciplines focus and emphasize different viewpoints. Furthermore, the goals and the structures of the settings where we practice may often limit the scope of our understanding of the problem. In order to deepen and refine our appreciation of the complex processes, by which the various risk factors interrelate, we need an ongoing exchange of ideas and observations across professional disciplines