Child-to-parent abuse by late teens and young adults: risks and interventions

Background: Child-to-parent abuse (CPA) is an area of family violence that has remained relatively under researched. Our current understanding of the risk factors and interventions for this type of abuse, particularly within the United Kingdom (U.K.), is limited. Aims: The current thesis aims to address four primary research questions: firstly, whether the Attachment Style Questionnaire (ASQ; Feeney et al., 1994) is a measure that demonstrates appropriate psychometric properties and is applicable to the assessment of attachment among adolescents and young adults (Chapter 2); secondly, what the estimated lifetime occurrence of CPA perpetrated by late teens and young adults and its situational antecedents are within the U.K. (Chapter 3); thirdly, whether there is a relationship between CPA, adverse childhood experiences and child to parent attachment (Chapter 4); and finally, what interventions currently exist for CPA and what empirical evidence is available to support the effectiveness of these (Chapter 5). Method: The topic of CPA and the justification of the current thesis are introduced in Chapter 1. With a view to informing the measurement of attachment within the empirical study described in Chapter 4, the ASQ as a measure of attachment tendencies for adolescents and young adults is critically evaluated in Chapter 2 with consideration of its reliability, validity, discrimination, appropriate norms, and limitations. Two empirical studies are described in Chapters 3 and 4, both of which were conducted using an internet-mediated research design and used opportunity and snowball sampling techniques: an estimate of the occurrence of CPA towards mothers (n=59) and fathers (n=77) within the U.K. and the situational antecedents for abuse is investigated from the child’s perspective, and the association between parental attachment, adverse childhood experiences and CPA towards mothers (n=48) and fathers (n=59) is explored. A mapping systematic review is presented in Chapter 5, which identifies existing interventions for CPA and assesses the effectiveness of interventions where possible; this was conducted through systematic searches of relevant literature databases and identification of grey literature through searches of appropriate online databases, contact with organisations delivering CPA interventions and experts in the field, and scanning of reference lists of key studies. Chapter 6 summarises the findings of this thesis and draws together the research and practice implications and recommendations. Results: The utility of the ASQ in attachment research is supported, although indicates limited clinical utility. Preliminary findings from the empirical studies highlight the extent of the problem, with 60.3% of respondents in the Mothers Survey reportedly having engaged in Moderate, High or Extensive levels of abuse, and 64.9% of respondents in the Fathers Survey being categorised as such. Differences in triggers for CPA perpetration were demonstrated according to victim gender, and the findings additionally suggest that different aspects of parental attachment are predictive of CPA towards mothers and fathers, but that adverse childhood experiences do not significantly predict CPA for either parent gender. Finally, a paucity of research describing and evaluating interventions for CPA is identified in the systematic review, resulting in an absence of conclusions about the efficacy of these interventions being drawn. Discussion: While only tentative conclusions are drawn from the current research due its own limitations, the findings provide clarity with regards to the presence and efficacy of existing interventions and afford substantive support for further research in this field of study. The findings indicate an urgent need for high quality randomised control trials to support the use of evidence-based treatment with affected families. Improving our understanding of how this form of abuse develops and is maintained is imperative for the development of effective evidence-based interventions