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. Author manuscript; available in PMC: 2026 Jun 29.
Published in final edited form as: Child Abuse Negl. 2026 May 15;177:108100. doi: 10.1016/j.chiabu.2026.108100

Maternal Childhood Sexual Abuse and Perpetration of Neglect: Exploring Risk Factors

Stephanie Gusler 1, Ginny Sprang 1, Adrienne Whitt 1, Holly Huber Gifford 1
PMCID: PMC13310522  NIHMSID: NIHMS2177248  PMID: 42140019

Abstract

Background:

Despite significant consequences (e.g., greater risk for internalizing and externalizing problems) and high prevalence rates (greater than 15%), neglect is currently the least studied form of child maltreatment. However, prior research suggests that maternal childhood sexual abuse may be a particularly salient risk factor for neglect as it is associated with a number of difficulties that can impair caregiving abilities.

Objective:

The current study explored multiple potential risk factors for the association between maternal childhood sexual abuse and perpetration of neglect.

Participants and Setting:

This study relied on secondary data analysis from a clinic that conducts evaluations of families involved in child protective services and with high-risk child maltreatment cases. The sample consisted of 410 mother-child dyads.

Methods:

Multiple risk factors, from the Kempe Family Stress Inventory, were examined as possible mechanisms for an indirect association between maternal childhood sexual abuse and perpetration of neglect. Substance use disorder was examined as a moderator for all effects.

Results:

Partial indirect effects were found for maternal childhood sexual abuse and perpetration of neglect, through maternal social-emotional functioning and harsh punishment. Substance use moderated the association between harsh punishment and perpetration of neglect, such that harsh punishment was only associated with an increased probability of perpetrating neglect when mothers also had a substance use disorder.

Conclusion:

Present results extend current literature on intergenerational mechanisms of risk and highlight the importance of supporting mothers’ own trauma recovery, the development of a positive social community, and the utilization of positive parenting practices.

Keywords: Childhood Sexual Abuse, Neglect, Risk, Coping, Substance Use

Child neglect is defined as a custodial person failing to meet a child’s basic needs (Leeb et al., 2008), including: physical (e.g., nutrition, clothing), emotional (e.g., affection, structure), educational (e.g., school enrollment, attendance), and medical (e.g., treatment for disease or injury; Stirling, 2019; Stoltenborgh et al., 2013). It has been estimated that, globally, more than 15% of children suffer from neglect, with prevalence of 16.3% experiencing physical neglect and 18.4% experiencing emotional neglect (Stoltenborgh et al., 2013). In the United States, the CDC identifies child neglect as a serious public health problem with an economic burden of hundreds of billions of dollars (CDC, 2024; Klika et al., 2020). Indeed, there can be serious immediate and long-term consequences for children who experience neglect (Stoltenborgh et al., 2013). These children are at greater risk for internalizing and externalizing problems (Vachon et al., 2015) and cognitive and emotional delays (Avdibegović & Brkić, 2020) during childhood, as well as substance abuse (Min et al., 2007), risky behaviors (Wilson & Widom, 2010), and posttraumatic stress disorder (Breslau et al., 2014) as they age.

Additionally, when child neglect is reported, affected children and families enter the child welfare system which can have its own impact. The Adoption and Foster Care Analysis and Reporting System showed that, in 2023 in the United States, 55% of welfare cases involved neglect at the time of a child’s entry into foster care (Children’s Bureau, 2025). As adults, children who have spent time in foster care are less likely to graduate high school and be employed, and are more likely to experience mental health problems, abuse substances, and engage in criminal behavior than those who were not in foster care (Gypen et al., 2017).

Despite these potential consequences and high prevalence rates, neglect is currently the least studied form of child maltreatment (Mulder et al., 2018). While experts in the field have called for more rigorous research, there are some known risk factors for neglect (Mulder et al., 2018). Specifically, Mulder et al.’s (2018) meta-analysis found that the strongest predictors of child neglect were at the parent, rather than the child level. For example, parents’ history of criminal offending, mental or psychiatric problems, low education level, and personal experiences of abuse in their own childhood were associated with greater risk of perpetrating child neglect. Further, much of this research has focused on mothers, as they are often disproportionally responsible for the caregiving of children and therefore over-represented in child welfare systems (Strega et al., 2008).

Though much of the literature on intergenerational continuity of maltreatment does not distinguish children’s experience of neglect from their experience of physical or sexual abuse, this literature does demonstrate the high prevalence and potential mechanisms for intergenerational risk. For example, children of mothers who experienced abuse or neglect when they were children are shown to be 50% more likely to experience a child protective services report of abuse or neglect (Bartlett et al., 2017). The most recent scoping review of intergenerational maltreatment demonstrated that evidence for mechanistic factors remains inconsistent, but currently the strongest evidence points to maternal mental health, substance use, age, limited social support, violent interpersonal relationships, and parenting difficulties as mechanisms accounting for the connection between maternal childhood abuse and child’s experience of abuse (Langevin et al., 2019). Prior research has also examined specific types of abuse experienced by mothers in their own childhoods and intergenerational risk. Among this literature, maternal childhood sexual abuse stands out as a significant risk factor for their children’s own experience of maltreatment (Lange et al., 2020; Marcenko et al., 2011). A recent qualitative systematic review found that in 57% of included studies, mothers who had experienced sexual abuse as children, also had children who were abused, and in 24% of studies, these mothers perpetrated maltreatment (Lange et al., 2020). Additionally, in a sample of mothers whose children were in foster care, 58% had experienced sexual abuse themselves as children (Marcenko et al., 2011). However, this prior research has not isolated mechanisms specific to maternal perpetration of neglect, rather than other forms of maltreatment, such as physical abuse.

Nonetheless, there is evidence indicating that maternal childhood sexual abuse is associated with a number of negative outcomes, which may subsequently increase their child’s risk for experiencing neglect. For example, experiences of sexual abuse in childhood have been found to relate to mothers’ use of harsh discipline (DiLillo & Damashek, 2003) and decreased involvement (Lyons-Ruth & Block, 1996). Further, qualitative studies have found that mothers who experienced sexual abuse as children may find it difficult to attach and be affectionate with their children (Cavanaugh et al., 2015). Relatedly, additional evidence has indicated that mothers with childhood sexual abuse histories find it particularly challenging to demonstrate warmth and care to their daughters (Cross et al., 2016). Lange et al. (2020) found that mothers, who had experienced childhood sexual abuse, qualitatively reported engaging in several different abusive behaviors towards their children, including neglect, which was often preceded by mothers feeling angry, frustrated, or stressed. Neglect was also described by mothers as resulting from traumatic sequelae, such as mental health and substance use problems, that prevented them from even caring for themselves.

Indeed, past research supports that substance use may relate to risk factors of child neglect perpetration. Martoccio and colleagues (2022) found that substance use mediated the association between maternal childhood sexual abuse and their child’s experience of abuse. This may be because substance use disorders often exacerbate negative parenting practices (e.g., mothers missing opportunities to develop healthy attachments with their children; Lander et al., 2013), relate to less parental monitoring of the child (Latendresse et al., 2008), and worse parent-child interactions (Hatzis et al., 2017). Additionally, Brady & Sinha (2005) reported that substance use disorders frequently co-occur with mental health problems (e.g., depression and post-traumatic stress disorder) that can impact one’s ability to parent effectively. In fact, mothers’ depression has been linked to decreased limit setting (Middleton et al., 2009) while post-traumatic stress disorder has been linked to more controlling behaviors and displays of hostility (Christie et al., 2019).

Taken together, prior research demonstrates that mothers who have experienced childhood sexual abuse may have a number of risk factors (e.g., mental health concerns, impaired bonding, and negative parenting practices) that could increase their probability of perpetrating neglect against their own children. Additionally, substance abuse has been linked to childhood experiences of sexual abuse and found both to exacerbate poor parenting and co-occur with mental health conditions that also limit parenting ability. However, it is currently unknown what mechanistic factors, among the many potential factors for intergenerational risk, may be specific in understanding the association between maternal childhood sexual abuse and perpetration of neglect.

One way to address this gap is to use psycho-social interviews, rather than self-report measures, as interviews allow for the collection of rich data, the development of trust and rapport leading to disclosure, and the use of probing questions and explanations that may benefit the interviewee’s memory (Bifulco & Schimmenti, 2019). Additionally, psycho-social interviews allow for the use of tools such as the Kempe Family Stress Inventory (KFSI; Korfmacher, 2000). The KFSI is a rating scale used to assess for parental risk of a wide range of caregiving problems (e.g., social-emotional functioning, use of harsh punishment, rigid or unrealistic expectations of children, and impulsive behavior), based on parental responses during a psychosocial interview and using clinical judgement. This tool allows for in depth and nuanced consideration of multiple areas of maltreatment risk, which go beyond what is often reported in self-report measures (Korfmacher, 2000; McGuigan et al., 2000).

The current study seeks to explore multiple potential risk factors, to better understand the association between maternal childhood sexual abuse history and risk for perpetration of neglect. We present three hypotheses. First, multiple risk factors, from the KFSI, will be associated with both maternal childhood sexual abuse and perpetration of neglect. Second, there will be a direct association between childhood sexual abuse and perpetration of neglect, and this will become an indirect association with the addition of identified KFSI risk factors, consistent with mediation. Third, indirect associations will be moderated by maternal substance use such that substance use increases the chance of experiencing multiple risk factors and the likelihood that risks will lead to the perpetration of child neglect.

Methods

Procedures

This study relied on secondary analysis of a dataset from a university-based clinic that conducts evaluations of families with high-risk child maltreatment cases. All caregivers had substantiated findings of maltreatment and were court-ordered to attend this comprehensive biopsychosocial risk assessment to support case planning with child protective services and related legal decision making. The full dataset included 1227 data points from multiple caregivers (e.g., biological parents, foster/adoptive parents, and grandparents) and sibling groups. For this analysis, only biological mothers were included as they constituted over 85% of biological parents represented in the dataset. Additionally, to prevent a nesting effect in the analysis, only the mothers’ first child identified in the database was used for reference, and only cases with complete data on maternal trauma history and abuse/neglect charges were included, as these were central to the investigation. The data was de-identified, and the participants had the choice to prohibit their information from being used for research but still participate in the assessment. This study was approved by the institutional review board for the associated university.

Participants

The subsample used for analyses consisted of 410 mother-child dyads, the average age of the mothers was 28.7 (SD= 7.1) and the average child age was 5.2 (SD= 4.2). Of the children, most of the sample identified as white at 77.6% (7.8 % African American, .5% Hispanic, 7.6% biracial, 1.4% other) and 46.3% as female. Due to the high-risk nature of these cases of child maltreatment, only 16.9% of the children were living with a biological caregiver while 83.1% of them were residing in out of home or kinship care. The mothers in the sample also mostly identified as white at 90.2% (8.4% African American, .7% Hispanic, .7% biracial) and reported an average education level of 11.1 years (SD= 1.9).

Measures

Independent variables.

Maternal substance use disorder was scored dichotomously as no (0) or yes (1) based on information from the review of child protection records provided and the caregiver psychosocial interviews conducted as part of the assessment.

Maternal childhood sexual abuse was measured using information from the caregivers’ psychosocial interviews and self-reported trauma history on the Trauma Recovery Scale (TRS, Gentry et al., 2002). The TRS is a brief instrument to measure recovery from traumatic experiences and guide therapeutic interventions. It contains three parts: Part I is used to determine whether the respondent meets Criterion A from the DSM-IV for Posttraumatic Stress Disorder (PTSD) regarding trauma exposure and response; Part II assesses exposure to 20 potentially traumatic events, age of exposure and frequency of exposure; and Part III measures trauma recovery on 10 items on a scale of 0% to 100%. For the current study, only Part II of the TRS was used in combination with information from the caregivers’ psychosocial interviews to measure whether they had experienced childhood sexual abuse and interpersonal violence. Based on this information, maternal childhood sexual abuse was scored dichotomously as no (0) or yes (1).

Scores from the Kempe Family Stress Interview (KFSI, Murphy et al., 1985) were used to assess risks for caregiving difficulties across 10 domains including psychiatric, substance use and criminal history, childhood experiences of caregiving, social-emotional functioning, attitudes toward and perception of children, discipline of children, and caregiving stress. Clinicians performing the KFSI rate each domain based on the information from the interview as well as other parts of the clinical database including child protection, criminal justice, and mental health records. There are three scoring anchors for each of the 10 domains: 0 (normal), 5 (mild) or 10 (severe; Murphy et al., 1985).

Psychometric studies of the KFSI have found good reliability and predictive validity for assessing future caregiving difficulties (Korfmacher, 2000; Nygren et al., 2004). Stevens-Simon and colleagues (2001) found that mothers rated as high-risk on the KFSI had higher rates of future child maltreatment, and designation as high-risk by the KFSI was found to have convergent validity with elevations on the Child Abuse Potential Inventory (Daro & McCurdy, 1996). High reliability scores (r = .93) have been established for the KFSI cross-sectionally and longitudinally (Katzev et al., 1997; McGuigan & Pratt, 2001).

For the current study, seven of the domains of the KFSI were selected for inclusion in the analysis. The first three domains (parent abuse, history of mental illness/substance use, and suspected of abuse in the past) were not included because they were captured by other measures more specific to the current study. The remaining KFSI domains and associated sample items are as follows:

  1. Parent isolation, low self-esteem, depression (normal- close to at least one family member, happy and content with life, can name more than one lifeline; mild- not close to family with no hostility, discontent with life but sees as temporary, can name only one lifeline; severe- not close to family with hostility, rarely sees other people, unable to cope with life stresses). This domain is a broad indicator for social-emotional functioning.

  2. Multiple stressors or crises (normal- can name nothing that is stressful, parents argue occasionally, finances are not a big problem; mild- parents argue frequently without violence, finances are tight but manageable, living situation seen as inadequate; severe- parents constantly in conflict with or without violence, finances cause much stress to the parent, chaotic lifestyles with continual crises)

  3. Violent temper outbursts (normal- no violence, yelling/screaming/leaving when angry; mild- parent throws things when angry, parent pushes or slaps when angry; severe- parent hits or kicks and leaves marks, parent has a history of violent behavior to others, one parent is afraid of violence in spouse/partner)

  4. Rigid, unrealistic expectations of child’s behavior (normal- no information on development but shows concern, will pick up crying baby, shows concern for child’s physical and emotional needs; mild- early expectations of walking or toilet training, worries about spoiling baby, fear of being an unsuccessful parent; severe- rigid expectations of walking or toilet training, intolerance of normal annoying behavior or excessive concern about spoiling, no concerns for needs of baby)

  5. Harsh punishment (normal- none for infant, physical punishment if used is a secondary strategy; mild- yelling at infant, use of physical punishment without implements or bruising; severe- physical punishment of infant, implements used on older children, punishment leaves marks)

  6. Parent perception of child as difficult (normal- child’s behavior viewed as normal part of growth process; mild- child is perceived as difficult but positives also mentioned; severe- behavior seen as provocative, child seen as having no good points, deserving of physical punishment)

  7. Child is unwanted or at risk for poor bonding (normal- child is wanted whether or not planned, child rearing looked upon as a positive life change; mild- unmarried parents, prolonged separation from parents; severe- child is unwanted, child seen as burden on lifestyle, not the biological parent of the child)

Dependent variable.

The variable measuring mothers’ perpetration of neglect was scored dichotomously as either no (0) or yes (1) based on information from the review of child protection records provided for the assessment.

Data Analyses

Missing data for the KSFI subscales was less than 3% and was thus handled using median imputation. All other data was complete.

IBM SPSS 28 was used for all analyses. Bivariate correlations between mothers’ childhood sexual abuse and perpetration of neglect and all KSFI subscales, substance use disorder, and child’s gender were first examined. KSFI domains that were significantly correlated with either mothers’ childhood sexual abuse or perpetration or neglect were included in analyses for indirect associations.

Model 59 of the PROCESS macro (V4.3; Hayes, 2022) was used for analyses to examine mechanisms for indirect associations between mothers’ childhood sexual abuse experience and perpetration of neglect. Mothers’ substance use disorder was included as a moderator for each association in this model. Significant interactions were plotted at low (−1 SD) and high (+1 SD) ends of variable means to better understand the pattern of effects (Aiken & West, 1991). Child gender was included as covariate variable in this model.

Results

Among the present sample, 62% of mothers experienced childhood sexual abuse and 89% of the mothers had been charged with neglect. As shown in Table 1, there were multiple significant correlations. Mothers’ childhood sexual abuse experience was positively associated with perpetration of neglect, having a substance use disorder, and the KSFI risk factors of poor social-emotional functioning,; multiple crises/stressors; and harsh punishment. Perpetration of neglect was also positively associated with poorer social-emotional functioning.

Table 1.

Correlations

1 2 3 4 5 6 7 8 9 10
Variables
1. Mothers’ CSA --
2. Perpetration of Neglect .16** --
3. Substance Use Disorder .11* .08 --
4. Poorer Social-Emotional Functioning .18** .14** .05 --
5. Multiple Crises/Stressors .12* .05 .10 .22** --
6. Temper Outbursts .00 .03 .09 .11* .17** --
7. Rigid Unrealistic Expectations .08 .09 −.08 .10* .17** .08 --
8. Harsh Punishment .10* −.06 .02 .14** .08 .14** .13** --
9. Difficult Child .05 .02 −.03 .09 .01 −.04 .07 .26** --
10. Risk for Poor Bonding .07 .09 .09 .01 −.07 −.04 .06 .11* .15** --
11. Child’s Gender −.02 −.02 −.08 .03 .02 .10* .00 −.02 .00 .04
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Note. CSA= Childhood Sexual Abuse. Poorer Social-Emotional Functioning comes from the KFSI domain Isolation, Low Self-Esteem, and Depression.

*

p < .05.

**

p < .01.

Regression Model

A regression model, consistent with mediation, was used to examine indirect associations between maternal childhood sexual abuse and perpetration of neglect, through poorer social-emotional functioning, multiple crises/stressors, and use of harsh punishment, with mothers’ substance use disorder as a moderator. Unstandardized regression coefficients are shown in Table 2 and visualized in Figure 1. This model indicated that there was a significant indirect effect through poorer social-emotional functioning. Specifically, mothers’ experience of childhood sexual abuse was significantly associated with poorer social-emotional functioning, and poorer social-emotional functioning was associated with perpetration of neglect. However, results were consistent with a partial mediation, as the direct effect of mothers’ childhood sexual abuse on perpetration of neglect remained significant even when accounting for indirect effects.

Table 2.

Regression Model

Independent Variables Poorer Social-Emotional Functioning Multiple Crises/Stressors Harsh Punishment Perpetration of Neglect
B SE B SE B SE B SE
Mother’s CSA .93 * .39 .20 .46 .94 ** .37 1.03 ** .42
Substance Use Disorder −.28 .54 −.47 .63 .74 .51 .46 .90
Mother’s CSA X Substance Use Disorder .78 .67 1.75 * .78 −1.04 .63 .19 .78
Child’s Gender .27 .31 .29 .36 −.15 .29 −.06 .33
Poorer Social-Emotional Functioning .13 * .06
Multiple Crises/Stressors .03 .05
Harsh Punishment −.18 ** .06
Poorer Social-Emotional Functioning X Substance Use .04 .13
Multiple Crises/Stressors X Substance Use −.13 .11
Harsh Punishment X Substance Use .44 * .21
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Note. CSA= Childhood Sexual Abuse. Poorer Social-Emotional Functioning comes from the KFSI domain Isolation, Low Self-Esteem, and Depression. Regression coefficients are unstandardized. Significant coefficients are bolded.

*

p < .05.

**

p < .01.

Figure 1. Regression Model.

Figure 1

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Note. Significant associations are represented with solid lines and dashed lines represent non-significant associations. Regression coefficients are unstandardized. Poorer Social-Emotional Functioning comes from the KFSI domain Isolation, Low Self-Esteem, and Depression. *p < .05. **p < .01.

There was not a significant indirect effect through multiple crises/stressors. However, a significant interaction was found between mothers’ childhood sexual abuse and substance use disorder. As shown in Figure 2, when plotted, this interaction showed that when mothers’ experienced childhood sexual abuse and had a substance use disorder their score on multiple crises/stressors was higher, than if they did not have a substance use disorder or did not experience childhood sexual abuse.

Figure 2. Interaction Between Mother’s Childhood Sexual Abuse and Substance Use Disorder in Predicting Multiple Life Crises.

Figure 2

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Note. CSA= Childhood Sexual Abuse. SUD= Substance Use Disorder

And additional significant indirect effect was found through the use of harsh punishment, with mothers’ experience of childhood sexual abuse being associated with greater use of harsh punishment and harsh punishment being negatively associated with perpetration of neglect. However, mothers’ substance use disorder moderated this effect. In Figure 3, this significant interaction is displayed and shows that harsh punishment was associated with a lower probability of perpetrating neglect when mothers did not have a substance use disorder. Conversely, when mothers had a substance use disorder, greater use of harsh punishment was associated with a greater probability of perpetrating neglect.

Figure 3. Interaction Between Harsh Punishment and Substance Use Disorder in Predicting the Probability of Perpetrating Neglect.

Figure 3

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Note. SUD= Substance Use Disorder

Discussion

This investigation explored potential risk factors that could clarify the relationship between the childhood experience of sexual abuse and the perpetration of neglect in a child welfare sample of mothers. A wide array of risk factors were examined, which tapped into intrapersonal factors, harsh punishment, life stressors, and emotion regulation and coping, as well as the interactions between these variables and substance use to further explain patterns of association. Studies of this kind are important to help those in charge of the care and protection of children identify intervenable risk factors for neglect, particularly among high-risk samples, such as mothers who have experienced childhood sexual abuse. The high rates of childhood sexual abuse in this sample and the prevalence of neglect perpetration make this sample ideal for exploring these concepts; however, there is a notable difference in the rates uncovered in this study compared to national norms. In the National Survey of Children's Exposure to Violence Study, the estimated lifetime prevalence rate of exposure to childhood sexual abuse was 26.6% for females, which increased to 31.6% when online sexual abuse was considered (Finkelhor et al., 2024). These figures represent an increase over previous studies that reported a prevalence rate of 13.5% of women who self-reported a childhood history of sexual abuse (Molnar et al., 2001). When estimating prevalence and examining the lifetime correlates of childhood sexual abuse, there has been an over-reliance on retrospective, self-report techniques to measure exposure, and a practice of concurrently eliciting information from the caregiver about their current functioning as a parent. In the absence of supporting data, social desirability bias may lead to inaccurate estimates. This study improves upon this practice by utilizing an expanded database of information (child protection history, interviews, psychometric self-reports) to determine the prevalence of exposure and to inform clinician ratings of caregiving risk. This “triangulation of methods” approach to data sourcing (Moon, 2019) is likely to yield more accurate estimates of risk and has utility in clinical settings as it contributes to best practice standards to guide practice.

The fact that poorer social-emotional functioning partially accounted for the relationship between a history of childhood sexual abuse and neglectful parenting is consistent with the stress and coping model of maltreatment, which emphasizes the role that a caregiver's internal cognitive processes play in mediating the relationship between a potentially traumatic event and maltreatment (Hillson and Kuiper, 1994). The tenets of this theory suggest that unresolved and ineffective cognitive appraisals (e.g., shame, hopelessness) may lead to a withdrawal of caregiving behaviors and the avoidance of interpersonal stress, ultimately leading to neglectful caregiving (Hillson & Kuiper, 1994). Prior research lends support for this theory. A study by Roscoe and colleagues (2018) found that caregivers with issues of emotional lability, developmental impairments, or cognitive deficiencies were twice as likely to lead households that failed to meet their children’s immediate needs. Similarly, a meta-analysis conducted by Mulder et al. (2018) also supports the claim that psychiatric problems and a personal history of childhood abuse are associated with a greater risk of perpetrating child neglect. Adding to these findings, a longitudinal study found that mothers’ odds of losing custody of their children increased by 8% per inpatient psychiatric admission, suggesting that the severity and chronicity of the caregiver’s distress are significant in determining child welfare outcomes (Hollingsworth, 2004). The availability and utilization of healthy social support, as captured by this domain of the KFSI, may also positively impact how threat is assessed as well as a caregiver’s perceived ability to cope, so that those who are less isolated believe they have more internal and external resources to manage difficult parent-child encounters (Cohen & McKay, 2020). Identification and cultivation of support networks in mothers at high-risk of neglectful parenting may be an important strategy in facilitating healthy coping.

In this study, childhood sexual abuse was associated with the use of harsh punishment, consistent with prior research (DiLillo & Damashek, 2003; Newcomb & Locke, 2001). It may be that mothers’ own childhood experiences could have contributed to a desensitization of harsh punishment and parenting practices (Affi et al., 2017). Understanding this relationship is crucial to safeguarding a child’s right to protection and safety by interrupting a cycle of violence that may persist across the lifecycle (Affi et al., 2017). However, harsh punishment was negatively associated with the perpetration of neglect when there was not a substance use disorder present, potentially distinguishing it from the phenomenon of physical abuse. One explanation may be that those mothers who were perpetrating neglect may not be engaging in either harsh punishment or nurturing care of their children. Their own childhood experiences may have left them without the socialization toward healthy caregiving needed to establish appropriate parenting practices, both in regards to warmth and punishment. Consistent with this notion is research demonstrating that a distinguishing feature of neglect versus physical abuse is parent-child involvement, in that parents who perpetrate neglect have been found to be much less involved in interactions with their child than physically abusive parents (Wilson et al., 2010). However, this finding is inconsistent with literature demonstrating an association between neglect and harsher parenting practices (Schweer-Collins et al., 2019). Further, when examining different types of neglect, prior literature has found no significant association between environmental neglect (e.g., making sure the child has shelter, food, clothing) and parental use of harsh punishment, but that supervisory neglect was associated with harsher punishment (Knutson et al., 2005). As such, it could be that different types of neglect (e.g., physical, emotional, medical, or educational) may be differentially associated with harsh parenting practices. Better understanding the nuance associations between different types of neglect and varying parenting practices, and how this functions in the context of intergenerational cycles of maltreatment, is an area ripe for future exploration.

The finding that harsh punishment is only associated with increased risk of neglect when mothers had a substance use disorder lends further credence to the fact that addiction interferes with the formation of healthy parent-child attachments and interactions, and inhibits supervision, monitoring, and limit setting (Hatzis et al., 2017; Latendresse et al., 2008; Middleton et al., 2009). The link between childhood sexual abuse and substance abuse later in life is well-established in the literature (Fletcher, 2020). Additionally, previous research has determined that caregivers impaired by substances confer risk of multiple trauma exposures to their children and have high rates of substantiated neglect charges (Sprang et al., 2008). The use of harsh punishment by mothers who are abusing substances and who may be exposing their children to multiple trauma exposures, is contraindicated. Multiple studies document the relationship between harsh discipline and the development of toxic stress and subsequent allostatic load (when the individual’s stress response system is overworked or fails to downregulate properly due to chronic exposures) on a child’s neurodevelopmental system (Shonkoff et al., 2009; McEwen, 1998). The good news is these impacts are not irreversible. In a study by Fisher et al. (2000) youth in out-of-home care experienced a stabilization of their cortisol levels and a reduction in maladaptive behaviors when their foster parents were trained to provide trauma-informed parenting practices. Interventions such as cognitive behavioral therapy, multisystemic therapy, and parent–child interaction therapy have been noted to be effective in facilitating recovery from destabilizing dysregulation associated with harmful parenting practices (Saunders, 2012). Mothers with a childhood history of sexual abuse who are abusing substances should be considered for these evidence-based interventions to interrupt the cycle and prevent the perpetration of neglect with their own children.

Limitations and Future Directions

Although the current sample represents a uniquely high-risk population, that is often not included in research studies, this may limit the generalizability of results. That is, the results and particular mechanisms in the association between maternal childhood sexual abuse and perpetration of neglect may not be replicated in among families not involved in child welfare. Further, the sample lacked racial/ethnic diversity, and it would be important for future research to examine if results are replicated among a more diverse group of mothers and children or if results vary. Additionally, the present results only included maternal caregivers. Future work is needed to understand the prevalence and intergenerational risk of abuse and neglect among fathers who experienced sexual abuse as children, as results may differ between men and women. Though no child gender effects were noted in this study concerning the perpetration of neglect, previous research has noted that maternal childhood sexual abuse is associated with less parental warmth toward daughters and not sons (Cross et al., 2016). As such, future studies should continue to examine the different ways that mothers and fathers provide for and supervise their children, considering gender, given the unique nature of the trauma sequelae subsequent to childhood sexual abuse (Hailies et al., 2019).

Through the use of the KFSI, our analysis of risk factors went beyond self-report measurement but still required mothers to discuss sensitive topics with an interviewer and thus may still be subject to underreporting and mothers trying to present in a socially desirable manner. Further, the KFSI being used for all potential risk factors could introduce shared method variance and potential rater bias from the clinicians performing the KFSI interview. Maternal childhood sexual abuse, perpetration of neglect, and maternal substance use disorder were also only captured by dichotomous variables. This limits our understanding how chronicity or severity of childhood sexual abuse experiences and substance use may impact chronicity or severity of neglect. As such, we recommend that severity and chronicity be included in future research. Further, only variables of risk were examined in the current study. Future work should explore protective factors such as treatment engagement and how or if these protective factors mitigate risk.

Conclusions

Understanding the complex relationship between childhood maltreatment experiences and caregiver functioning requires a deep dive into mechanisms that create and increase the risk for intergenerational cycles. Current results point to the importance of supporting mothers’ own coping and trauma recovery, development of a positive social community, and utalization of positive parenting practices.

Highlights.

  • Among mothers involved in child protective services, 62% had experienced childhood sexual abuse.

  • There was a significant direction association between maternal childhood sexual abuse and perpetration of neglect and indirect associations through mothers’ poor social-emotional functioning and use of harsh punishment

  • Harsh punishment was associated with perpetration of neglect only when mothers had a substance use disorder.

Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Footnotes

Declarations

Ethical Approval: This research was approved by the University of Kentucky College of Medicine Institutional Review Board (IRB; Protocol # 89332; 8/14/23) and was performed in accordance with the 1964 Helsinki Declaration and its later amendments.

Consent to participate: Informed consent was obtained from all participants.

Financial Interests: The authors have no financial interests.

Competing Interests: The authors have no competing interests to disclose.

CRediT Roles: Stephanie Gusler: Conceptualization, Methodology, Formal analysis, Writing-Original draft preparation, Visualization, Writing-Reviewing and editing; Ginny Sprang: Methodology, Project Administration, Writing-Original draft preparation, Writing-Reviewing and editing; Adrienne Whitt: Project Administration, Writing-Original draft preparation, Writing-Reviewing and editing; Holly Huber Gifford: Writing-Original draft preparation.

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Data Statement:

Participants did not give consent for their data to be shared publicly, and as such, supporting data is not available. Data analysis code is available upon request.

References

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Participants did not give consent for their data to be shared publicly, and as such, supporting data is not available. Data analysis code is available upon request.

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