Denholm, RE; (2013) Investigating the effects of child maltreatment and household dysfunction on child physical development in a British birth cohort. Doctoral thesis , UCL (University College London).

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Abstract

Recent evidence suggests adverse childhood experiences (maltreatment and household dysfunction) may have long-term effects on adult health. One possible pathway is through physical development. This thesis investigated the prevalence of child maltreatment and household dysfunction in a population sample, and assessed their association with child-to-adult height and pubertal development. The 1958 British birth cohort includes all children (≈17,000) born in one week, March 1958, followed-up to age 50y. Adverse experiences were ascertained in childhood and at 45y. Repeated measurements of height and pubertal development were recorded by trained medical personnel. Multivariate response models were adopted to examine child maltreatment and household dysfunctions association with height at different ages simultaneously, accounting for within individual correlations. The relationship between adverse childhood experiences and categorical markers of puberty were assesed using multinomial logistic regression models. Approximately one third of the cohort was identified as high risk for child maltreatment (abuse and neglect): one in ten reported abuse (physical, emotional and sexual abuse and witnessing abuse). Of those reporting abuse, two thirds reported another form of child maltreatment. Children from dysfunctional family backgrounds were at an increased risk. Although the association between adverse childhood experiences and physical development attenuated after adjustment for demographic and socio-economic factors, some relationships persisted. Early neglect was related to short stature at ages 7, 11, 16y and in adulthood. Associations were generally stronger at 7y (deficits ranged 0.8-2.0cm) than at 45y (0.3-0.7cm). Neglect was also associated with late maturation, as indicated by a greater relative risk ratio (RRR) of pre-pubertal development at 11y (e.g. late pubic hair growth RRR=1.2-1.6 for boys and 1.5 for girls) and menarche at ≥14y (RRR=1.4) in girls. Sexual abuse was associated with early menarche in girls (RRR:2.41;1.19,4.88), and advanced testicular development at 11y in boys (RRR:5.50;1.00,30.17). In conclusion, neglect was associated with delayed physical development. Associations between abuse and physical development were mostly explained by socio-economic factors, although there was some indication that sexual abuse may be related to early pubertal development. These growth patterns may have an impact on health outcomes in adulthood.

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