Citation
Adolescent patients with conduct and substance problems and adolescent controls

Material Information

Title:
Adolescent patients with conduct and substance problems and adolescent controls examining perpetrator type and physical and sexual abuse
Creator:
Upwood, Elisa Francine
Place of Publication:
Denver, Colo.
Publisher:
University of Colorado Denver
Publication Date:
Language:
English
Physical Description:
x, 66 leaves : ; 28 cm

Thesis/Dissertation Information

Degree:
Master's ( Master of Integrated Sciences)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
College of Liberal Arts and Sciences, CU Denver
Degree Disciplines:
Integrated Sciences
Committee Chair:
Koester, Stephen
Committee Members:
Mikulich-Gilbertson, Susan
Crowley, Thomas

Subjects

Subjects / Keywords:
Abused teenagers ( lcsh )
Sexually abused teenagers ( lcsh )
Teenagers -- Drug use ( lcsh )
Abused teenagers ( fast )
Sexually abused teenagers ( fast )
Teenagers -- Drug use ( fast )
Genre:
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 64-66).
General Note:
Integrated Sciences Program
Statement of Responsibility:
by Elisa Francine Upwood.

Record Information

Source Institution:
|University of Colorado Denver
Holding Location:
|Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
318794815 ( OCLC )
ocn318794815
Classification:
LD1193.L584 2008m U68 ( lcc )

Full Text
ADOLESCENT PATIENTS WITH CONDUCT AND SUBSTANCE PROBLEMS AND
ADOLESCENT CONTROLS: EXAMINING PERPETRATOR TYPE AND
PHYSICAL AND SEXUAL ABUSE
by
Elisa Francine Upwood
B.S., Colorado State University, 1997
A thesis submitted to the
University of Colorado Denver
in partial fulfillment
of the requirements for the degree of
Master of Integrated Sciences
2008


2008 by Elisa Francine Upwood
All rights reserved.


This thesis for the Master of Integrated Sciences
degree by
Elisa Francine Upwood
has been approved
by
Stephen Koester
6 flJcfc-
Date


Upwood, Elisa Francine (M.I.S., Integrated Sciences)
Adolescent Patients with Conduct and Substance Problems and Adolescent Controls:
Examining Perpetrator Type and Physical and Sexual Abuse
Thesis directed by Professor Stephen Koester
ABSTRACT
Adolescent reports about the perpetrators of physical and sexual abuse vary. Studies
report that physical abuse perpetrators are more often parents, whereas sexual abuse
perpetrators are more likely to be strangers or acquaintances and not family members.
Does this hold true in adolescents with serious substance use and conduct problems?
Also, how do physical and sexual abuse correlate with substance use, conduct problems
and major depression? Methods: 97 adolescents in treatment for substance use and
conduct problems and 102 community controls (both groups ~40% female) completed an
extensive battery of assessments including the Colorado Adolescent Rearing Inventory, a
structured abuse and neglect assessment with probes of each endorsed item providing
details including perpetrator, frequency, and onset. Cumulative occurrences of physical
and separately sexual abuse events are utilized as proxy measures of abuse severity and
their association with severity of substance use and conduct disorder are examined in
comparison to previously reported abuse severity measures. Results: In patients, 26.5%
reported physical abuse by parents and only 1.0% reported physical abuse by
stranger/acquaintance (p<.0005). No patients reported sexual abuse by parents and
16.3% reported sexual abuse by stranger/acquaintance. In controls, 9.8% reported
physical abuse by parents and none reported physical abuse by stranger/acquaintance.
Only 1.0% of controls reported sexual abuse by parents and 7.8% reported sexual abuse


by stranger/acquaintance (p<.02). The correlations found in the entire sample between the
proxy measures of abuse severity, substance use, Conduct Disorder and Major
Depression are all positive and significant, most are highly significant (p<0.0005).
Conclusions: Our results confirm the relationships between physical and sexual abuse
perpetrator type that have been previously reported in other studies, but extend those
findings to a sample of adolescent patients with serious substance and conduct problems.
Although the correlations of the proxy measures of abuse severity with substance use,
Conduct Disorder and Major Depression are significant, the results are very similar to the
results obtained in a previous publication that used simple item counts of different types of
abuse to quantify severity.
This abstract accurately represents the content of the candidates thesis,
publication.
recommend its
Signed
Stephen Koester


DEDICATION
I dedicate this thesis to my mother and grandfather, who each taught me separately about
the value of determination, hard work, and independent thinking. They are an inspiration to
me now and always. I also dedicate this thesis to Jim, a man of compassion, insight,
unending support and patience. My deepest gratitude and all my love to each of you.


ACKNOWLEDGMENT
My sincere appreciation to my mentor, Susan Mikulich-Gilbertson, for her thoughtful
leadership and endless support and encouragement throughout this endeavor. I would
also like to thank Drs. Thomas Crowley and Stephen Koester for their guidance in
preparing this manuscript. This study was supported by grants DA009842 and DA011015
from the National Institute on Drug Abuse, National Institutes of Health. Furthermore, I
would like to thank Shannon McWilliams, for her assistance in data management, and all of
the staff at the Synergy Evaluation Center for their dedication to this research. Finally, I
am grateful to all of the participants for their time and interest in this study.


TABLE OF CONTENTS
Figures.............................................................ix
Tables...............................................................x
CHAPTER
1. INTRODUCTION......................................................1
Definitions of Abuse and Neglect...............................2
Perpetrators of Abuse..........................................2
Abuse and Psychopathology......................................3
Hypotheses.....................................................4
2. METHODS...........................................................5
Sample.........................................................5
Assessments....................................................5
Analyses.......................................................9
3. RESULTS..........................................................10
Perpetrators of Physical and Sexual Abuse.....................12
Abuse Correlations with Substance use, Conduct
Disorder and Major Depression.................................18
4. DISCUSSION.......................................................22
Implications..................................................24
Limitations...................................................25
Future Directions.............................................25
APPENDIX
A. COLORADO ADOLESCENT REARING INVENTORY (CARI).....................27
REFERENCES................................................................64
viii


FIGURES
Figure
3.1 Frequency of Physical Perpetrator Types..........................................14
3.2 Frequency of Sexual Perpetrator Types............................................15
IX


TABLES
Table
3.1 Demographics............................................................10
3.2 Prevalence of psychiatric diagnoses.....................................12
3.3 McNemars table of patient physical abuse...............................16
3.4 McNemars table of patient sexual abuse.................................17
3.5 McNemars table of control physical abuse...............................17
3.6 McNemars table of control sexual abuse.................................17
3.7 Descriptive information of the CARI physical and sexual abuse variables.19
3.8 Correlations of Colorado Adolescent Rearing Inventory Items
with Dependence Vulnerability, Conduct Disorder and Major
Depression symptom counts...............................................21
x


CHAPTER 1
INTRODUCTION
In 2006, Child Protective Services investigated 3.6 million reports of child abuse
and/or neglect. Of these, some 905,000 were classified as victims and nearly 75% of them
had no history of prior victimization (U.S. Department of Health and Human Services,
2008). However, according to the Third National Incidence Study, Child Protective
Services investigates less than half of child maltreatment cases (Sedlak & Broadhurst,
1996); no more recent estimate is available at this time as the Fourth National Incidence
Study is currently underway. In another nationally representative sample, nearly 14% of
U.S. children and adolescents reported at least one incident of maltreatment (Finkelhor,
Ormrod, Turner, & Hamby, (2005).
Fromm (2001) estimated the annual legal and healthcare costs of child abuse and
neglect at over $24 billion. Wang and Holton (2007) updated the cost analysis performed
by Fromm and estimated the 2007 annual cost of meeting the immediate legal and
healthcare needs of abused and/or neglected children at over $33 billion, accounting for
changes in inflation in their analyses. Even more surprising is their estimated total costs,
or costs of immediate need plus those of long-term or secondary effects of child abuse and
neglect, which they estimate at over $103 billion in 2007 (Wang & Holton, 2007). These
financial burdens are not only on the victims of child abuse and neglect, but on their
families and society at large. Clearly child abuse and neglect are serious social and public
health concerns.
1


Definitions of Abuse and Neglect
What constitutes child maltreatment? Unfortunately, definitions used by child
protection agencies, law enforcement, medical practitioners and researchers vary. It is
important to note that each jurisdiction or state may also have differing definitions of child
abuse and neglect.
Generally, child maltreatment includes all types of abuse and neglect
which occur in children under the age of 18 that are caused by a parent
or other caregiver. Physical abuse occurs when a child is injured
physically as a result of hitting, kicking, burning etc. Sexual abuse
involves engaging a child in sexual acts, including fondling, rape and
exposure to other sexual acts. Emotional abuse refers to behaviors that
harm a childs self-worth or emotional well-being like name calling,
rejection and withholding love. Neglect is the failure to meet a childs
basic needs of shelter, food, clothing etc. (Centers for Disease Control,
2006).
In an effort to establish uniform definitions of child maltreatment and enhance discussions
across disciplines, Leeb, Paulozzi, Melanson, Simon and Arias (2008) have published,
along with the Centers for Disease Control, a set of recommendations of terminology and
data collection variables.
Perpetrators of Abuse
The U.S. Department of Health and Human Services (2008) reports that the
perpetrators of child maltreatment in general were nearly 80% parents and overall about
58% female; sixty percent perpetrated neglect, 10% perpetrated physical abuse, 7%
perpetrated sexual abuse and more than 11% of perpetrators were responsible for more
2


than one type of maltreatment. The Third National Incidence Study of Child Abuse and
Neglect reported 78% of maltreatment was by birth parents and further delineated all
perpetrators stating 87% of neglect was by females, whereas 67% of abuse and 89% of
sexual abuse was by males (Sedlak & Broadhurst, 1996).
Reports about the perpetrators of physical and sexual abuse vary. Physical abuse
studies report 69-73% of perpetrators are parents and 9-13% are strangers/acquaintances
(Holmes & Sammel, 2005; Sedlak & Broadhurst, 1996; Tyler & Cauce, 2002). Sexual
abuse studies report 1-25% of perpetrators are parents and 58-92% of perpetrators are
strangers/acquaintances (Drezett, Caballero, Juliano, Prieto, Marques, & Fernandes, 2001;
Pagare, Meena, Jiloha, & Singh, 2005; Sedlak & Broadhurst, 1996; Tyler & Cauce, 2002).
Abuse and Psychopathology
Associations of physical and sexual abuse with substance use and with conduct
problems have been repeatedly demonstrated. In a sample of psychiatric inpatients,
histories of substance abuse were more common among those who reported physical or
combined physical and sexual abuse than those who did not report abuse (Brown &
Anderson, 1991). Kaplan et al. (1998) report physically abused adolescents are 18.6 times
more likely to have substance use disorders, and 8.7 times more likely to have conduct
disorder than non-abused adolescents. MacMillan et al. (2001) state that in a community
sample, abused subjects were 1.8 times more likely to have alcohol and illicit drug
abuse/dependence and 3.7 times more likely to exhibit antisocial behaviors.
Adolescents who experience more incidents of physical and/or sexual abuse may
have an increased risk of substance use and conduct problems than those who experience
single or few incidents. Similarly, adolescents who experience more types of physical
and/or sexual abuse may have an increased risk of substance use and conduct problems
3


than those who experience single or few types. This may suggest a need to evaluate
abuse experiences early to help inform clinical treatment.
Hypotheses
First, as has been shown in controls, it is hypothesized that adolescent patients
with serious substance use and conduct problems will report significantly more physical
abuse by parents than by strangers/acquaintances. Those patient adolescents will also
report significantly more sexual abuse by strangers/acquaintances than by parents.
Second, patient adolescents lifetime sums of reported physical and sexual abuse events,
which are called Frequency Sums in this report, will be positively correlated with their
substance use, Conduct Disorder and Major Depression symptom counts. Third, it is
hypothesized that Frequency Sums will be more highly correlated with severity of
substance use, Conduct Disorder and Major Depression than patient and control
adolescents sums of different types of physical and sexual abuse, which were reported in
a previous publication (Crowley, Mikulich, Ehlers, Hall, & Whitmore, (2003) and which are
called Item Sums in this report. For example,
Johnny was hit with a belt 10 times, kicked 5 times and choked 2 times.
Physical Abuse Frequency Sum = 17
Physical Abuse Item Sum = 3
4


CHAPTER 2
METHODS
Sample
This study provides additional analyses to those reported in Crowley, Mikulich,
Ehlers, Hall, and Whitmore (2003). Ninety-seven patient adolescents in treatment for
substance use and/or conduct problems and 102 community control adolescents recruited
from the same neighborhoods as patients were included in this report. Crowley, Mikulich,
Ehlers, Hall, and Whitmore (2003) relied on the stem questions of the Colorado Adolescent
Rearing Inventory (CARI, described in assessments) to quantify abuse. These stem
questions inquired about different types of physical (and separately sexual) abuse such as
differentiating being kicked from being hit. This study utilizes frequency information about
each reported type of abuse from the CARI physical and sexual abuse probes. It is
important to note that one subject was removed from the sample reported in Crowley,
Mikulich, Ehlers, Hall, and Whitmore (2003) as that subject refused to respond to some
portions of the physical and sexual abuse probes.
Assessments
All study participants received an extensive battery of research assessments
including the following used in this report.
5


Diagnostic Interview Schedule for Children
The Diagnostic Interview Schedule for Children, 4th Edition (DISC-IV) is a
structured interview which assesses Conduct Disorder (CD), Major Depressive Disorder
(MDD, subsequently referred to as Major Depression) and numerous other psychiatric
disorders (Fisher et al., 1993; Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000).
DISC-IV provides symptom counts and diagnoses based on the criteria in the Diagnostic
and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric
Association, 2000).
Lifetime symptom counts were used as the measure of Conduct Disorder (CD)
severity as patients may have been in jail or treatment preventing their recent engagement
in CD activities, a requirement of DSM-IV diagnosed CD. As the measure of Major
Depression, past year symptom count reported by the participants was used because it
was self-reported like the other psychiatric measures and it correlated the most with the
Frequency Sum abuse measures. We examined three other Major Depression variables
not reported here: (1) past year symptom count reported by either the participant or their
parent, (2) lifetime symptom count reported by the participant and (3) lifetime symptom
count reported by either the participant or their parent.
Composite International Diagnostic Interview- Substance Abuse Module
Composite International Diagnostic Interview- Substance Abuse Module (CIDI-
SAM) is a structured interview which assesses drug and alcohol use, including nicotine
(Cottier et al., 1995). The paper and pencil version used in this study provides DSM-IV
(American Psychiatric Association, 2000) substance dependence symptom counts and
diagnoses, including abuse and dependence, for nicotine, alcohol and each of eight
different illicit drug categories i.e. cannabis, cocaine, heroin, hallucinogens, etc.
6


In this study, substance use severity is operationalized as Dependence
Vulnerability, which is the across-drug sum of DSM-IV dependence symptoms divided by
the number of drugs used to a minimum threshold with the effects of age and gender
corrected and expressed in standard deviation units. An earlier study selected
Dependence Vulnerability from ten candidate phenotypes as the substance severity
measure with the highest heritability (Stallings et al., 2003).
Colorado Adolescent Rearing Inventory
The Colorado Adolescent Rearing Inventory (CARI) is a structured abuse and
neglect assessment with probes of each endorsed item providing details including
perpetrator(s), frequency and onset (Crowley, Mikulich, Ehlers, Hall, & Whitmore, 2003).
The CARI is administered by trained, non-clinician interviewers who read the interview
questions to participants who then verbally respond while the interviewer records their
answers. Interviewers are careful to administer the CARI after building rapport with the
participants.
CARI is composed of 48 stem questions divided into three sections assessing
neglect, antisocial cruel (psychological)/ physical abuse and sexual abuse. A sample
physical abuse stem question: Were you ever hit with something hard like a board or brick,
a stick or rod, a club or a bat, or something else like that? CARI instructs participants not
to include physical fights with other peers or siblings who were not responsible for their
care. A sample sexual abuse stem question: Has anyone rubbed their genitals against
yours or had intercourse with you? Of note, CARI contains criteria limiting the reporting of
sexual abuse by a boyfriend/girlfriend. Participants are given five guidelines about
reporting sexual abuse in relation to their boyfriends/girlfriends. For example, you were 14-
16 and the other person was more than 4 years older than you. Unless one of these
7


guidelines was true, they were instructed not to include that incident in reports of sexual
abuse. If a participant endorsed a stem question item of abuse, a detailed probe including
perpetrator(s), frequency and onset information of the experience was obtained. Red Flag
responses reveal flagrant physical or sexual abuse which usually would be reportable to
child welfare agencies. In the CARI, 7 of 12 physical abuse stem questions are Red Flag
items and 10 of 13 sexual abuse stem questions are Red Flag items. The last CARI
question asks participants to choose up to three statements about how they were affected
by their experiences of abuse and neglect. A sample response to the how it affected me
question: It was one reason for my taking drugs or drinking alcohol.
For the purpose of this report, physical and sexual abuse are the foci and proxy
measures of physical and separately sexual abuse severity were created. Then their
associations with severity of substance use, Conduct Disorder and Major Depression
symptom counts were examined. In doing these analyses how these severity measures
related to more easily assessed abuse measures previously reported in Crowley, Mikulich,
Ehlers, Hall, and Whitmore (2003) was also examined. They reported Physical Abuse
Item Sums and Sexual Abuse Item Sums, which are the sum of an adolescents positive
endorsements to stem questions assessing different types of physical and sexual abuse
respectively. This studys Physical Abuse Frequency Sums and Sexual Abuse Frequency
Sums are the lifetime sum of an adolescents reported physical and sexual abuse events
respectively. Recall the example given previously,
Johnny was hit with a belt 10 times, kicked 5 times and choked 2 times.
Physical Abuse Frequency Sum = 17
Physical Abuse Item Sum = 3
8


Analyses
All data were analyzed using SPSS version 15.0 (SPSS, 2006). Group
demographics were compared using independent t-tests for continuous, approximately
normally distributed variables (or the Mann-Whitney U analogue when normality
assumptions were violated) and by using chi-square tests for categorical variables.
McNemars tests were completed to investigate whether physical and sexual abuse
differed by perpetrator types separately in patients and controls. Bivariate associations
between measures of physical and sexual abuse and severity of psychiatric disorders were
assessed with Spearmans Rank-Order Correlations as most of the abuse measures were
non-normally distributed. Two-tailed p values for all statistical tests are reported.
9


CHAPTER 3
RESULTS
Table 3.1 describes the demographics of the participants included in this report.
On average both patients and controls were 16 years old. Patients were 38% female and
controls 39% female. The ethnic breakdown of the two groups was also similar. Patients
were 52% Caucasian, 32% Hispanic and 16% other ethnicity. Controls were 57%
Caucasian, 32% Hispanic and 11 % other ethnicity. In terms of the evaluated demographic
characteristics, only socioeconomic status (SES) (updated from Hollingshead & Redlich,
1958) differed between patients and controls: Patients SES was about 45, lower middle
class; while Controls SES was about 34, middle class.
Table 3.1
Demographics
Patients Controls Test Statistic (df) P
Age (mean SD) 16.2 1.2 Yrs. 16.0 1.2 Yrs. t(197)=-0.94 0.346
Gender Male 61.9% 60.8% x2(1)=0.02 0.877
Female 38.1% 39.2%
Ethnicity Caucasian 51.5% 56.9%
Hispanic 32.0% 32.4% x2(2)=1.46 0.483
Other 16.5% 10.8%
SES (mean SD) 45.3 14.1 34.3 14.0 t(188)=-5.38 <0.0005
missing for 9 subjects
* SES information is missing for 6 patients and 3 controls.
10


As one would expect in a population of adolescents in treatment for conduct and
substance use problems, patients had relatively high prevalence of psychiatric diagnoses.
Also as expected, the community controls had significantly lower prevalence of psychiatric
diagnoses. Seventy-nine percent of patients and 6% of controls had lifetime Conduct
Disorder (CD). Patients reported a mean of 5 lifetime CD symptoms, while controls
reported a mean of only 1 symptom. Furthermore, 9% of patients and 5% of controls had
lifetime Major Depression. Patients reported a mean of 1 past year Major Depression
symptom and controls reported a mean of less than 1 symptom (see Table 3.2).
In terms of substance use diagnoses, 43% of patients and 2% of controls had
alcohol dependence. Furthermore, 64% of patients and only 3% of controls received a
cannabis dependence diagnosis. Additionally, dependence on any of 10 substances
assessed by CIDI-SAM revealed 80% of patients and 6% of controls had a diagnosis.
Finally, patients have a Dependence Vulnerability mean of 4, while controls have a mean
of less than 1 (see Table 3.2).
11


Table 3.2
Prevalence of psychiatric diagnoses
Patients Controls Test Statistic (df) P
Lifetime Conduct Disorder 79.4% 5.9% X2(1)=110.47 <0.0005
Lifetime Conduct Disorder Symptom Count (mean SD) 5.2 2.7 0.9 1.2 0539.50 <0.0005
Lifetime Major Depression 9.3% 4.9% x2(1)=1.46 0.228
Past Year Major Depression Symptom Count (mean SD) 1 02.0 0.41.4 04341.00 0.024
Alcohol Dependence 43.3% 2.0% X2(1)=49.33 <0.0005
Cannabis Dependence 63.9% 2.9% X2(1)=84.05 <0.0005
Any Substance Dependence 80.4% 5.9% x2(1)=113.22 <0.0005
Dependence Vulnerability (mean SD) 3.82.0 0.11.4 0449.00 <0.0005
Perpetrators of Physical and Sexual Abuse
In the CARI participants endorsed individual events of physical and separately
sexual abuse. Twenty-eight patients (29%) and 12 controls (12%) reported at least one
incident of physical abuse. Sixteen patients (16%) and 9 controls (9%) reported at least
one incident of sexual abuse.
Each endorsed physical or sexual abuse item was probed to obtain detailed
information about the abuse event, including perpetrator type. Figures 3.1 and 3.2
graphically show the frequency of physical and sexual abuse perpetrator types
respectively. Each figure graphs multiple perpetrator types including: mother, father, step
parent, sibling/step sibling, grandparent/other relative, adult in foster home, subjects
boyfriend/girlfriend (sexual abuse only), teacher, babysitter, and stranger/acquaintance. It
12


is important to understand that specific types of physical and sexual abuse could have
been perpetrated by more than one individual. For example, a subject could have reported
that they were kicked by their mother, stepfather, and babysitter and each of those
perpetrators would be included in Figure 3.1. The same is true if the subject was reporting
about sexual abuse in Figure 3.2. If the same perpetrator did different types of physical
abuse and/or sexual abuse to a subject that perpetrator would only be counted once in
these figures under physical abuse and sexual abuse respectively. For example, if
Johnnys mother hit, kicked and fondled him, she would be counted in the mother category
of physical abuse once and in the mother category of sexual abuse once. It is also
important to note that subjects were instructed not to include physical fights with other
peers or siblings who were not responsible for their care. In addition, subjects were given
five guidelines about reporting sexual abuse in relation to their boyfriends/girlfriends. For
example, you were 14-16 and the other person was more than 4 years older than you.
Unless one of these guidelines was true, they were instructed not to include that incident in
reports of sexual abuse.
From Figures 3.1 and 3.2, it is evident that physical abuse is more commonly
perpetrated by parents than strangers/acquaintances; and sexual abuse is more commonly
perpetrated by strangers/acquaintances than by parents. Of interest, no subjects reported
physical abuse by either adults in a foster home or teachers; and no subjects reported
sexual abuse by mothers or teachers.
13


Perpetrator Type
Figure 3.1
Frequency of Physical Perpetrator Types


Number of Perpetrators
10
8
E Patient Males
E Patient Females
E3 Control Males
Control Females
3"
CD
0)
CD
(D
"O
"0
fit
(D
3
w o n DO
Er 9 3 o c/> O <
5 CQ_ S' a -< TJ 0 O
0) J sj Hi
0 CD 3 0
"O Ct 3 a
CD
0)
O
3"
CD
Perpetrator Type
Figure 3.2
Frequency of Sexual Perpetrator Types
Stranger/
Acquaintance


In order to examine the contribution of perpetrator type to each category of abuse,
mother and father categories were combined and McNemars tests comparing abuse by
parents and strangers/acquaintances were completed separately in patients and controls.
In patients, 27% reported any physical abuse by parents and only 1% reported any
physical abuse by strangers/acquaintances (p<.0005) (see Table 3.3). No patients
reported sexual abuse by parents and 16% reported any sexual abuse by
strangers/acquaintances (see Table 3.4). In controls, 12% reported any physical abuse by
parents and none reported any physical abuse by strangers/acquaintances (see Table
3.5). Only 1% of controls reported any sexual abuse by parents and 8% reported any
sexual abuse by strangers/acquaintances (p<.02) (see Table 3.6).
Table 3.3
McNemars table of patient physical abuse
Patients N=97 PARENTS
NO YES
Male: 44 Male: 15
Female: 25 Female: 11
Total: 69 Total: 26
Male: 1 Male: 0
Female: 0 Female: 1
Total: 1 Total: 1
16


Table 3.4
McNemars table of patient sexual abuse
Patients N=97 PARENTS
NO YES
Male: 54 Male: 0
Female: 27 Female: 0
Total: 81 Total: 0
Male: 6 Male: 0
Female: 10 Female: 0
Total: 16 Total: 0
Table 3.5
McNemars table of control physical abuse
Controls N=102 PARENTS
NO YES
Male: 53 Male: 9
Female: 37 Female: 3
Total: 90 Total: 12
Male: 0 Male: 0
Female: 0 Female: 0
Total: 0 Total: 0
Table 3.6
McNemars table of control sexual abuse
Controls N=102 PARENTS
NO YES
Male: 58 Male: 0
Female: 35 Female: 1
Total: 93 Total: 1
Male: 4 Male: 0
Female: 4 Female: 0
Total: 8 Total: 0
17


Abuse Correlations with Substance use, Conduct
Disorder and Major Depression
Next the relationships between Frequency Sums and Item Sums were examined,
where Frequency Sums again are the lifetime sum of an adolescents reported physical or
sexual abuse events, and Items Sums are the previously reported measures in Crowley,
Mikulich, Ehlers, Hall, and Whitmore (2003) which simply sum up positive responses to
stem questions assessing different types of physical and sexual abuse. Again recall the
previous example with Johnny, who was hit with a belt 10 times, kicked 5 times and
choked 2 times. Johnnys Physical Abuse Frequency Sum is 17 and his Physical Abuse
Item Sum is 3.
Table 3.7 presents descriptive information of the Item Sum and Frequency Sum
variables. It is important to notice that the Item Sum variables have discrete ranges of
possible responses, where as the Frequency Sum variables have an undefined upper
bound of possible responses. Note that the median for each variable is 0 indicating that at
least 50 percent of the combined sample reported no occurrences of any of these abuse
measures. This contributes to these variables non-normality. Thus, all bivariate
associations are computed using Spearmans Rank-Order Correlations.
18


Table 3.7
Descriptive information of the CARI physical and sexual abuse variables
OVERALL SAMPLE (N=199)
Colorado Adolescent Rearing Inventory Variable Mean/ Median Possible Range Endorsed Range
Physical Item Sum 0.44/0.0 0-12 0-7
Physical Frequency Sum 19.15/0.0 0 undefined 0 2080
Red Flag Physical Item Sum 0.19/0.0 0-7 0-4
Red Flag Physical Frequency Sum 4.81/0.0 0 undefined 0-700
Sexual Item Sum 0.40/0.0 0-13 0-7
Sexual Frequency Sum 3.16/0.0 0 undefined 0-123
Red Flag Sexual Item Sum 0.31/0.0 0-10 0-6
Red Flag Sexual Frequency Sum 1.80/0.0 0 undefined 0-80
In the entire sample, N=199, the Physical Frequency Sum variable correlated at
0.992 with the Physical Item Sum variable (p<.0005). The Red Flag Physical Frequency
Sum variable correlated at 0.998 with the Red Flag Physical Item Sum variable (p<.0005).
The Sexual Frequency Sum variable correlated at 0.996 with the Sexual Item Sum variable
(p<.0005). Finally, the Red Flag Sexual Frequency Sum variable correlated at 0.999 with
the Red Flag Sexual Item Sum variable (p<.0005). These high correlations mean that
subjects who report a lot of occurrences of abuse also report a lot of different types (i.e.
kicked, hit) of physical and separately sexual abuse.
Finally, the relationship between the Physical and Sexual Abuse Frequency Sum
measures and their association with severity of substance use, Conduct Disorder and
Major Depression symptom counts in comparison to those analyses previously reported in
Crowley, Mikulich, Ehlers, Hall, and Whitmore (2003) were examined. Table 3.8 shows the
results of the correlations of the Frequency Sum and Item Sum abuse measures with
Dependence Vulnerability, Conduct Disorder, and Major Depression symptom counts. All
correlations in the entire sample are significant (p<0.01 to p<0.001) and most are highly
19


significant (p<0.0005). Of note, the Frequency Sum and Item Sum relationships with the
other psychiatric measures are remarkably similar throughout Table 3.8. For example,
Physical Item Sum correlates with Dependence Vulnerability at 0.30 (p<0.0005), while
Physical Frequency Sum correlates at 0.31 (p<0.0005). In terms of associations with
psychiatric measures, reducing the variables to only Red Flag Item Sums and Red Flag
Frequency Sums often reduces the strength of the correlation, likely due to a reduction in
range in the Red Flag variables. However, looking at the Red Flag Sexual Abuse variables
and Major Depression the correlation is strengthened suggesting that flagrant sexual
abuse is strongly associated with Major Depression.
Examining patients and controls separately, many correlations remain significant
even with the reduction in the sample size. In patients, Major Depression symptom count
correlated with all of the measures of abuse, Dependence Vulnerability correlated with
measures of physical abuse and Conduct Disorder is unrelated to any of the measures of
abuse. Though recall that these patients are in treatment for their conduct problems and
therefore range restriction might explain the lack of correlation between Conduct Disorder
and abuse measures in patients. In controls the story is different, Conduct Disorder
symptom count correlated with all of the measures of abuse. Dependence Vulnerability is
not related to physical abuse as it was in the patients; in controls, it is related to the sexual
abuse measures as is Major Depression. Furthermore, in controls, the associations with
Conduct Disorder and Physical Red Flag variables are strengthened when reducing to the
Red Flag variables only. The strongest relationships observed in the overall sample, that
between the Red Flag Sexual Abuse measures and Major Depression, remains significant
in both groups separately.
20


Table 3.8
Correlations of Colorado Adolescent Rearing Inventory Items with Dependence Vulnerability, Conduct Disorder and Major
Depression symptom counts
Nonparametric Correlations Spearmans Rho, r s
All Subjects (N=199) Patients (N=97) Controls (N=102)
Colorado Adolescent Rearing Inventory Variable DVa Number of Conduct Disorder Symptoms Number of Major Depression Past Year Symptoms DVa Number of Conduct Disorder Symptoms Number of Major Depression Past Year Symptoms DVa Number of Conduct Disorder Symptoms Number of Major Depression PastYear Symptoms
Physical Item Sum 0.30**** 0.36**** 0.25**** 0.29** 0.17 0.25* -0.07 0.32*** 0.17
Physical Frequency Sum 0.31**** 0.37**** 0.27**** 0.28** 0.18 0.27** -0.07 0.32*** 0.18
Red Flag Physical Item Sum 0.22** 0.30**** 0.24*** 0.18 0.16 0.26** -0.05 0.35**** 0.16
Red Flag Physical Frequency Sum 0.22** 0.30**** 0.26**** 0.16 0.16 0.28** -0.05 0.35**** 0.17
Sexual Item Sum 0.26**** 0.25**** 0.31**** 0.16 0.14 0.30** 0.30** 0.35**** 0.29**
Sexual Frequency Sum 0.25**** 0.25**** 0.30**** 0.15 0.14 0.28** 0.29** 0.36**** 0.29**
Red Flag Sexual Item Sum 0.26**** 0.24*** 0.39**** 0.18 0.14 0.36**** 0.26** 0.26** 0.40****
Red Rag Sexual Frequency Sum 0.26**** 0.24*** 0.39**** 0.19 0.14 0.36**** 0.26** 0.26** 0.40****
aDV (Dependence Vulnerability) is the across-drug sum of dependence symptoms divided by the number of drugs used to a minimum
threshold with the effect of age and gender corrected
*p<0.05 **p<0.01 ***p<0.001
****p<0.0005


CHAPTER 4
DISCUSSION
Using data from adolescents in treatment for substance and conduct problems and
community controls, which were originally presented in Crowley, Mikulich, Ehlers, Hall, and
Whitmore (2003), additional analyses investigating perpetrator type and correlations of
abuse frequency measures with substance use, Conduct Disorder and Major Depression
symptom counts were completed. Recall that one subject was removed from the sample
reported in Crowley, Mikulich, Ehlers, Hall, and Whitmore (2003) as that subject refused to
respond to some portions of the physical and sexual abuse probes. Then the measures of
abuse severity, Frequency Sums, were compared to the more easily assessed measures,
Item Sums, reported in the Crowley, Mikulich, Ehlers, Hall, and Whitmore (2003).
The results of this study confirm previously documented relationships between
physical and sexual abuse perpetrator type in normal adolescents (U.S. Department of
Health and Human Services, 2008; Holmes & Sammel, 2005) as well as in other
populations like homeless and runaway adolescents (Tyler & Cauce, 2002), and children
and adolescents registered at a health reference center (Drezett, Caballero, Juliano,
Prieto, Marques, & Fernandes, 2001), and non-delinquent boys/adolescents at an
observation home (Pagare, Meena, Jiloha, & Singh, 2005) and extend those findings to a
sample of adolescent patients with serious substance and conduct problems. That is,
adolescents with serious substance use and conduct problems report significantly more
physical abuse by parents than by strangers/acquaintances. No patient adolescents
reported sexual abuse by parents, while they did report sexual abuse by
22


strangers/acquaintances. The community controls in this sample reported no physical
abuse by parents, but did report physical abuse by strangers/acquaintances and they
reported significantly more sexual abuse by strangers/acquaintances than by parents. The
repetitive nature of these findings in different types of populations, suggests that parents
are more commonly the perpetrators of physical abuse and strangers/acquaintances are
more commonly the perpetrators of sexual abuse. An interesting side note, counter to
popular media coverage, no patients nor controls in this sample reported physical or sexual
abuse by a teacher.
In the overall sample, this studys measures of abuse severity, the Frequency Sum
variables, correlate significantly with substance use, Conduct Disorder and Major
Depression symptom counts; most are highly significant. However, when the sample is
divided into patients and controls only some of the significant findings persist. Perhaps this
is due to the reduction in sample size where there is less power to detect significant
results. Nonetheless, in patients, all abuse measures consistently correlated with Major
Depression symptom count and physical abuse measures correlated with substance use.
In controls, all abuse measures consistently correlated with Conduct Disorder symptom
count and sexual abuse correlated with substance use. Furthermore, in both groups, Red
Flag Sexual Abuse correlated with Major Depression, suggesting that flagrant sexual
abuse is strongly associated with Major Depression. Perhaps clinicians treating depressed
adolescents should consider reviewing their sexual abuse histories as that information may
help inform their treatment.
In comparing Frequency Sum variables, which again are the lifetime sum of
reported physical and sexual abuse events, and Item Sum variables, which are the sum of
positive endorsements to different types of physical and sexual abuse, the results are very
similar. To illustrate this concept, consider that being kicked 1000 times versus being
23


kicked once corresponds to similar associations with substance use, Conduct Disorder and
Major Depression Symptoms counts. These data do not support the hypothesis that the
lifetime sums of reported physical and sexual abuse events are more highly correlated with
adolescent substance use and Conduct Disorder. In this study abuse was quantified as
the number of occurrences (events) of abuse and the number of different types of abuse
and those two measures were very highly correlated suggesting that those adolescents
who experience a variety of types of abuse (hit, kick, etc.) also experience a lot of
occurrences of abuse. Related research by Clemmons, Walsh, DiLillo & Messman-Moore
(2007), Higgins (2004) and Schenkel, Spaulding, DiLillo & Silverstein (2005) suggest that
severity of maltreatment is related to the level of psychological maladjustment of abused
individuals. Considering these conflicting, though differently assessed, results, additional
research is needed into the association of severity of abuse and substance use and
psychiatric disorders among adolescents in treatment for substance and conduct problems.
Implications
Researchers and clinicians are able to obtain valuable physical and sexual abuse
information and associate that with substance use, Conduct Disorder and Major
Depression without having to go through the lengthy CARI item-by-item probe process.
While adolescent abuse is positively associated with substance use, Conduct Disorder and
Major Depression, from this report it appears that adolescents who experience more
incidents of physical and/or sexual abuse do not have an increased risk of substance use,
conduct problems or Major Depression than those who experience single or few incidents.
Thus, the information obtained in the 48 stem questions in the CARI, which take
approximately 15-20 minutes appears to be as useful as the extensive additional
information obtained in the probe process, which can take over an hour depending on the
24


extent of the abuse. This lends support for the recently created CARI-Q instrument
presented in Crowley, Young, Raymond, Mikulich-Gilbertson, and Rhea (2008, in review),
which is a shortened version of the CARI that is in a self-administered questionnaire
format. While participant or patient time is frequently a consideration in research and
treatment, it is important to recognize there may be clinical utility in the information
obtained within the abuse probes, i.e. onset, frequency, perpetrator(s), etc.
Limitations
Though the subjects in this research were adolescents, physical and sexual abuse
may have occurred years prior to their participation in this study. Thus, there is a potential
for recall bias. Additionally, participation required parental consent and adolescent assent.
The consent/assent form stated incidents of abuse would be reported to Social Service
Agencies. Thus, there is also a potential for under, and possibly over, reporting of abuse.
Over reporting is feasible if for example an adolescent was angry with their perpetrator,
they could be vindictive in this manner. Finally, the CARI was administered by trained,
non-clinician interviewers who read the interview questions to participants who then
verbally responded while the interviewer recorded their answers. The information in the
CARI is obviously sensitive and adolescents may have been embarrassed or afraid to
provide abuse information to a non-clinician interviewer. However, interviewers were
careful to administer the CARI after building rapport with the participants and their level of
reporting of abuse suggests they were comfortable during the interview.
Future Directions
Further investigation into the perpetrators of abuse and the associations of
perpetrator type with substance use and psychiatric disorders is needed. Is physical or
25


sexual abuse perpetrated by a parent different than physical or sexual abuse perpetrated
by a stranger/acquaintance? Are those differences in type, number of occurrences, need
for medical attention etc.? Does abuse perpetrated by a parent have a different effect on
the development of substance use and psychiatric disorders than abuse perpetrated by a
stranger/acquaintance? What about on the severity of those substance use and
psychiatric disorders?
Further investigation is also needed into the chronology of abuse and onset of
substance use and psychiatric disorders within this population. Substance use and
psychiatric disorders tend to run in families, as does physical and sexual abuse. Does the
abuse pre-date the substance use and/or psychiatric disorder or is abuse the result of
being intoxicated or having the disorder? It is likely there is evidence of both scenarios.
Could additional information be elicited by following the younger siblings of adolescent
patients in treatment for conduct and substance problems and adolescent controls in a
prospective study? That is, follow younger siblings, of both patients and controls, who
have not been abused nor exhibited substance use or behavior problems throughout
adolescence and analyze the differences in onset and severity of abuse, substance use
and behavioral problems.
Last, in a recent publication an appraisal of a participants experience of witnessing
family violence was included in a measure of overall maltreatment (Higgins, 2004). The
CARI in its current form does not have a section including questions about a participants
experience of witnessing family violence. In future studies, it may be valuable to add
questions assessing witnessing family violence to CARI. Doing so would also allow a
better comparison of maltreatment in the patient population to the results reported in
Higgins (2004).
26


APPENDIX A
COLORADO ADOLESCENT REARING INVENTORY (CARI)
27


COLORADO ADOLESCENT REARING INTERVIEW
INSTRUCTION MANUAL
Version 2.1 April 1995
INTERVIEW ADMINISTRATION
Prepared by Shannon K. Hall and Kristen M. Ehlers,
Professional Research Assistants*
COMPUTER ENTRY AND SCORING
Prepared by Susan K. Mikulich, Sr. Professional Research Assistant*, and
Anastasia Forrester, Professional Research Assistant*
*Under supervision of Thomas J. Crowley, M.D., Professor of Psychiatry,
Addiction Research and Treatment Services, University of Colorado School of
Medicine,
Denver, CO 80262, USA, to which inquiries may be addressed.
This document is in the public domain.
28


COLORADO ADOLESCENT REARING INTERVIEW (CARI)
VERSION 2.1
Addiction Research and Treatment Services
University of Colorado School of Medicine
Development of this interview was supported by Grant DA 06941 (to Thomas J.
Crowley, M.D., Principal Investigator) from the National Institute on Drug Abuse, USPHS.
The interview is in the public domain. Version 1 was drafted by Debra Shanks, Ph.D., a
postdoctoral fellow, with supervision of Dr. Crowley and consultation from Dr. Crowleys
staff. Pilot administration was by Cheryl Martin and Tammy Moss, and scoring and
entering protocols were devised by Susan Mikulich. Marilyn Macdonald and Susan
Mikulich analyzed pilot data. Based on pilot testing for Version 2, some questions were
dropped, others added, and remaining questions were modified by Crowley, Mikulich,
Martin, Macdonald, Mark Walter, and Kristen Ehlers. All of them were Dr. Crowleys
employees. After further administration to nearly 200 adolescents, minor changes were
suggested by Shannon Hall and Kristen Ehlers, resulting in Version 2.1.
Address queries or comments to Thomas J. Crowley, M.D., Box C-268, University
of Colorado Health Sciences Center, Denver, Colorado, 80262.
rev. April 1995
29


Colorado Adolescent Rearing Interview (CAR1)
INSTRUCTION MANUAL
I. Introduction to the CARI
A. The CARI interview is a detailed, self-reported, structured interview
questioning abuse and/or neglect that an adolescent may have
experienced. It is aimed at 13-19 year old boys and girls. The first
section assesses neglect, the second section concerns antisocial/cruel
and physical abuse and the third section asks about sexual abuse.
The first 50 questions require a YES or NO response. If the
response is in the critical direction indicating abuse/neglect, that
question is probed for further information. Probes address the
victims age at onset and offset of neglect or abuse, the duration and
frequency, the victims relationship to the perpetrator, and use of
substances at the time by the victim and perpetrator. The last
question of the interview asks the clients opinion about the effect of
neglect or abuse on his/her life.
II. Overview of Materials Needed
A. Interview booklet
The interview booklet consists of 7 pages, and contains 51 questions
divided into three sections. The interviewer is to read to the client
each question exactly as it is written. The bold, bracketed words for
each question are inserted into the bold, bracketed [incident] on each
probe sheet; these are reference phrases which are repeated in each
probe. For example, on question 1, when doing Probe 1, insert you
often went hungry into any item marked [incident].
Interviewer instructions are printed in capital, bold, italicized letters
and are in parentheses.
B. Answer Sheet
The answer sheet is one page long and is numbered from 1 to 51,
and is also divided into three sections. If a client answers yes to a
question the interviewer is to circle a 1 on the answer sheet. If a
client answers no to a question the interviewer is to circle a 0 on
the answer sheet.
30


A number on the answer sheet which is starred (*, **, or ***)
indicates a positive response to an abuse or neglect incident. This
positive response is then probed. Each section of the interview uses
a probe sheet formatted specifically for that section.
One by the number circled on the answer sheet is an indication to
use Probe 1; a two ** by the number circled indicates use of Probe
2; and a three *** by the number indicates use of Probe 3.
C. Cards
Living Situation Card to be used with Probe 1
Frequency Card to be used with Probes 1-3
Section 2 Who did it? Card to be used with Probe 2.
Section 3 Who did it? Card to be used with Probe 3.
Section 3 Card to be used with Probe 3.
How I w as affected by these experiences Card to be used
when asking question #51.
D. Probe Sheets
Probe 1: If an answer with one by it is circled, Probe 1 is asked.
Probe 1 is used for questions 1-15 in Section 1. This probe
emphasizes who the client was living with, how many times the
incident occurred, and its duration. One probe sheet is used per
incident.
Probe 2: If an answer with two * by it is circled. Probe 2 is asked.
Probe 2 is used for questions 16-35 in Section 2. This probe
emphasizes identification of the perpetrator(s) and severity of the
abuse for each incident. One probe sheet is used per perpetrator per
incident.
Probe 3: If an answer with three *** by it is circled, Probe 3 is
asked. Probe 3 is used for questions 37-49 in Section 3. This probe
qualifies a sexual incident on the basis of age relationship to the
client, comfort level of the client, and status of caregiving
responsibility of the perpetrator(s). It assesses the number of times
the incident occurred and identifies the perpetrator(s). One probe
sheet is used per incident, regardless of the number of perpetrators.
31


It is possible that many questions may be probed, so be certain to
have a sufficient supply of Probes 1,2, and 3 for each interview.
III. Administration of Interview
A. Preface statement: The administrators of this interview will first
need to make sure that the preface statement is in accordance with
their jurisdiction, as laws on reporting physical/sexual abuse may be
different in each jurisdiction. Make changes in this section as
needed.
Read the preface introduction to the client verbatim so that all
confidentiality aspects are reported in a standardized way to each
client.
B. Section 1 NEGLECT: Begin interview with question 1. The
interviewer is to read to the client each question exactly as it is
written. If a client seems uncertain about a response, simply read the
question again. Do not explain it, an explanation could bias the
clients answer. Circle the answer on the CAR! Answer Sheet. If
the answer circled does not have a by it, then proceed to the next
question. If the answer circled does have a by it, then ask Probe 1.
Probe 1:
- For each probe sheet, fill out the Subject #, Question #, and
Occurrence #.
- The Living Situation Card is needed for question 2 of this probe.
The Frequency Card is needed for questions 3 and 4.
- When showing the Frequency Card to the client, if they are unsure
of the answer say, Just try to give me your best answer. If the
client does not know or cannot answer, code 999.
- If question 5 is answered noor I dont know, code 999 for
questions 6, 7, and 8, and skip to question 9. Note that question 9 is
coded in months.
- If question 10 is answered no, then continue the interview by
asking the next question in the interview booklet.
32


- If question 10 is answered yes, then start another Probe 1 sheet.
For each additional occurrence, a separate probe sheet is filled out.
An occurrence can either be in a different living situation, or it may
be the same living situation at a different period of time. If
additional probe sheets are filled out, the occurrence # at the top of
the page should be filled in accordingly, in addition to Subject # and
Question #.
- On additional probe sheets, for question 1 ask when this next
occurred, and for question 9 ask how long that particular period
lasted. Question 10 is again asked, and if it is answered yes
another probe sheet is filled out. A client may have numerous probes
to one question.
C. Section 2 PSYCHOLOGICAL AND PHYSICAL ABUSE: Begin
this section by reading the Section 2 introduction paragraph.
Remember to exclude fights with other kids, gang fights, or
girlfriend/boyfriend fights and accidental injuries caused by others.
Include abuse by older siblings (> 4 years than the client) serving as
caretakers. If the answer circled does not have a ** next to it, then
proceed to the next question. If the answer circled does have a **
next to it. then ask Probe 2.
Probe 2:
- For each probe sheet fill out the Subject #, Question #, and
Occurrence #.
- The Living Situation Card is needed for question 2 of this probe.
The Frequency Card is needed for questions 5 and 6.
- When showing the Frequency Card to the client for question 5, if
they are unsure of the answer say, Just try to give me your best
answer. If the client does not know or cannot answer, code 999.
- For question 6 do not allow an I dont know answer, have the
client give their best guess/answer.
- If question 7 is answered no or I dont know, code 999 for
questions 8, 9, and 10, skip to question 11.
33


- If no injuries are reported in question 11, then code 999 for
questions 12 and 13.
- If interview questions 17-23 are probed, skip questions 11, 12, and
13 on the probe sheet.
- If question 14 is answered no, then continue the interview by
asking the next question in the interview booklet. If question 14 is
answered yes, then fill out an additional Probe 2 sheet. For each
additional perpetrator, a separate probe sheet is filled out.
D. Section 3 SEXUAL ABUSE: Begin this section by reading the
Section 3 introduction paragraph. Then review the Section 3 Card
with the client before proceeding further. The administrator should
remind the client that the administrator is interested in situations
where at least one of the descriptions on the card is true. If the
answer circled does not have a *** next to it, then proceed to the
next question. If the answer circled does have a *** next to it, then
ask Probe 3.
Probe 3:
- For each probe sheet fill out the Subject #, Question #, and
Occurrence #.
- The Section 3 Who did it? Card, the Section 3 Card, and the
Frequency Card are needed for this probe.
- For question 1, show the client the Section 3 Card and circle the
appropriate answers for questions la-le.
- If the client answers no to questions la-le skip the rest of Probe 3
and continue with next interview question.
- If the client answers yes to any. part of question 1, continue with
probe question 2.
- For question 6 show the client the Section 3 Who did it? Card
and circle all that are applicable.
34


- For question 10 do not allow an I dont know answer. Have the
client give his or her best guess/answer.
- If question 11 is answered no or I dont know, code 999 for
questions 12, 13, and 14.
E. Concluding Remarks: Read the concluding remarks to the client.
This interview may be upsetting for some clients, and it may be
useful to have a list of resources available for the client.
F. Reports: If the client has reported any incidents of abuse or neglect
the administrator should make a report to the appropriate agency
within the time required in that jurisdiction.
IV. Question by Question Specifications
A. Section 1
1. For question 6, discount visits mandated by social services
agencies. Regardless of how question 6 is answered, this
question is never probed.
2. For question 14, if there were no substances in the house
code yes. Code no if either alcohol or drugs are easily
available.
B. Section 2
1. For question 21, do not score a client only possessing
personally used drugs supplied by adults as yes.
2. For question 24, if client answers yes, ask them to describe
what happened. Code no if infrequent, light spankings on
buttocks with non-buckle end of belt or light strap or switch.
Otherwise, list items on answer sheet and ask Probe 2.
3. For question 25, if the response is yes, ask the client to
describe what happened. Code no if infrequent, light
spankings on buttocks or hand with a ruler, pencil or other
light instrument. Otherwise, list items on answer sheet and
ask Probe 2.
35


4. For question 28, if the response is yes, ask the client to
describe what happened. Code no if light objects that
cannot injure i.e., chalk, towels or pillows. Otherwise, list
items on answer sheet and ask Probe 2.
5. For question 31, if the response is yes list items on the
answer sheet and ask Probe 2.
6. For question 33, if question 32 was answered yes, ask the
client Was that separate from when you were choked?. If
no, code no and dont probe. If yes, code yes and
ask Probe 2.
7. For question 36, skip this question if there were no probes on
interview questions 24-35 in Section 2.
C. Section 3
1. State bold, bracketed words as appropriate to gender.
2. For question 37, code reasonable sex education as no.
3. For question 50, skip this question if there were no probes on
interview questions 37-49 in Section 3.
D. Question 51
1. If no probes were completed in Sections 1-3, skip this
question and code 999.
2. If any probes were completed, read question 51 verbatim and
show the client the How I was affected by these
experiences Card, and code the number for their first,
second and third choices.
3. If client responds with an answer that is not on the card, list
on the answer sheet. If the interviewer judges that this
answer is in categories 1 -9, enter that number, otherwise,
enter a 0 for other.
36


V. Data Entry
The program for scoring CARI requires Macintosh with System 7, a
color monitor, 4 megabytes of RAM, and Microsoft Excel version
3.0 or more recent; a Macintosh Excel data entry template and
scoring algorithm are available upon request; a PC Windows
version utilizing Microsoft Excel will be available soon.
A. Introduction: Because most questions on the CARI have the
potential for being probed one or more times which provides
additional data for those items, the entry system is complicated by
the need for four data storage worksheets: one worksheet containing
item responses and summary scores and three separate worksheets
containing the additional probed information for endorsed items
from each section.
The algorithm generates separate counts of neglect items, physical
abuse items, sexual abuse items, and total neglect and abuse items
endorsed by each client.
Note: These instructions assume that CALCULATION under the
OPTIONS menu in Excel is set to automatic not manual.
B. General Data Entry Procedures: Open all of the files in the CARI
folder (on the Macintosh this can be done by pressing command A
and then command O, or by pulling down to select each file under
the File Menu). The required files are CARI MACRO, CARI
MAIN ALGORITHM and the four data storage sheets: CARI
MAIN.DATA, CARI PROBE 1, CARI PROBE 2, CARI PROBE 3.
Once all six worksheets are open, the top or active window can be
changed by pulling down the WINDOWS menu and selecting the
desired worksheet. All open windows will be listed under this
menu.
All variables to be entered are in purple font; enter corresponding
values in the adjacent, purple-bordered cells.
37


1.
Entry of Main Items: Answer Sheet
a. Select the CARI MAIN ALGORITHM worksheet
from WINDOWS menu. Enter the identifiers
(Identification #, date, time, interviewer initials and
entry persons initials) at the top of the worksheet
b. Below the identifiers, there is a section titled
Summary Counts of Items Probed at least Once
containing Computer-generated counts of neglect
items, physical abuse items, sexual abuse items, and
total neglect and abuse items. Before entering any
data the top two cells in this section will, by default,
show a 5, while the bottom two will each show a
0. Do not enter anything in this area.
c. Go to question number 1 in Section 1 and begin
entering data vertically in the purple-bordered
column. Data should be entered exactly as it is
circled on the answer sheet (leave blank answers
blank).
d. Section 2 begins with question 16. Enter data
vertically in the purple column. If no questions were
probed, enter 0 for question 36 (number of days
physically abused). Ignore (do not enter) any text
responses written in the blanks corresponding to
questions 24, 25, 28 and 31.
e. Section 3 begins with question 37. Enter data
vertically in the purple-bordered column. If no
questions were probed, enter 0 for question 50
(number of days sexually abused). After entering
questions 37-50, examine all probe sheets
corresponding to these items. When there are one or
more uyes responses for questions la-e, al should
be entered into the column (F) next to the item entry
column for the corresponding question. Multiple
probes may occur for a single question; score a 1 in
column (F) no matter how many times (la-e on the
38


probe sheet) were scored yes. If no items la-e are
scored yes for a probe on a question or if there is
no probe for that question, leave the corresponding
cell in column (F) blank.
For all three parts of question51, leave blank items
blank.
f. Note: the computer automatically generates scores as
data is being entered.
2. Printing the Score Sheet
a. DO NOT SAVE CARI MAIN ALGORITHM, this is a
worksheet, not a document to be saved.
b. After completing entry, print the document to generate a
one page summary of responses.
c. Check the numbers scored on the hard copy against the
Score Sheet and the number of probes attached to the
CARI.
3. Macro the Data
a. The macro transfers data from the CARI MAIN
ALGORITHM worksheet to the spreadsheet CARI
MAIN.DATA, where each patients responses are
stored in a horizontal (row) record suitable for further
analysis; To begin, pull down the WINDOWS menu
and select CARI MAIN.DATA. Make sure the
active cell is the first empty cell in the column one.
If a different cell is selected the macro will begin
pasting at that cell (over any data that might already
be there).
b. To macro the document, pull down the menu under
Macro and select run. When the selection
window opens select a CARI MACRO!Record 1.
this will engage the macro.
39


c. When all data has been transferred to the spreadsheet,
the worksheet CARI MAIN ALGORITHM will be
blank. At this time another record can be entered.
d. Note: All of the data is now in CARI MAIN.DATA
spreadsheet. This window must be saved before it is
closed.
C. Entering Probes
The number of probes for each section is equal to or greater than the
total number of items endorsed in that section since some questions
may be probed multiple times depending on number of incidents and
perpetrators. Select the appropriate window to begin entry of each
probe (e.g. select CARI PROBE 1 to enter neglect probes). Enter
each probe horizontally beginning at the first empty cell in the first
empty row. Code yes as 1, no as 0, and 999 for not applicable.
Continue on the next empty row entering additional probes for the
current patient.
1. Probe 1: Question number 2, if multiple numbers are circled
enter each number in ascending order (except for 0, which
should be added last) with no delimiters (e.g. commas,
spaces, etc.).
2. Probe 2: Question number 11, if no injuries are reported,
code 0. If number 11 is coded 0, then the next two questions
numbered 12 and 13 should be coded 999 not applicable.
If multiple numbers are circled enter each number in
ascending order (except for 0, which should be added last)
with no delimiters (e.g. commas, spaces, etc.).
3. Probe 3: Question number 6 if multiple numbers are circled
enter each number in ascending order (except for 0, which
should be added last) with no delimiters (e.g. commas,
spaces, etc.). Do not enter probes which did not qualify for
scoring on the main algorithm based on a positive (yes)
response to any of the questions la-le.
D. Exiting CARI
When closing windows the computer will ask you if you wish to
save. For CARI MAIN ALGORITHM select NO, because changes
in this document will permanently be saved and can alter the
40


algorithm and the macro. For CARI MACRO select NO, because
changes in this document will permanently be saved and cal alter the
macro, All other windows should be saved in order to save any data
which has been entered.
41


(PREFACE TO BE READ TO SUBJECT:)
This questionnaire concerns things you may have experienced while
growing up. Some of the questions are very personal and talk about private,
sensitive things. I encourage you to try and answer honestly although I realize that
some of the subject matter may be difficult to talk about. The first section asks
about whether you felt you received the basic things you needed while growing up,
the second part asks about how you were treated, and the third part asks about any
sexual experiences you may have had.
Some things that you tell us, we may have to tell to others. These things
include child abuse. If you report that you have been physically or sexually
abused, we must tell a Social Service Agency. That way, if other children are still
in danger from those same people, that report may help protect those children. We
will provide counseling services if you need them, after our talk today. If you dont
want to answer a certain question or if you want to stop the interview, you may do
so.
Now Im going to ask about whether you received basic things you needed
while you were growing up.
Section (ON PROBE 1, INSERT INTO [INCIDENT] THE [BRACKETED]
MATERIAL IN EACH QUESTION).
(IFSTARRED (*) ANSWER IS GIVEN, GO TO PROBE 1).
1. Was there ever a time in your life when [you often went hungry]?
2. Was there ever a time in your life when [you didnt have necessary
clothing]?
3. Did you always have shoes and clothes that fit and were reasonably clean?
[your clothes were bad]
42


4. Did the people you lived with always try to keep your house clean and free
of insects, rats or mice? [your house was dirty]
5 a. Have you ever been seriously sick or hurt?
IF YES, 5b. When [you were sick or hurt] did the adults who were
responsible for you take you to the doctor or to the hospital?
6. When you were growing up, did the adults who were responsible for you
ever take you to the dentist? (DISCOUNT VISITS MANDATED BY
SOCIAL SERVICE AGENCIES).
7. Was there ever a time when the adults who were responsible for you did not
see to it that your teeth usually got brushed and you usually were clean?
[you often went dirty]
8. Was there ever a time when adults did not attempt to enforce rules for you?
(For example, rules like telling the adults where you were going, or when
you were to be home)? [there were no rules]
9. Did the adults who were responsible for you always push you to go to
school on time, to stay there, and to do your homework? [you were not
pushed about school]
10. Was there ever a time when you couldnt do normal social activities like
clubs, teams, and church groups because the adults you lived with moved
around too much or had too many rules or chores at home? [you were kept
from activities]
11. Was there ever a time when you were younger than 12, when the adults
sometimes would leave you without anybody older than 12 to take care of
you when they left you? [you were sometimes left without an older
person]
43


12. Did you usually feel the adults who were responsible for you would have
been warm and caring if you had turned to them with a problem? [you
didnt have any warm and caring adults you could turn to]
13. Up until you were 17 years old, was there ever a time when the adults who
were responsible for you repeatedly threaten to leave you on your own, or
abandon you, or throw you out? [you were threatened with separation]
14. Did the adults you lived with really try to prevent you from using drugs or
alcohol? For example, did they enforce firm rules against your drinking or
using drugs in the house, or if they had drugs or alcohol in the house, did
they really seriously try hard to keep you out of their supplies. (IF NO
SUBSTANCE IN HOUSE MARK YESMARK NO, IF EITHER
ALCOHOL OR DRUG IS TOO AVAILABLE).
[you could easily get drugs or alcohol]
15. Was there ever a lengthy time when the adults you lived with just withdrew
from youlike they were too high, or too depressed, or too mad to pay
attention to you? [you were ignored]
Section 2: Sometimes people who are responsible for kids, hurt the kids by
hitting them or doing other things that harm them or make them feel bad. They
might be parents, parents friends who live in the house, foster parents, baby sitters,
teachers, or others. The following questions are about things that happened to you
when you were growing up. Please do not include fights with other kids.
(EXCLUDE FIGHTS WITH OTHER KIDS, GANG FIGHTS, OR
GIRLFRIEND/BOYFRIEND FIGHTS, AND ACCIDENTAL INJURIES
CAUSED BY OTHERS. INCLUDE ABUSE BY AN OLDER (> 4 YEARS)
SIBLING SERVING AS CARETAKER).
(** IF STARRED (**) ANSWER IS GIVEN, GO TO PROBE 2)
16. Did any of the adults who were responsible for you ever punish you by
confining you in dark places like a closet?
44


17. Was there ever a time in your life when any of the adults you lived with
yelled, cursed or said threatening things to you almost every day?
18. Was there ever a time when any of the adults you lived with tormented you
frequently about scary things, like ghosts, burglars, or snakes?
19. Was there ever a time when any of the adults you lived with threatened to
really hurt you or someone else because of what you did or might do, for
example, like they said they would really hurt you or your mother if you
told her something?
20. Was there a time when any of the adults who were responsible for you put
you down every few days, made fun of you, or called you names, like
saying you were stupid, or ugly, or said, Youre just like your old man! or
something like that?
21. Did the adults who were responsible for you ever encourage you to break
the law or help you break the law? For example, tell you to steal things, or
give you drugs to sell (not just to use yourself, but to sell), or do other
illegal things. (DO NOT SCORE YOUTHS ONL Y POSSESSING
PERSONALLY USED DRUGS SUPPLIED BY ADULTS AS YES).
[you were encouraged to break the law]
22. Was there ever a time when a family member who was responsible for you
told you they didnt love you or wished that you had never been born?
23. Was there ever a time when the adults who were responsible for you gave
you drugs or more than a few swallows of alcohol?
24. Were you ever hit with something like a belt, belt buckle, a heavy whip or
switch, an extension cord or cable, or something else that was whippy? (IF
YES, ASK WOULD YOU DESCRIBE WHAT HAPPENED? MARK
NO IF INFREQUENT LIGHT SPANKINGS ON BUTTOCKS WITH
NON-BUCKLE END OF BELT OR LIGHT STRAP OR SWITCH
45


OTHERWISE, MARK YESAND LIST ITEMS ON THE ANSWER
SHEET AND ASK PROBE 2).
25. Were you ever hit with something hard like a board or brick, a stick or rod,
a club or a bat, or something like that? (IF YES, ASK WOULD YOU
DESCRIBE WHAT HAPPENED? MARK NO IF INFREQUENT
LIGHT SPANKINGS ON BUTTOCKS OR HAND WITH RULER,
PENCIL OR OTHER LIGHT INSTRUMENTS. OTHERWISE, MARK
YES AND LIST ITEMS ON THE ANSWER SHEET AND ASK
PROBE 2).
26. Were you ever hit with someones fist?
27. Were you ever purposely kicked?
28. Did anyone ever purposely hit you with thrown things, like a plate, or hit
you with something else I didnt mention? (IF YES, ASK WOULD YOU
DESCRIBE WHAT HAPPENED? MARK NO IF LIGHT OBJECTS
THAT CANT INJURE LIKE CHALK, TOWELS, OR PILLOWS.
OTHERWISE, MARK YES AND LIST ITEMS ON THE ANSWER
SHEET AND ASK PROBE2).
29. Did anyone ever intentionally burn you, for example, with cigarettes, or
matches, or scalding water, or a stove top?
30. Did anyone ever intentionally cut you with something like a knife or
scissors, or stab you with something sharp like a pin or a pencil?
31. Were you ever forced to eat or drink something harmful or something that
was not food?
(IF YES, LIST ITEM ON ANSWER SHEET AND ASK PROBE 2).
32. Did someone ever choke you?
46


33. Did anyone ever shake you really hard in a violent way? (IFCHOKED
WAS YES; SAY, WAS THAT SEPARATE FROM WHEN YOU WERE
CHOKED? IF NO MARK NO, IF YES, MARK YES AND ASK
PROBE 2).
34. Did anyone ever purposely throw you around, or knock you down, or throw
you down stairs, or something like that?
35. Did anyone ever hold your head underwater, like in a tub, or toilet, or lake,
so long that you almost ran out of air or thought you might drown?
36. (SKIP THIS ITEM IF THERE WERE NO PROBES ON INTERVIEW
QUESTIONS 24-35). Now Id like you to think about when someone hit
you or physically hurt you in ways like we just discussed. For example,
when [person] [did________] (GIVE 1 OR 2 EXAMPLES FROM
PROBE 2). In your whole life, about how many days have there been when
one or more of those things happened? Like one day, or ten days, or a
hundred or a thousand days. Just try to give me your best guess.
Section 3: Sometimes people are touched in their private areas by others in
such a way that they become scared, uncomfortable, or physically injured. The
following questions pertain to things you may have experienced. Im not asking
about normal medical exams or treatments, or things like an adult checking on an
injury that you had.
(REVIEW THE SECTION 3 CARD WITH CLIENT BEFORE STARTING
THIS SECTION. *IF STARRED (***) ANSWER GIVEN, GO TO PROBE 3).
37. Except for normal sex education, did anyone ever talk about sexual things
in front of you, show you pictures or X-rated movies of people engaging in
sex, or did people engage in sexual activity in front of you? (MARK
REASONABLE SEX EDUCATION AS NO).
47


38. Except for normal locker room situations or occasional accidents, did
people purposely show themselves to you in the nude?
39. Did anyone ever rub their body up against you either when you had your
clothes on or off?
40. Did anyone ever remove your clothing, or ask you to do that, so they could
see your [breasts, girls only] genital area, or buttocks?
41. Did anyone ever touch your [breasts, girls only], buttocks, or genital area
when you had your clothes on or off?
42. Did anyone ever french kiss you (put their tongue in your mouth)?
43. Did anyone ever rub your genitals (masturbate you), ask you to rub their
genitals, or masturbate themselves in front of you?
44. Did anyone ever touch your genitals with their mouth, or the other way
around?
45. Has anyone rubbed their genitals against yours or had intercourse with you?
46. Did a male ever put his penis in your buttocks?
47. Did anyone ever stick their fingers or any other objects inside your [vagina
or, girls only] buttocks?
48. Did anyone ever encourage you to have sex with them or with other people
for money or drugs?
49. Did anyone ever have you do sexual things in front of cameras or tape-
recorders?
48


50. (SKIP THIS ITEM IF THERE WERE NO PROBES IN SECTION 3).
Now Id like you to think about these sexual things that weve just talked
about. Just consider the ones that were on this list [show card], like when
[person] [did________] (GIVE 1 OR 2 EXAMPLES FROM PROBE
3). In your whole life, about how many days have there been when one or
more of those things happened? Like one day, or ten days, or a hundred or
a thousand days. Just try to give me your best guess.
(IF NO PROBES WERE COMPLETED IN SECTIONS 1 3, CODE 999 AND
SKIP QUESTION 51).
51. This final question concerns how you feel you were affected by your
experiences. Please take a look at this list [show card for feelings] and tell
me the item which best reflects your strongest feelings (PAUSE), Now go
back through the list and tell me if there is another item which next best
reflects your feelings (PAUSE). If there is an item which third best reflects
your feelings, tell me what that is. (CODE NUMBER OF 1ST CHOICE,
AND IF PRESENT, 2ND AND 3RD CHOICES. IF NO 2ND OR 3RD
CHOICE CODE 999 ON ANSWER SHEET. IF OTHERASK,
WHA T? AND LIST ON ANSWER SHEET. IF INTER VIEWER
JUDGES THA T THE OTHER IS IN CA TEGORIES 1-9, ENTER
THA T NUMBER, OTHER WISE ENTER A (0 FOR OTHER).
(CONCLUDING REMARKS TO BE READ TO SUBJECT:)
Thanks for responding to these difficult questions. If they brought back unpleasant
memories or feelings, you may want to talk to a counselor or someone you feel
comfortable with. If there is no one you can talk to, let me know. I can arrange for
you to speak with one of our counselors.
49


Colorado Adolescent Rearing Interview (CARI)
Version 2.1 (Answer Sheet)
Subject#: Date:
Subject Initials: Interviewer Initials:
YES = 1 NO = 0
Section 1 1. 1* 0 26. ] ** 0
2. 1* 0 27. | ** 0
3. 1 0* 28. 0
4. 1 0* Items:
5 a. 1 0 If no 0 skip to 6. 29. 0
b. 1 0* 30. J** 0
6. 1 0 (No Probe) 31. 1** 0
7. 1* 0 Items:
8. 1* 0 32. j ** 0
9. 1 0* 33. J ** 0
10. 1* 0 34. J** 0
11. 1* 0 35. 0
12. 1 0* 36. #
13. 1* 0 Section 3:
14. 1 0* 37. J *** 0
15. 1* 0 38. | *** 0
Section 2 39. ]*** 0
16. | ** 0 40. ] *** 0
17. ] ** 0 41. ]*** 0
18. ] ** 0 42. J *** 0
19. J ** 0 43. j *** 0
20. 1 ** 0 44. J*** 0
21. | ** 0 45. | *** 0
22. 0 46. ] *** 0
23. | ** 0 47. ] *** 0
24. J ** 0 48. J*** 0
Items: 49. ]*** 0
25. 0 50. #
Items: 51. 1st 2nd
50


PROBE 1
LIVING SITUATION CARD
(Tell All That Apply)
1 - Mother
2 - Father
3 - Stepfather, stepmother (or boyfriend,
girlfriend)
4 - Brother, sister, stepbrother, stepsister
5 - Grandparents or other relatives
6 - Foster home, foster parent, group home, proctor
home, treatment program
7 - Friend, neighbor, other acquaintance
8 - Stranger/Other
9 - Homeless/On the streets/Living alone
0 - Detention Center or jail Rev 4/95
51


PROBE 1
FREQUENCY CARD
0 - NEVER
1 - ABOUT A QUARTER OF THE TIME
2 - ABOUT HALF OF THE TIME
3 - ABOUT THREE QUARTERS OF THE TIME
4 - NEARLY ALL OF THE TIME
Rev. 4/95
52


PROBE 1
SUBJECT #________
QUESTION #_______
OCCURRENCE #_______
1. How old were you when this [first/next] occurred? _
2. Who were the adults you were living with during
that time when [incident]?
(SHOWLIVING SITUATION CARD, 1 2 3 4 5 6
CIRCLE ALL NUMBERS THAT APPLY)
3. How often were the people who should have been
taking care of you using drugs or drunk when this
happened? (DONTEXPLAIN, SAY JUST 0 12 3
TRY TO GIVE ME YOUR BEST ANSWER.
SHOW FREQUENCY CARD WITHOUT 999,
BUT ALLOW 999 (DONT KNOW OR CANT
REMEMBER)).
4. How often were you drunk or using drugs during this
time? 0 12 3 4
(DONT EXPLAIN, SAY, JUST TRY TO GIVE ME
YOUR BEST ANSWER. SHOW FREQUENCY CARD.
FORCE ANSWER, DONT ALLOW 999).
YES NO
5. Were any other adults who should have been taking
care of you at this time aware that [incident]?
(IF NO OR DONT KNOW, 1 0
CIRCLE 999 ON PROBE 1 QUESTIONS
6, 7, 8, AND SKIP TO QUESTION 9)
6. Did any of them try to help you? 1 0
(yrs.)
7 8 9 0
4 999
N/A
999
999
53


7. Did any of them ignore or refuse to believe
you about it? 1 0 999
8. Did any of them blame you when [incident]? 1 0 999
9. That [first/particular] period of time in your life when [incident],
when you were living with (NAME ADULTS LISTED ABOVE),
how long did it last ____________(months)
10. Were there any other times when [incident]? 1 0
(IF NO, GO TO NEXT INTERVIEW QUESTION IF YES, CONTINUE ON
NEXT PROBE 1 SHEET).
Probe 1-1
54


PROBE 2
FREQUENCY CARD
NEVER
ABOUT A QUARTER OF THE TIME
ABOUT HALF OF THE TIME
ABOUT THREE QUARTERS OF THE TIME
NEARLY ALL OF THE TIME
Rev. 4/95
55


PROBE 2
WHO DID IT? CARD
1 - Mother
2 - Father
3 - Stepfather, stepmother (or parents boyfriend,
girlfriend)
4 - Older brother, sister, stepbrother, stepsister
who was taking care of you
5 - Grandparents or other relatives
6 - Adults in foster home, group home, proctor
home or other place where you lived
7 - Friend, neighbor, other adult acquaintance
8 - Teacher
9 - Baby Sitter
0 - Stranger/Other Rev 4/95
56



PROBE 2
SUBJECT #_______
QUESTION #______
OCCURRENCE #______
1. Tell me who did that. (SHOW PROBE 2
WHO DID IT? CARD, COMPLETE 1234567890
ONE PROBE PER PERPETRA TOR).
2. How old were you when that person first did this? ___(yrs.)
How old were you the last time that person did this? (yrs.)
4. About how many times did that person do this?________
(IF UNCLEAR, SAY WELL, LIKE WAS IT
ONCE,OR THREE OR FOUR TIMES, OR TEN,
OR A HUNDRED,OR A THOUSAND TIMES?
JUST TRY TO GIVE ME YOUR BEST ANSWER. )
5. When [person] did that, how often was [he/she] using drugs
or drunk when it happened? 0 1 2 3 4 999
(SHOW FREQUENCY CARD.DONT
EXPLAIN SAY, JUST TRY TO GIVE ME
YOUR BEST ANSWER. SHOWCARD
WITHOUT 999 BUT ALLOW 999).
6. Sometimes kids who get treated that way feel a 0 12 3 4
need to drink alcohol or use drugs. How often did
you happen to be drunk, high, or using drugs at that
particular time when that happened?
(DONTEXPLAIN, SAY, JUST TRY TO GIVE
ME YOUR BEST ANSWER. SHOW FREQUENCY
CARD. FORCE ANSWER, DONT ALLOW 999). Probe 2 1
57


YES NO
N/A
7. Were any other adults who should have been taking
care of you then aware that [this person] did that?
(IF NO OR I DONT KNO,; CIRCLE 999 1 0 999
ON QUESTIONS 8, 9,10, AND SKIP TO
QUESTION 11).
8. Did any of them try to help you? 1 0 999
9. Did any of them ignore or refuse to believe
you about it? 1 0 999
10. Did you get blamed by any of them for
what happened? 1 0 999
(FOR INTERVIEW QUESTIONS 17-23, SKIP TO QUESTION 14).
11. Did you have any injuries like... (ASK EACH AND CIRCLE NUMBER) ?
Bruises(l)
Welts or red marks(2)
Blisters(3)
Bleeding(4)
Broken bones(5)
Scars(6)
Knocked out/ unconscious(7)
No injuries (0)
Yes No N/A
12. Did you ever go to a doctor, emergency room, or a hospital for this? 1 0 999
13. Do you think you ever should have been taken to a doctor, emergency room or hospital for this? 1 0 999
14. Did anybody else ever do this to you? Yes (1) No (0)
(IF NO, GO TO NEXT INTERVIEW QUESTION.
IF YES, CONTINUE ON NEXT PROBE 2 SHEET) Probe 2-2
58


PROBE 3
Section 3 Card
You were Other person was
A. Younger than 12 yrs. Old AND More than 2 yrs. older than you
-OR-
B. You were 12-13 yrs. old AND More than 3 yrs. older than you
-OR-
C. You were 14-16 yrs. old AND More than 4 yrs. older than you
-OR-
D. You felt uneasy with that, or didnt want that done, or were
forced into it.
-OR-
E. The other person was responsible for taking care of you, like a
teacher, baby sitter, camp counselor, or relative.
FREQUENCY
0 - NEVER
1 - ABOUT A QUARTER OF THE TIME
2 - ABOUT HALF OF THE TIME
3 - ABOUT THREE QUARTERS OF THE TIME
4 - NEARLY ALL OF THE TIME rev. 4/95
59


PROBE 3
Who did it? Card
1 - Mother
2 - Father
3 - Stepfather, stepmother (or parents boyfriend
or girlfriend)
4 - Older brother, sister, stepbrother, stepsister
who was taking care of you
5 - Grandparents or other relatives
6 - Adults in foster home, group home, proctor
home or other place where you lived
7 - Boyfriend, girlfriend
8 - Teacher
9 - Baby Sitter
0 - Stranger, friend, neighbor, or other rev 4/95
60


PROBE 3
SUBJECT #____
QUESTION #___
1. During any of the times that this happened to you were
any of these things true? (SHOWSECTION 3 CARD)
Yes No
You were younger than 12 and the other person was more than 2 years older than you? 1 0
-or-
You were 12-13 and the other person was more than 3 years older than you? 1 0
-or-
You were 14-16 and the other person was more than 4 years older than you? 1 0
-or-
You felt uneasy with that, or didnt want that done, or were forced into it. 1 0
-or-
The other person was responsible for taking care of you, like a teacher, baby sitter, camp counselor, or 1 0
relative.
(SKIP REST OF PROBE IF ALL NO ABOVE)
READ: The following questions are only about situations that fit the
description on this card.
How many times did that happen when any of the things on
the card were true?
3. Just thinking of those times when the things on the card were true,
how old were you when that first happened? _________yrs.
4. How old were you when that last happened? _________yrs.
Probe 3-1
61


5. Just thinking of the times when the things on the card
were true, how many people have done that?
6. Who were these people? 1234567890
(SHOW WHO DID IT? CARD)
1. Of the people on the card who did this, were any of them
of the opposite sex? 1 0
8. Were any of them of your same sex? 1 0
9. How often was the other person drunk, high, or
Using drugs when that happened? 0 1 2 3 4 999
SHO W FREQUENCY CARD
10. Sometimes kids who get treated that way feel a need
to drink alcohol or use drugs. Now just think of those
same times. How often did you happen to be drunk,
high, or using drugs when that happened? 0 12 3 4
(DON'T EXPLAIN, SAY, JUST TRY TO GIVE ME
YOUR BEST ANSWER. SHOW FREQUENCY
CARD. FORCE ANSWER, DONT ALLOW 999).
Yes No N/A
11. Were any other adults who should have been taking
Care of you then, aware that this ever happened?
(IF NO OR I DONT KNOW, CIRCLE 999 1 0 999
ON QUESTIONS 12,13,14).
12. Did any of them try to help you?
13. Did any of them ignore it or refuse to believe
you about it?
1
999
1 0 999
14. Did you get blamed by any of them for what
Happened?
1 0 999
Probe 3 2
62


FOR QUESTION 51:
HOW I WAS AFFECTED BY THESE EXPERIENCES:
1
2
3
4
5
6
7
8
9
0
Its one reason for my taking drugs or drinking
alcohol.
It is harder for me to trust other people and have good
relationships with them.
I am more angry or violent now.
It caused me to harm myself or try suicide.
I am more depressed, nervous or anxious now.
I have more aches and pains, health problems or
illnesses now.
It caused me to skip school more or do worse in school.
I ran away more.
It didnt affect me.
Other. rev. 4/95
63


REFERENCES
American Psychiatric Association. (2000). Fourth diagnostic and statistical manual of
mental disorders (DSM-IV) (Text Revision). Washington, D.C: American Psychiatric
Association.
Brown, G.R., & Anderson, B. (1991). Psychiatric morbidity in adult inpatients with
childhood histories of sexual and physical abuse. American Journal of Psychiatry,
148(1), 55-61.
Center for Disease Control and Prevention. (2006). Understanding Child Maltreatment:
Fact Sheet. Retrieved November 28, 2007, from the Center for Disease Control
website: http://www.cdc.gov/ncipc/dvp/CMP/child maltreatment.htm
Clemmons, J.C., Walsh, K., DiLillo, D., & Messman-Moore, T.L. (2007). Unique and
combined contributions of multiple child abuse types and abuse severity to adult
trauma symtomatology. Child Maltreatment, 12(2), 172-181.
Cottier, L.B., Schuckit, M.A., Helzer, J.E., Crowley, T.J., Woody, G., Nathan, P., et al.
(1995). The DSM-IV field trial for substance use disorders: Major results. Drug and
Alcohol Dependence, 38, 59-69.
Crowley, T.J., Mikulich, S.K., Ehlers, K.M., Hall, S.K., & Whitmore, E.A. (2003).
Discriminative validity and clinical utility of an abuse-neglect interview for adolescents
with conduct and substance use problems. American Journal of Psychiatry, 160(8),
1461-1469.
Crowley, T.J., Young, S.E., Raymond, K.M., Mikulich-Gilbertson, S.K., & Rhea, S.A.
(2008, in review). Multi-year stability of abuse-neglect self-reports: Adolescents with
serious conduct and substance problems. Child Abuse and Neglect.
Drezett, J., Caballero, M., Juliano, Y., Prieto, E.T., Marques, J.A., & Fernandes, C.E.
(2001). Study of mechanisms and factors related to sexual abuse in female children
and adolescents. Jornal de Pediatria (Rio J), 77(5), 413-419.
Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. (2005). The Victimization of children
and youth: A comprehensive, national survey. Child Maltreatment, 10(1), 5-25.
64


Fisher, P.W., Shaffer, D., Piacentini, J.C., Lapkin, J., Kafantaris, V., Leonard, H., et al.
(1993). Sensitivity of the Diagnostic Interview Schedule for Children, 2nd edition (DISC
2.1) for specific diagnoses of children and adolescents. Journal of the American
Academy of Child and Adolescent Psychiatry, 32(3), 666-673.
Fromm, S. (2001). Total estimated cost of child abuse and neglect in the United States:
Statistical evidence. Chicago, IL: Prevent Child Abuse America. Retrieved November
28, 2007, from the Prevent Child Abuse America website:
http://www.preventchildabuse.org/learn more/research docs/cost analvsis.pdf
Higgins, D.J. (2004). The importance of degree versus type of maltreatment: A cluster
analysis of child abuse types. Journal of Psychology, 138(4), 303-324.
Hollingshead, A.B. & Redlich, R.C. (1958). Social class and mental illness: A community
study. New York: Wiley.
Holmes, W.C., & Sammel, M.D. (2005). Brief communication: Physical abuse of boys and
possible associations with poor adult outcomes. Annals of Internal Medicine, 143(8),
581-586.
Kaplan, S.J., Pelcovitz, D., Salzinger, S., Weiner, M., Mandel, F.S., Lesser, M.L., etal.
(1998). Adolescent physical abuse: Risk for adolescent psychiatric disorders.
American Journal of Psychiatry, 155(1), 954-959.
Leeb, R.T., Paulozzi, L.J., Melanson, C., Simon, T.R., & Arias, I. (2008). Child
Maltreatment Surveillance: Uniform Definitions for Public Health and Recommended
Data Elements. Atlanta, GA: US Department of Health and Human Services, Centers
for Disease Control and Prevention, National Center for Injury Prevention and Control.
MacMillian, H.L., Fleming, J.E., Streiner, D.L., Lin, E., Boyle, M.H., Jamieson, E., et al.
(2001). Childhood abuse and lifetime psychopathology in a community sample.
American Journal of Psychiatry, 758(11), 1878-1883.
Pagare, D., Meena, G.S., Jiloha, R.C., & Singh, M.M. (2005). Sexual abuse of street
children brought to an observation home. Indian Pediatrics, 42, 134-139.
Sedlak, A.J., & Broadhurst, D.D. (1996). Third National Incidence Study of Child Abuse
and Neglect (NIS-3). Washington, DC: US Department of Health and Human
Services, Administration on Children, Youth and Families, National Center on Child
Abuse and Neglect.
65


Shaffer, D., Fisher, P., Lucas, C.P., Dulcan, M.K., & Schwab-Stone, M.E. (2000). NIMH
Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description,
differences from previous versions, and reliability of some common diagnoses. Drug
and Alcohol Dependence, 38, 28-38.
Schenkel, L.S., Spaulding, W.D., DiLillo, D. & Silverstein, S.M. (2005). Histories of
childhood maltreatment in schizophrenia: Relationships with premorbid fundtioning,
symptomatology, and cognitive deficits. Schizophrenia Research, 76, 273-286.
SPSS Inc. (2006). SPSS Base 15.0 for Windows User's Guide. Chicago, IL: Author.
Stallings, M.C., Corley, R.P., Hewitt, J.K., Krauter, K.S., Lessem, J.M., Mikulich, S.K., etal.
(2003). A genome-wide search for Quantitative Trait Loci influencing substance
dependence vulnerability in adolescence. Drug and Alcohol Dependence, 70, 295-
307.
Tyler, K.A., & Cauce, A.M. (2002). Perpetrators of early physical and sexual abuse
among homeless and runaway adolescents. Child Abuse and Neglect, 26, 1261-1274.
U.S. Department of Health and Human Services, Administration on Children, Youth and
Families. (2008). Child Maltreatment 2006. Washington, DC: U.S. Government
Printing Office.
Wang, C.T., & Holton, J. (2007). Total estimated cost of child abuse and neglect in the
United States. Chicago, IL: Prevent Child Abuse America. Retrieved October 7, 2008,
from the Prevent Child Abuse America website:
http://member.Dreventchildabuse.ora/site/DocServer/cost analysis.pdf?doclD=144
66