Pediatric Annals

Adolescent Parenting: Potential for Child Abuse and Neglect?

Olle Jane Z Sahler, MD

Abstract

A recurrent theme among professionals who work in the area of child protection is that the potential for abuse and neglect is inversely related to the age of the parents - that is, younger parents are more likely to be abusive and neglectful than older parents. As the birth rate among adolescents less than 15 years of age increases and, therefore, the age of young mothers continues to decrease, more systematic attention must be directed toward evaluating the young mother's ability to be an effective parent. Indeed, good parenting - or warm, consistent, stable, anticipatory care giving - to a dependent infant or child seems an unlikely role for the stereotypical Iy independence-seeking, rebellious, energetic, egocentric adolescent. But is it?

PROBLEMS OF THE ADOLESCENT PARENT

Adolescent parenthood poses several problems and questions for society. For example, is the young teenager really mature and responsible enough to have legal custody of the child and to make major decisions regarding his health care? Is the public-school system obligated to provide day care for infants so that young mothers can have equal access to education through high school? Because these questions apply to only a small segment of the population, society has been slow to resolve these issues. Thus, adolescent parents face certain concerns and stresses that are radically different from those confronting their peers who are not parents.

On another level, however, teenage parents and their families must cope as individuals with the changes in the usual maturational process of adolescence that are created by pregnancy at a young age.

In this article I plan to focus primarily on the teenage girl and discuss her motivations for becoming pregnant and her choice of married or single parenthood. Within the context of the living arrangement she has selected, we will examine the support systems that are available to her, the effects of these support systems on her perceptions of herself as a parent, and her parenting abilities as measured by objective outcome studies of her children.

Many, many factors contribute to successful or unsuccessful parenting. Thus, it is important to remember that the studies presented here represent research findings in small, well-defined populations; the results cannot be generalized to apply to every young mother in every community. The individual experiences of some pediatricians may be quite different from those reported here, depending on the context in which they work with teenage parents. It is clear, however, that the data are limited and much more needs to be learned about the adolescent as a mother.

There are no factors that conclusively discriminate between the mother who is potentially adequate and the one who is potentially inadequate, regardless of her age. A constellation of certain factors, however, can provide insight and make it possible to predict which mother-child relationships are likely to be "high-risk" for potential abuse or neglect and which relationships are not.

MOTIVATIONS FOR PREGNANCY

The motivations behind teenage pregnancy and the changes in family dynamics that occur during pregnancy form a background in which to view the adolescent mother. The reasons she had for becoming pregnant and her family's response to that event provide a context that will have an effect on the type of parent she will become.

Some authors have hypothesized that pregnancy in the young adolescent is an acting-out of a hidden wish or a deep-seated conflict often directed towards the parents, especially the mother.1 Such motivation implies chronic estrangement between the adolescent and her parents that predates conception. The pregnancy then becomes a vehicle for complete separation and the establishment of an independent household. A corollary is that…

A recurrent theme among professionals who work in the area of child protection is that the potential for abuse and neglect is inversely related to the age of the parents - that is, younger parents are more likely to be abusive and neglectful than older parents. As the birth rate among adolescents less than 15 years of age increases and, therefore, the age of young mothers continues to decrease, more systematic attention must be directed toward evaluating the young mother's ability to be an effective parent. Indeed, good parenting - or warm, consistent, stable, anticipatory care giving - to a dependent infant or child seems an unlikely role for the stereotypical Iy independence-seeking, rebellious, energetic, egocentric adolescent. But is it?

PROBLEMS OF THE ADOLESCENT PARENT

Adolescent parenthood poses several problems and questions for society. For example, is the young teenager really mature and responsible enough to have legal custody of the child and to make major decisions regarding his health care? Is the public-school system obligated to provide day care for infants so that young mothers can have equal access to education through high school? Because these questions apply to only a small segment of the population, society has been slow to resolve these issues. Thus, adolescent parents face certain concerns and stresses that are radically different from those confronting their peers who are not parents.

On another level, however, teenage parents and their families must cope as individuals with the changes in the usual maturational process of adolescence that are created by pregnancy at a young age.

In this article I plan to focus primarily on the teenage girl and discuss her motivations for becoming pregnant and her choice of married or single parenthood. Within the context of the living arrangement she has selected, we will examine the support systems that are available to her, the effects of these support systems on her perceptions of herself as a parent, and her parenting abilities as measured by objective outcome studies of her children.

Many, many factors contribute to successful or unsuccessful parenting. Thus, it is important to remember that the studies presented here represent research findings in small, well-defined populations; the results cannot be generalized to apply to every young mother in every community. The individual experiences of some pediatricians may be quite different from those reported here, depending on the context in which they work with teenage parents. It is clear, however, that the data are limited and much more needs to be learned about the adolescent as a mother.

There are no factors that conclusively discriminate between the mother who is potentially adequate and the one who is potentially inadequate, regardless of her age. A constellation of certain factors, however, can provide insight and make it possible to predict which mother-child relationships are likely to be "high-risk" for potential abuse or neglect and which relationships are not.

MOTIVATIONS FOR PREGNANCY

The motivations behind teenage pregnancy and the changes in family dynamics that occur during pregnancy form a background in which to view the adolescent mother. The reasons she had for becoming pregnant and her family's response to that event provide a context that will have an effect on the type of parent she will become.

Some authors have hypothesized that pregnancy in the young adolescent is an acting-out of a hidden wish or a deep-seated conflict often directed towards the parents, especially the mother.1 Such motivation implies chronic estrangement between the adolescent and her parents that predates conception. The pregnancy then becomes a vehicle for complete separation and the establishment of an independent household. A corollary is that the pregnant adolescent may see motherhood as a means for greater status and recognition within her family and community when other modes of adult achievement are not attainable.2

These hypotheses have been at least partly substantiated by recent research. In some families experiencing major conflict, a truce phase in motherdaughter relationships during pregnancy has been described, attributable to the mother's apparently greater understanding of and interest in her pregnant daughter.3 In addition, a study of pregnant adolescents in Baltimore by Fischman showed that young women who chose to deliver and keep their babies reported much closer relationships with their mothers than those who chose abortion, at least while pregnant.4 This phenomenon has been generally considered a temporary alteration in the relationship confined to the duration of the pregnancy. However, as discussed below, there may be some longer-term adjustments that extend well into the child-rearing phase. Since, in psychoanalytic terms, one of the primary tasks of the young adolescent is the painful severance of the tie to her mother, such a period of increased allegiance might be considered developmentally maladaptive. It may be, however, that an exception to this theory of maladaptation occurs if the extended tie is used for the ultimate good of the infant and results in positive role identification by the teenager with her own mother.

Fischman also found that the young women who chose to deliver tended to be less educated and more socioeconomically depressed than those who had abortions.4 This finding lends some credence to the suggestion that the role of mother may represent a deliberate attempt by teenagers who have limited resources or creative outlets to increase their sense of self-worth.

MARRIED VS. SINGLE PARENTHOOD

Once a decision has been made to maintain the pregnancy and keep the infant, the teenager and her family are able to consider a number of alternative parenting life styles.

Although a series of complex conscious and unconscious processes are operative in decisions about marriage, two factors, in particular - subcultural expectation and the age of the adolescent - are related to the probability of marriage. Furstenberg and CrawfordSifi found that 70 percent of the white adolescents in their clinic population in Baltimore married when the girl became pregnant, as against 16 percent of the black adolescents. Most other studies of unwed pregnant adolescents confirm this finding of subcultural differences. The black population, however, generally tends to be overrepresented in hospital -based obstetric dinics in large cities where statistics have been gathered. Thus, the true incidence of early pregnancy and marital outcome in white populations is less well known. Despite this obvious limitation of reported studies, it has been suggested that this pattern of single parenthood is consistent with the matriarchal family system prevalent among low-income blacks, among whom successive generations of unmarried or previously married women form the basic family structure.7

Among both white and nonwhite populations, however, older maternal age is associated with an increased frequency of marriage. This age-related effect may be due to the potentially greater ability of the couple to form a stable relationship as well as their ability to attain ultimately greater financial security because of a higher educational level. Both these factors may result in increased family pressure for independence through marriage.

It should be noted that many young black adolescents view marriage as a more serious undertaking than motherhood. Fischman found that very few of the mothers-to-be in her study equated childbearing with marriage. In addition, none of the adolescents reported using pregnancy as a means to force a marriage. Apparently, unlike motherhood, marriage was seen as potentially more confining and, therefore, as a greater interference with such goals as completing high school and participating in the more common adolescent pursuit of fun-loving peer-group interaction. These girls tended to see themselves as too young to make a commitment to marriage and expressed fears that the marriage would either fail or be too stressful.4 Such fears are certainly realistic in view of the twofold greater incidence of divorce among teenage marriages than in the older population.8

On the other hand, similar concerns about motherhood were not mentioned. However, this may reflect the fact that these girls had already made the decision to bear their children. Thus, they either had already resolved their feelings of apprehension about motherhood or had some moral reservations about abortion that removed any element of choice from the decision to be a mother once pregnancy occurred.

SUPPORT SYSTEMS

The perception among these young women of single motherhood as a less confining role than wifehood indicates a high degree of expectation that the extended family will actively participate in her child's care, freeing the teenager for other activities, in fact, Furstenberg and Crawfordfi found that more than 98 percent of unmarried young mothers did indeed live with their families throughout pregnancy. This percentage decreased only slightly, to 88 percent, one year later. Five years after the index pregnancy, 70 percent of nevermarried mothers continued to live with their families. Even married mothers showed a high propensity for remaining with their families of origin. One-half of once-married but now separated or divorced women and 19 percent of currently married women were living with their families of origin five years after the index pregnancy.

As Furstenberg and Crawford noted, young parents who live with the extended family are more likely to be offered and to accept both subtle and overt help from their kin than are those who Jive independently. Such assistance may include room and board, readily available child care, and advice in child rearing. Furthermore, these investigators found that families that were able to accommodate the young mother and her child for extended periods tended to be more financially secure and better educated than the families of teenage mothers living independently. Girls who lived with parents were more likely to receive assistance in care for their children in order to assure a return to school or an opportunity to work outside the home, thus perpetuating the expectation of a continued sound financial status.

Married women, regardless of living arrangement, reported such assistance less frequently than their unmarried counterparts. This may reflect, at least in part, the family's expectation that the husband will provide such support and advice.6 This implicit or explicit expectation of cooperative conjugal effort may well be one reason why young mothers fear marriage, realizing in advance that their boyfriends are unlikely to be as knowledgeable or resourceful as their families in providing help in child rearing.

The ability of the family as a unit to adapt positively to the daughter's motherhood is further substantiated by a recent study by Zuckerman and coworkers* in Boston. The index group consisted of primiparous mothers aged 1 8 years or less. A comparison group was composed of primiparous and multiparous mothers who were at least 21 years old. One finding of the study was that only 8 percent of the young mothers were married and 95 percent of the total group lived with extended family, a highly statistically significant difference between the adolescent and the comparison groups. In addition, they found that, two weeks after delivery, the teenage mothers were significantly more likely to seek their own mothers' advice on numerous issues that were usually discussed by older mothers with health-care professionals. Three months after delivery, the teenagers were more likely to have and to rely on someone else at home for child-care tasks and baby-sitting. Thus, the young woman's expectation that support would be forthcoming was, indeed, justified and confirms the findings of other investigators.

A small but nonetheless significant proportion of young unmarried women choose to live independently. When this occurs, under economically unfavorable or borderline conditions, unresolvable conflict with parents may be one of the most salient motivations. From our previous discussion of the motivations for pregnancy as well as the data suggesting that many families mobilize their available resources in support of the pregnant daughter, it is very likely that this estrangement reflects a longstanding parent-child conflict rather than a reaction to the pregnancy per se. Such estrangement takes its toll not only emotionally but also very practically, since it tends to sever lines of communication and assistance from kin - which, as we have seen, can be very beneficial to the young mother as she develops her parenting skills.

The effect such an estrangement can have on the mother's perception of her infant in this situation is highly variable. For example, the young mother may see the child as the primary determinant for her separation from her family and thus may displace her anger and hostility toward her parents onto her child.10 On the other hand, she may view her infant as her means to independence and thus cherish her child. Only a closer look at each mother-child dyad can provide some insight into the variety of motivations for independent living operative among this group.

Since there are some families that cannot or will not provide the young mother with the kind or extent of assistance with parenting that may be crucial to successful child rearing, a variety of community-based mother-child programs have been developed. Acting as family surrogates, these programs usually offer special classes in child rearing and child care during school hours so that the young mother can continue her education and be reintegrated into her peer group.11·12 From our previous discussion of the various relationships of extended families to young mothers, it can be seen that teenagers may rely on such programs, where available, either to provide an entire support system or to complement the assistance provided by kin. By design, these programs fill exactly the practical and emotional needs that are naturally provided by some extended families.

WHAT KIND OF PARENTS DO TEENAGERS MAKE?

The paucity of data available about teenagers as parents tends to support conflicting views of the quality of their parenting. Zuckerman and colleagues,9 for example, found a study sample of adolescent mothers as likely to breast-feed their infants and as likely to view their children as being easy to handle and enjoyable as did women in the older control group. Attachment and investment were similar in the two groups of mothers during the first three months postpartum,

Shared child rearing did, however, have an effect on the teenager's self-image as a mother. More teenagers were concerned that their infants would be confused about roles within the family, and more teenagers worried about their inability to interpret their infants' needs and wants.9 The kinds of concerns these mothers demonstrated and their ways of coping with external circumstances as shown in this study suggested that they may be more aware of their children, their effects on their children, and their limitations in child rearing than might be anticipated from theories about adolescent development.

Zuckerman et al.9 hypothesized that if the adolescent mother lives with her extended family and perceives it and uses it as a support, her normal developmental needs to move away from her family of origin may be superseded by her need for her family. As noted from Furstenberg and Crawford's study,* this adaptive mechanism of living with kin is one that the teenager can use for an apparently extended period after childbirth. As mentioned earlier, the adolescent is thus possibly at risk for not completing her developmental task of severing her tie with her mother if they align too closely together over the care of the infant. How, or if, this living arrangement does actually interfere with this normal developmental progression of the adolescent into responsible adulthood is not known.

On the other hand, in a study of marital adjustment and parenting among teenagers in a predominantly semirural area of central Pennsylvania, deLissovoy10 found teenagers to be "an intolerant group - impatient, insensitive, irritable, and prone to physical punishment with their children." He also found them to be relatively uninformed about child rearing, although their level of knowledge was not significantly different from age-matched controls' among their high-school counterpane, most of whom had had an additional year of school (10.5 vs. 11. 5 years).

Demographic information provided in the report of this study did not include the ethnic background of these married couples. However, onequarter of the couples lived independently, almost one-half lived with the wife's family, and the rest lived with the families of the husbands. Interestingly, although the couples perceived their parents as being helpful in a variety of ways, especially in helping them to achieve marital stability, they did not find their parents very effective in helping them cope with their children. In particular, the young couples perceived their parents as giving them almost no advice about child rearing. Whether this reflects the apparent tendency of the extended family to expect the married couple to seek information, support, or other resources from each other, as mentioned previously, or whether this is an ethnically determined coping style is an area requiring further research.

Child abuse. Several epidemiologie studies have shown that abuse of children of teenage parents does occur.13"16 The incidence, surprisingly, appears to be similar to that found among parents who are in their late 30s or older, despite the emphasis in the lay press on adolescents who are abusive parents. By far the greatest incidence of child abuse occurs in families whose parents are in their mid- to late 20s. This finding is consistent with the fact that this is the primary childbearing and childrearing age.

Lauer and co-workers16 found that abusive parents tended to be somewhat younger than nonabusive parents of similarly aged children admitted to the same hospital for other reasons mothers: 22. 5 years vs. 26. 5 years; fathers: 25. 2 years vs. 29 years). Although the median age of the abused children was 20 months in the study by Lauer et al. and that of the controls 24 months, there were no data concerning the ordinal position of the abused child within the family or the ages of his siblings. Thus, one cannot determine from the study what age the parents were at the time their first child was born. Although it is not entirely satisfactory to focus on the median ages of the parents and of their abused children, it does appear that the children in this study were born to mothers who, on the average, became pregnant at about 20 years of age.

Why is there an increase of abusive parenting in early adulthood? Opportunity is certainly a factor. However, very young adolescent parenting, by itself, is not necessarily the prime factor in this high proportion of abusing parents in their early 20s.

Solomon,17 in his demographic review, reported that the overwhelming majority of abusive parents were married, living together, and socially isolated. A large proportion of abused children were conceived out of wedlock, an event that commonly resulted in forced marriages.

Earlier it was stated that the expectation for marriage increases with age. This is true regardless of whether or not the marriage is precipitated by pregnancy. As we have also seen, marriage is positively associated with independent living.

American society has generally been accepting of marriage and childbearing that occur immediately after high school , commonly at age 1 7 or 1 8 years. Since one or both parents have finished high school or obtained occupational skill, it is more likely that these couples will form independent households and that they will actually receive less overall parental support, both financially and through assistance in child rearing, than will their younger counterparts. This may place them at greater risk for potential abuse if they experience stress from the effects of forming an independent household and child rearing almost simultaneously.

In this context, it might be hypothesized that there is a protective element in early child rearing if it occurs within the context of a supportive extended family. Very young age may actually insulate the teenage mother from a forced marriage, financial insecurity, isolation, and full-time parenting in the face of little or no experience. This certainly appears to be a possibility for mothers and their young infants.9 We have no data yet about the outcome of these children during later childhood and adolescence.

Child neglect. Whereas overt child abuse has been reasonably well defined, neglect, also a form of serious parental dysfunction, is more insidious except in its most blatant forms. The distinction between laissez-faire parenting and neglect may be difficult. The poorly defined personal identity of the adolescent, her inability to anticipate the needs of others, and her egocentricism - all developmentally normal characteristics - may put her at increased risk for neglectful parenting.

A study of second-grade students by Stone and Rowley18 uncovered some interesting correlations between maternal age at delivery and the kinds of school problems manifested by sons. Boys born to younger mothers (median age 24.8 years at delivery) tended to have "conduct problems" (overexpression of impulses), whereas boys born to older mothers (median age 27.3 years at delivery) tended to have "personality problems" (overinhibition of impulses). Interestingly, a similar correlation was not found among daughters.

Children's impulsivity often reflects ineffective or inconsistent parental control. Although the study did not focus on the teenage mother, by extrapolation it can be hypothesized that the impulsive adolescent may actually foster more of this kind of behavior in her offspring because of her inability to focus sustained attention on her child or to anticipate the consequences of her child's behavior. At present, there are no data to either substantiate or deny this hypothesis. (Since the vast majority of children of teenage mothers are raised within the extended family and thus appear to be significantly influenced by the maternal grandmother, such an inference may be entirely erroneous. Indeed, the role of the grandmother has been studied primarily through the eyes of the young mother4·9 but is worthy of direct investigation if we are to fully understand her, her daughter, and her grandchild.)

Is a teenage mother, by simple virtue of her age, at increased risk of becoming an abusing or neglecting parent? The question is still open to debate. Too many variables influence the success or failure of the young mother's nontraditional developmental pattern for this issue to be easily resolved.

Research in this area must focus on defining more clearly the role of age, per se, in parenting. This will require large sample populations, with adequate controls for ethnic background, extended-family relationships, living arrangements, marital status, educational level, financial resources, and motivation for pregnancy as well as for the physical health and delivery of the infant.

Parenting is an extremely complex subject. We are now only at the earliest stage of understanding what makes some persons effective and others ineffective as parents.

REFERENCES

1. Young, L. OMÍ of Wedlock. New York: McCraw-Hill, 1954.

2. Vincent, C. Unmarried Mothers. New York: Free Press of Glene oe, 1961.

3. Barglow, P., et al. Some psychiatric aspects of illegitimate pregnancy in early adolescence. Am. /. Orthopsychiatry 38 (1968), 672-687.

4. Fischman, S. Delivery or abortion in inner-city adolescente. Am. ]. Orthopsychiatry 47 (1977), 127-133.

5. Furetenberg, F. Unplanned Parenthood. New York: Free Press, 1976.

6. Fursienberg, F., and Crawford, A. Family support: helping teenage mothers to cope. Farn. Plann. Perspect. 10 (1978), 322-333.

7. Ladner, J. Tomorrow's Tomorrow: The Black Woman. Garden City, N.Y. : Doubleday & Company, 1971.

8. National Center for Health Statistics, DHEW. Teenagers: marriage, divorces, parenthood, & mortality. Vital and Health Statistics Series 21 (1974), 18.

9. Zuckerman, B., Winsmore. G., and Alpert, J. A study of attitudes and support systems of inner city adolescent mothers. /. Pediatr. 95 (1979), 122-125.

10. deLissovoy, V. Child care by adolescent parents. Chad. Today 2 (1973), 22-25.

11. Levenson, P. M., et al. A parent program serving teenage mothers and their high risk infants. Child. Today 7 (1978), 11-15.

12. Osofsky, H. J., and Osofsky, J. D. Adolescents as mothers - results of a program for low-income pregnant teenagers with some emphasis upon infants' development. Am, /. Onhopsychiatry 40 (1970), 825-834.

13. Gil, D. Incidence of child abuse and demographic characteristics of persons involved. In Heifer, R., and Kempe, C. (eds.t: The Battered Child. Chicago: University of Chicago Press, 1968.

14. Johnson, B., and Morse, H. Injured children and their parents. Children 15 (1968), 147-152.

15. Justice, B., and Justice, R. The Abusing Family. New York: Human Science Press, 1976.

16. Lauer, B., Ten Broeck, E., and Grossman, M. Battered child syndrome: review of 130 patients with controls. Pediatrics 54 (1974), 67-70.

17. Solomon, T, History and demography of child abuse. Pediatrics 51 (1973), 773-776.

18. Stone, F., and Rowley, V. Children's behavior problems and mother's age. J. Psychol. 63 (1966), 229-233.

10.3928/0090-4481-19800301-09

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