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The CECA has been published over a number of years in different research contexts. The list below summarises those of the CATS centre (formerly Lifespan Research Group).


Wednesday's Child: Research into Women's Experience of Neglect and Abuse in Childhood and Adult Depression

A book by Antonia Bifulco and Patricia Moran

Synopsis
As many as one in four women have suffered neglect or abuse in childhood, doubling the likelihood of their suffering clinical depression in adult life. Based on twenty years of systematic research, this book examines the reasons why neglect and abuse occur and demonstrates how such negative experience in childhood often results in abusive adult relationships, low self-esteem and depression. Through the words of many ordinary women interviewed in the course of the research the authors show vividly what can be learned from the experience of adult survivors of abuse. Most importantly, this book assesses the factors which can reduce the later impact of such experience on both the children of today and the parents of tomorrow.


Published papers
and Research abstracts

The Childhood Experience of Care and Abuse Questionnaire (CECA.Q) - Validation in a community series
Bifulco A et al. British Journal of Clinical Psychology, (2005) 44: 563-581

Exploring Psychological Abuse in Childhood: I. Developing a New Interview Scale
Moran P M et al. Bulletin of the Menninger Institute (2002), vol 66(3), 213-240

Exploring Psychological Abuse in Childhood: II. Association with Other Abuse and Clinical Depression
Bifulco A et al. Bulletin of the Menninger Institute (2002), vol 66(3) 240-258


Childhood adversity, parental vulnerability and disorder: Examining inter-generational transmission of risk
Bifulco A et al. Journal of Child Psychology and Psychiatry (2002) 43, 1075-1086


Childhood social arena and cognitive sets in eating disorders: A preliminary investigation
Nicholas A. Troop & Antonia Bifulco British Journal of Clinical Psychology; (2002) 41: 205-21

Memories of childhood neglect and abuse. Corroboration in a series of sisters
Bifulco A et al. Journal of child psychology and psychiatry, (1997) 38: 365-374


Childhood Experience of Care and Abuse (CECA): A retrospective interview measure.
Bifulco A et al. Journal of Child Psychology and Psychiatry (1994), 35 (8), 1419-1435


THE CHILDHOOD EXPERIENCE OF CARE AND ABUSE QUESTIONNAIRE (CECA.Q) - VALIDATION IN A COMMUNITY SERIES
A. Bifulco, O. Bernazzani, P.M. Moran & C. Jacobs
British Journal of Clinical Psychology, (2005) 44: 563-581

Background
Childhood neglect and abuse as measured by retrospective interview, is highly predictive of psychiatric disorder in adult life and has an important role in etiological models. However, such measures are labour-intensive, costly and thus restricted to relatively modest sample sizes. A compact self-report assessment of childhood experience is invaluable for research screening purposes and large-scale survey investigation.
Method
A self-report questionnaire (CECA.Q) was developed to mirror an existing validated interview measure: the Childhood Experience of Care and Abuse (CECA). The questionnaire assessed lack of parental care (neglect and antipathy), parental physical abuse, and sexual abuse from any adult before age 17. A high-risk series of 179 London women were interviewed using the CECA together with the PSE psychiatric assessment, and completed the CECA.Q at later follow-up. Repeat CECA.Qs were returned for 111 women and 99 women additionally completed the Parental Bonding Instrument (PBI) (Parker et al., 1979).
Results
Satisfactory internal scale consistency was achieved on the CECA.Q for antipathy (alpha=0.81) and neglect (alpha=0.80) scales. There was satisfactory test-retest for both care and abuse scales. Significant associations were found between CECA.Q scales and the parallel interview scales with cut-offs determined for high sensitivity and specificity. CECA.Q neglect and antipathy scales were also significantly related to PBI parental care. CECA.Q scales were significantly related to lifetime history of depression. Optimal cut-off scores revealed significant odds ratios (average of 2) for individual scales and depression. When indices were compiled to reflect ‘peak’ severity of each type of adversity across perpetrator, odds-ratios increased (average 3). A 'dose -response' effect was evident with the number of types of neglect/abuse and rate of lifetime depression.
Conclusion
The CECA.Q shows satisfactory reliability and validity as a self-report measure for adverse childhood experience. The merits of having parallel questionnaire and interview instruments for both research and clinical work are discussed.

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EXPLORING PSYCHOLOGICAL ABUSE IN CHILDHOOD: I. DEVELOPING A NEW INTERVIEW SCALE
P.M. Moran, A. Bifulco, C. Ball, C.Jacobs & K. Benaim
Bulletin of the Menninger Institute (2002), vol 66(3), 213-240

Abstract

Definitions of psychological abuse are reviewed and a new definition proposed, operationalized as an extension of an existing measure of childhood, the Childhood Experience of Care and Abuse (CECA). This semi-structured, investigator-based interview is designed for use with adults to collect retrospective accounts of childhood adverse experience. The CECA extension identifies nine subtypes of psychological abuse, with a single global severity rating. The definition is clearly differentiated from other adverse experiences with emotionally abusive elements such as parental antipathy (hostile parenting), neglect and role-reversal and examples are given. A community-based series of 301 women were interviewed using the extended CECA to gather a range of experiences of childhood maltreatment on which to devise the new measure. Inter-rater reliability was satisfactory, and several features of psychological abuse were examined, including its prevalence, frequency and the characteristics of the abused child and perpetrator. The new scale is discussed in terms of its potential use not only by researchers, but also by practitioners such as clinicians and social workers in the child protection field, in order to more accurately identify and assess multiples of abuse in childhood. A companion paper (Bifulco, Moran, Baines, Bunn & Stanford, submitted) examines the relationship of psychological abuse to adult major depression.

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EXPLORING PSYCHOLOGICAL ABUSE IN CHILDHOOD
II. ASSOCIATION WITH OTHER ABUSE AND ADULT CLINICAL DEPRESSION
A. Bifulco, P.M. Moran, R.Baines, A. Bunn & K. Stanford
Bulletin of the Menninger Institute (2002), vol 66(3) 240-258

Abstract
A new retrospective interview assessment of childhood psychological abuse, an extension to the Childhood Experience of Care and Abuse (CECA) instrument, is described in a companion paper (Moran, Bifulco, Ball, Jacobs & Benaim, submitted). The purpose of the present paper is to examine its relation to other adverse childhood experiences and to major depression and suicidal behavior in adult life. Childhood experience and lifetime disorder was assessed retrospectively in a high-risk, community series of London, UK women (N=204). Psychological abuse from parents was examined in relation to seven other parental behaviors (neglect, antipathy, role- reversal, discipline, supervision, physical and sexual abuse). Psychological abuse was significantly related to all, the highest associations found were with antipathy (gamme=.76), neglect (.73) and sexual abuse (.72). Factor analysis showed the existence of two factors reflecting care and control with psychological abuse associated with both factors. Childhood psychological abuse was highly related to chronic or recurrent adult depression with a 'dose-response' evident for severity of abuse the rates from 83% for 'marked' to 55% for 'mild' abuse and 37% 'little/no' psychological abuse (p<0.002). Psychological abuse was also related to lifetime suicidal behavior but here any level of abuse from marked to mild having similar rates (36% overall versus 18% with no psychological abuse, p<0.04). There was no evidence of specificity of childhood experience to adult depression, nearly all types of childhood adversity examined were significantly related. An analysis using an index of multiple abuse including psychological abuse showed a clear dose-response relationship to disorder. Somewhat fewer forms of maltreatment related to suicidal behavior, but again multiples showed a clear dose-response effect.


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CHILDHOOD ADVERSITY, PARENTAL VULNERABILITY
AND DISORDER:
EXAMINING INTER-GENERATIONAL TRANSMISSION OF RISK
A. Bifulco*, P.M. Moran, C. Ball, C. Jacobs, R. Baines, A. Bunn & J. Cavagin

Journal of Child Psychology and Psychiatry (2002) 43, 1075-1086


Abstract
Background
An investigation of intergenerational factors associated with psychiatric disorder in late adolescence/early adulthood was undertaken to differentiate influences from maternal disorder, maternal poor psychosocial functioning and poor parenting on offspring.
Method
The sample comprised an intensively studied series of 276 mother-offspring pairs in a relatively deprived inner-city London area with high rates of lone parenthood and socio-economic disadvantage. The paired sample was collected over two time periods: first a consecutively screened series of mothers and offspring in 1985-90 (n=172 pairs) and second a 'vulnerable' series of mothers and offspring in 1995-99 (n=104 pairs). The vulnerable mothers were selected for poor interpersonal functioning and/or low self-esteem and the consecutive series were used for comparison. Rates of childhood adversity and disorder in the offspring were examined in the two groups. Maternal characteristics including psychosocial vulnerability and depression were then examined in relation to risk transmission.
Results
Offspring of vulnerable mothers had a fourfold higher rate of yearly disorder than those in the comparison series (43% vs. 11%, p<0.001). They were twice as likely as those in the comparison series to have experienced childhood adversity comprising either severe neglect, physical or sexual abuse before age 17. Physical abuse, in particular, perpetrated either by mother or father/surrogate father was significantly raised in the vulnerable group. Analysis of the combined series showed that maternal vulnerability and neglect/abuse of offspring provided the best model for offspring disorder. Maternal history of depression had no direct effect on offspring disorder, its effects were entirely mediated by offspring neglect/abuse. Maternal childhood adversity also had no direct effect.
Conclusion
Results are discussed in relation to psychosocial models of risk transmission for disorder. Maternal poor psychosocial functioning needs to be identified as a factor requiring intervention in order to stem escalation of risk across generations.

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CHILDHOOD SOCIAL ARENA AND COGNITIVE SETS IN EATING DISORDERS: A PRELIMINARY INVESTIGATION
Nicholas A. Troop* & Antonia Bifulco
British Journal of Clinical Psychology; (2002) 41: 205-21


Dr Nicholas A. Troop, Department of Psychology, London Guildhall University, Calcutta House, Old Castle Street, London E1 7NT; e-mail ntroop@lgu.ac.uk

Abstract
Objective
While there is much evidence to suggest that women with eating disorders experience difficulties in the social domain, little has been done to establish whether such difficulties play a causal role or the extent to which these involve cognitive factors. The purpose of this report is to determine whether difficulties in certain aspects of the childhood social arena are reported as existing prior to developing an eating disorder.
Method
43 women with a history of eating disorders and 20 women with no such history were interviewed retrospectively about their feelings and experiences of loneliness, shyness and inferiority in childhood and adolescence.
Results
Women with a history of anorexia nervosa of the binge/purge subtype reported higher levels of loneliness, shyness and feelings of inferiority in adolescence than did women with no history of an eating disorder and women with a history of bulimia nervosa reported higher levels of shyness. However, this was not true for earlier childhood where such feelings did not differ significantly between groups. This difference could not be accounted for by current depressive disorder, recovery from the eating disorder or level of victimisation in adolescence.
Conclusion
There are a number of differences in the aetiology of subtypes of eating disorder. The present results suggest that cognitive styles pertaining to the social arena in adolescence, and prior to the onset of any eating disorders, may play a causal role in the development of anorexia nervosa of the binge/purge subtype but not anorexia nervosa of the restricting subtype.

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MEMORIES OF CHILDHOOD NEGLECT AND ABUSE. CORROBORATION IN A SERIES OF SISTERS
Bifulco A, Brown GW, Lillie A & Jarvis J
Journal of child psychology and psychiatry (1997) 38: 365-374


Abstract
Reports from 87 community-based sister-pairs, selected for high rates of neglect or abuse in childhood, have been used to establish validity of the CECA, a retrospective interview measure of childhood experience. Corroboration was based on independent assessments of sisters’ accounts of what happened to each other in childhood. Corroboration of scales assessing parental neglect, physical abuse in the household, and sexual abuse (either household or non-household) was satisfactory, with a mean correlation for the three experiences of .60 (weighted kappa).
Concordance reflected the degree to which the experience was shared and was judged by comparing the sisters’ accounts of their own experience. Among sisters with shared (concordant) experience for neglect or abuse, corroboration was high (mean of .74) but for those with non-shared (nonconcordant) experience it was largely absent (mean of .01). The degree to which experiences of neglect or abuse were concordant was related to whether the perpetrator was a member of the household. Neglect and physical abuse were by definition from household members (mainly parents) and involved high concordance of experience. Sexual abuse occurred from many sources and in practice was commonly from an adult living outside the household and such experiences were less likely to be shared by sisters. An overall index indicating the experience of at least one abusive experience before the age of 17 showed a concordance of .64 with corroboration between sisters as high as .70. Issues involving retrospective recall and measurement are discussed.

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CHILDHOOD EXPERIENCE OF CARE AND ABUSE (CECA): A RETROSPECTIVE INTERVIEW MEASURE
A, Bifulco, GW Brown and T.O. Harris
Journal of Child Psychology and Psychiatry(1994) 35 (8) 1419-1435


Abstract
The development of a retrospective, investigator-based interview measure of Childhood Experience of Care and Abuse (CECA) used with two community samples of adults in London, is described. The component ratings are shown to have satisfactory inter-rater reliability and also validity as determined by agreement between sisters’ independent accounts. The association between different childhood scales is explored, as well as the relationship of childhood experiences to adult depression. Methodological issues concerning investigator-based versus respondent-based measures of childhood are discussed and a case made for use of the former. Advantages of using the CECA, a retrospective, time-based measure of childhood, are outlined.

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