Developmental Problems of Maltreated Children and Early Intervention Options for Maltreated Children. Background


Awareness of the negative consequences of early child maltreatment calls for the continued development of intervention programs for young children and their families (Kaplan, Pelcovitz, & Labruna, 1999). Both prevention and intervention programs are necessary components in enhancing the development of children.

Prevention programs, timed to take place before the appearance of undesirable outcomes, are important because they have the potential to decrease the number of child maltreatment victims and avoid a number of associated problems (Braden & Hightower, 1998). Prevention efforts such as home visitation programs, parent education programs (with or without home visits), and comprehensive early education programs that use a number of therapeutic components (e.g., parent education, child individual and group therapy, social support, etc.) are directed toward families at risk. Risk is variably defined, although common examples of child risk factors include low birth weight, presence of a single parent, financial disadvantage, and low-educated or young mothers (or both). Of important interest, home visitation programs (Heinicke, Fineman, Ponce, & Gutherie, 2001; Olds, Henderson, Chamberlain, & Tatelbaum, 1986, 1988; Olds, Henderson, Kitzman, & Cole, 1995; ) as well as parent education intervention and comprehensive early education programs (Cowen, 2001; Reynolds, Temple, & Ou, 2003) have demonstrated success in improving parental sensitivity, educating parents about child development, and ultimately reducing cases of maltreatment. In some cases, these home visitation prevention programs produce long-term effects, for example, positive results 15 years after the program (Olds, et al., 1997).

Intervention programs, in contrast, take place after the maltreatment (and its consequent negative effects) is revealed (Braden & Hightower, 1998). A strength of intervention programs is that they can be directed at children and families who already demonstrate problematic functioning, thus increasing the efficiency with which limited treatment resources are distributed (Offord & Bennett, 1994). In this way, more of the children who actually need help receive assistance and corrective support. As discussed in Part 1, maltreated children younger than the age of 3 display a number of medical, physical, cognitive, social, and emotional problems. Although it is not known whether these problems are caused by the maltreatment itself, evidence suggests that these early problems impair important areas of functioning and that their effects can be long lasting. Early intervention efforts are needed to address these problems and keep them from further disrupting other developmental achievements. Reynolds et al. (2003) defined early childhood intervention as the provision of educational, family, health, and/or social services in the first five years of life to children at risk of poor outcomes due to socioenvironmental disadvantages or developmental disabilities (p. 634). Using this definition, the early intervention programs and psychotherapeutic interventions highlighted in this paper will concentrate on those programs with demonstrated efficacy, effectiveness, or both that are designed to help children from birth to age 3.

Most of the programs reviewed here are designed to improve multiple aspects of child functioning (i.e., the social, behavioral, and emotional functioning of young maltreated children; fewer programs concentrate on cognitive and physical development). Because most of these programs seek to address numerous problems at the same time, it is difficult to neatly categorize interventions based on desired outcomes. Rather, within the section, discussion considers the interventions by the type of treatment used, including both the intervention setting and the targeted population. These different types of early intervention programs include (a) therapeutic daycare centers, preschools, or both; (b) foster care therapeutic interventions; (c) clinic-based mental health services; and (d) infant-focused interventions. Through the review of the various programs for maltreated infants, toddlers, and preschoolers, one is able to see the strengths of current early intervention programs. In summary, research on early intervention programs suggests that maltreated children and their families may receive benefit from these programs. These benefits are summed up in Table 1.

Although many useful early intervention programs exist, the need remains for more early intervention programs, more trained early intervention specialists to administer these programs, and more scientifically rigorous research (program evaluation) on the specific conditions under which these interventions can be most effective. These needs prompted two additional sections that are included at the end of this paper. One section reviews other early intervention programs for developmental delays and health-related problems that may be useful for maltreated children but which have not been exclusively tested with maltreated populations. The final section discusses future research and provides suggestions for (a) improving research designs to determine how effective various treatments are and (b) increasing the likelihood that young maltreated children who need services will be recognized and enrolled and will actively participate in those programs.

Table 1.
Effective Maltreatment Interventions and Their Target Populations
Maltreatment Interventions Target Population Outcomes
Daycare and Preschool Interventions
Therapeutic Daycare and Preschool Abused infants and toddlers who have difficulty functioning in regular daycare
  • Improved cognitive skills
  • Improved motor skills
  • Emotion regulation
  • Higher likelihood that child will be mainstreamed into regular classroom
  • Delinquency, drug use, arrest for violent crime all lower
Foster Care Therapeutic Interventions
Early Intervention Foster Care Maltreated preschoolers in foster care
  • Foster parents  do more monitoring, more positive reinforcement, less discipline
  • Foster parents  less stressed
  • Children  better emotionally regulated, fewer behavioral problems
  • Children  less stressed
Attachment and Biobehavioral Catch Up Maltreated infants and preschoolers in foster care (Based on case studies only)
  • Foster parents  improved sensitivity
  • Children  more securely attached
Clinic-Based Mental Health Treatment
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Sexually abused preschoolers with posttraumatic stress disorder (PTSD) symptoms and their nonoffending parent
  • Parental guilt decreased
  • Parents  more empowered
  • Children  lower PTSD symptoms, depression symptoms
  • Children  improved coping and stress-management skills
  • Children  decreased inappropriate sexualized behavior
  • Children  increased self-worth
Abuse-Focused Cognitive Behavioral Therapy(AF-CBT) Physically abused preschoolers and the offending parent
  • Parental hostility, anger, poor interaction with child, negative perception of child, and harsh parenting all decreased
  • Child  behavioral problems decreased
  • Child  improved social skills and peer relations
Parent-Child Interaction Therapy (PCIT) Physically abused 2- and 3-year-olds with behavioral problems
  • Parents  improved positive interaction with child
  • Parents  reduced harsh parenting and coercive interactions
  • Child  increased compliance
  • Child  decreased oppositional and defiant behaviors
Resilient Peer Training Intervention Withdrawn, maltreated preschoolers
  • Improved social skills and peer relations
Child-Parent Therapy Children with PTSD symptoms from witnessing domestic violence and the non-offending parent
  • Child  behavioral problems and PTSD symptoms decreased
The Incredible Years Parenting Program Maltreating parents of preschoolers
  • Parent  positive interaction with children increased
  • Child  behavior unchanged
Infant-Focused Interventions (Clinic- and Home-Based)
Infant-Parent Psychotherapy Maltreated infants
  • Increased quality of child attachment, emotional expression and regulation, eating and sleeping patterns
  • Parents  sensitivity and responsive behaviors increased

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