Many of the problems described in this section have been touched on in earlier sections (e.g., social-emotional problems) but this section specifically addresses diagnosable mental health difficulties in very young children. The occurrence of developmental problems for maltreated children younger than the age of 3 is summarized in these prevalence data:
- Fourteen percent to thirty-seven percent of maltreated children demonstrate externalizing problems such as aggressive behavior and oppositional behavior (Bennett et al., 2005; Black et al., 2002; English et al., 2005; Fontanella, Harrington, & Zuravin, 2000; Heflinger, Simpkins, & Combs-Orme, 2000; Toth et al 2000b; U.S. DHHS Child Maltreatment, 2005).
- Approximately 11% of maltreated children demonstrate internalizing problems such as depression, anxiety, and somatic complaints (Black et al., 2002; Culp, Howell, Culp, & Blankemeyer, 2001; Fantuzzo, Weiss, Atkins, Meyers, & Noone, 1998; Heflinger et al., 2000).
- Maltreated children exhibit the following specific disorders:
- Reactive Attachment Disorder approximately 7% (Reams, 1999; Zeanah et al., 2004)
- Post Traumatic Stress Disorder (Reams, 1999) or the PTSD symptom of hypervigilance (Frankel, Boetsch, & Harmon, 2000; Pollak, Vardi, Bechner, & Curtin, 2000; Pollak et al., 2005)-approximately 7%
- Adjustment Disorders 40% (Reams, 1999)
- Regulatory Disorders 22% (Reams, 1999)
Research has estimated that 10% to 61% of maltreated children have mental health problems (Leslie et al., 2005a; Reams, 1999). Undoubtedly, differences in maltreatment status, duration, and severity as well as the way psychopathology was measured account for some discrepancies in prevalence. Maltreated boys display higher rates of aggression than maltreated girls whereas maltreated girls displayed higher rates of internalizing problems (e.g., depression, anxiety, somatic, etc.) than maltreated boys (Black et al., 2002; Fontanella et al., 2000; Heflinger et al., 2000; Litrownik, Newton, & Landsverk, 2005). Maltreatment that includes witnessing or experiencing painful events has been related to PTSD (Reams, 1999), hypervigilance (Frankel et al., 2000; Pollak, Vardi, Bechner, & Curtin, 2000; Pollak et al., 2005), and clinical levels of dissociation (Macfie, Cicchetti, & Toth, 2001a, 2001b).
Maltreatment occurring during the first few years of life may have enduring adverse influences on adult psychological health. Research has linked maltreatment in early childhood to adolescent and adult antisocial behaviors. In particular, recent studies indicate that physical abuse and neglect are positively related to aggression, arrests for violent crimes, and major and minor theft (Caspi et al., 2002; Jaffee et al., 2005; McCord, 1983; Moe, King, & Bailly, 2004; Widom, 1989; Widom, Weiler, & Cottler, 1999). Because these studies are mainly based on retrospective self-reports, these findings can be questioned. However, research using substantiated reports of abuse and prospective longitudinal designs provides more evidence that maltreatment in the early years is related to antisocial behavior (Jaffee et al., 2005; Koenig, Cicchetti, & Rogosch, 2004). In a lab-based study, Koenig et al. (2004) found that physically abused children engaged in more stealing than nonmaltreated children whereas neglected children displayed more cheating and less adherence to rules during a game situation. Egeland, Yates, Appleyard, and van Dulmen (2002), using a longitudinal design, found that 79% of children who had been maltreated in infancy and preschool exhibited clinically problematic externalizing behavior during adolescence, with 50% of these children meeting criteria for conduct disorder (see Keiley, Howe, Dodge, Bates, & Pettit, 2001). Moreover, they found that a child's resulting inability to trust and use parents for regulatory assistance was one consequence of maltreatment that led to antisocial behavior.
Other studies have found that early maltreatment is related to increased problems of internalizing in middle childhood and adolescence (Appleyard, Egeland, van Dulmen, & Sroufe, 2005; Dubowitz et al. 2005; Keiley et al., 2001; Manly, Kim, Rogosch, & Cicchetti, 2001). Appleyard and colleagues (2005) showed early childhood risk (e.g., maltreatment before the age of 64 months, low SES, life stress, interpersonal violence, and family disruption) to predict internalizing problems at age 16. Additionally, the relationship between early childhood risk and internalizing problems at age 16 continued to be significant after the effects of middle childhood risks were removed, signifying that early childhood maltreatment and related risks directly affect adolescent functioning.
In brief, maltreated children are more likely to demonstrate both externalizing and internalizing behaviors. Although externalizing problems are more common than internalizing behaviors, the differences may be artificial because young children rarely report their internal states and internal disturbances are not easily observable. Nevertheless, maltreated boys show more problems with aggression than girls whereas girls show more withdrawn, sad behaviors than boys. These gender differences may point to genetic predispositions, distinct socialization experiences, differences in maltreatment histories, or some combination. Maltreatment, especially that which includes experiencing abuse and witnessing violence, is also linked with PTSD and pathological rates of dissociation in preschoolers. Early maltreatment also relates to psychological dysfunction and antisocial behavior later in life.