Developmental Status and Early Intervention Service Needs of Maltreated Children. Finding #1: Children ages birth to 36 months who have been maltreated are at substantial risk of experiencing subsequent developmental problems

04/01/2008

Young children who experience child neglect and abuse are at high risk of developmental problems.  Moreover, much research highlights the importance of the early years in both physical and psychosocial development. Specific domains potentially affected include cognitive, social, emotional, and physical health in addition to the potential for subsequent development of psychopathology. Effects are similar to poverty, but may be more severe.

Young children from birth to three years of age are most at risk of experiencing maltreatment. Approximately 3.5 million children are investigated for maltreatment annually. Of that group, nearly 900,000 are eventually substantiated to have experienced maltreatment. Children birth to three years have the highest rate of victimization, 16.1 per 1,000, while infants (children less than one year old) accounted for over 10% of all maltreated children or nearly 90,000 infants per year (U.S. DHHS, 2006). Some research suggests that children with unsubstantiated maltreatment reports may not differ developmentally from those who were substantiated (Hussey et al., 2005). This would place the entire population of children reported for maltreatment at risk for developmental problems.

Using data from the National Survey of Child and Adolescent Well-Being (NSCAW) and the National Early Intervention Longitudinal Study (NEILS), the developmental risk and well-being of maltreated children birth to 36 months of age was investigated. Specific literature relating to the developmental experiences of maltreated infants and young children was reviewed. Using the two longitudinal studies, NSCAW and NEILS, analyses were completed to describe the characteristics and developmental experiences of these children.

Maltreatment places the child at increased risk for problems in any developmental domain. Such domains include cognitive, language, social, and emotional. Moreover, negative developmental effects are typically seen in at least one domain regardless of the type of maltreatment experienced (Hoffman-Plotkin & Twentyman, 1984; Porter, Lawson, & Bigler, 2005).

Cognitive and language development may be markedly affected by maltreatment. Maltreated children have shown poorer performance across an array of cognitive and language sub-domains. Children experiencing emotional maltreatment or neglect often perform the most poorly of maltreated children. These differences persist even after poverty or low socioeconomic status (SES), a risk that commonly co-occurs with maltreatment, is controlled for (Beers & De Bellis, 2002; Eigsti & Cicchetti, 2004; Pears & Fisher, 2005; Yasik, 1998). The cognitive and language effects of maltreatment persist into at least elementary school years (Koenig, Cicchetti, & Rogosch, 2000; Toth & Cicchetti, 1996). Maltreated children have an increased likelihood of being held back in school (Shonk & Chicchetti, 2001).

The social and emotional development of young children is also adversely affected by maltreatment. When infants do not experience responsive relationships; are met with threats or criticism during emotional events; and are exposed to violence, intense anger, and fear, their social-emotional development may be impaired (Edwards, Shipman, & Brown, 2005; Howes, Cicchetti, Toth, & Rogosch, 2000; Shipman & Zeman, 1999).

The negative effects of maltreatment on young childrens development are increasingly defined and understood. However, specific domains of development are often differentially affected according to the type of maltreatment experienced. Neglect seems to more profoundly affect cognitive and social development areas, in particular, but any maltreatment may negatively affect development.

Study Findings

Findings from the NSCAW cohort tend to support what has been found by other researchers. Children from birth to three with substantiated cases of maltreatment experienced numerous factors that place them at risk for developmental problems.  In addition to their risk-laden environmental experiences, these children are also likely to have developmental delays based on the results of developmental screeners administered during the study.

Developmental risk is commonplace among infants and toddlers with substantiated cases of maltreatment. All of these children have at least one risk for developmental problems because of their maltreatment experience. A majority (55%) of children have at least five risk factors associated with developmental problems. Specific risk factors that were examined are shown below, with the percentage of children with that risk factor in parentheses:

Child Maltreatment (100%) Caregiver Mental Health Problem (30%)
Minority Status (58%) Low Caregiver Education (29%)
Single Caregiver (48%) Biomedical Risk Condition (22%)
Poverty (46%) Teen-aged Caregiver (19%)
Domestic Violence (40%) 4 or More Children in Home (14%)
Caregiver Substance Abuse (39%)  

Further evidence for the high levels of risk these children are subject to is found in the scores on the Bayley Infant Neurodevelopmental Screener (BINS). The BINS, a developmental screening instrument for children 3 to 24 months of age classified 56% of children in this age range at high risk and an additional 32% at moderate risk for developmental problems.

Risk may change over time. Some risk factors such as having been maltreated or being a member of a racial or ethnic minority group are fixed and permanent in duration. Others are temporary but may be brief or chronic in duration. For example, teen-aged caregiver is necessarily a time-limited risk factor while poverty may be experienced briefly or chronically (or intermittently). The practical consequence is that a child who has eight risk factors (i.e., High Risk using the DRIGs) at baseline may have only four risks at a follow-up because the primary caregiver is now 20 years old (no longer teen-aged), is now married and gainfully employed (no longer single or living in poverty), and has obtained a post-high school vocational certificate (no longer has low educational achievement). Labile risk factors were re-assessed at each time of data collection so a degree of instability in the DRIG high/lower risk classifications is expectable.

In addition to risk, many children had a low score on a developmental measure, a measured delay. Children were screened in the domains of cognitive functioning, communication skills, and adaptive behavior in the area of daily living. The cognitive portion of the Battelle Developmental Inventory (BDI), Kaufman Brief Intelligence Test (K-BIT), and the Pre-School Language Scale 3rd Edition (PLS-3) were administered, and the daily living skills portion of the Vineland Adaptive Behavior Screener (VABS) were all completed by caregivers.

Results of developmental screening were organized within the DRIGs. Based on these instruments, almost half of the children (49%) had a low score on at least one measure at baseline and were classified in the Measured Delay category of the DRIGs. An additional 28% had five or more risk factors resulting in their classification as High Risk. The remainder (23%) had no delay and four or fewer risk factors, and were categorized as Lower Risk.

Stability of the DRIGs was assessed. At the 18-month follow up when children were approximately 18 to 52 months in age, the disposition of the sub-group of children who had a Measured Delay at baseline was re-assessed. Half were reported to have a Measured Delay while 31% were classified as High Risk, and 18% at Lower Risk. When this same sub-group of children were approximately 3 to 6 years of age at the 36-month follow-up the proportion with a Measured Delay decreased slightly to 44%, but only 13% were classified as High Risk, and 43% were Lower Risk (see Exhibit 1).

Exhibit 1.
Disposition of Children with a Measured Delay at Baseline

Exhibit 1. Disposition of Children with a Measured Delay at Baseline. See text for explanation.

Source:  NSCAW

Part of this pattern of change over time is related to the childs age at the time the case was investigated. At baseline, infants less than 12 months of age with substantiated cases of maltreatment had the highest number of risk factors on average, and the lowest levels of measured delay. This small proportion of infants with a low score on a developmental measure is related to the difficulty using a standardized measure to assess delay in an infant. At baseline, children with substantiated cases of maltreatment investigated during the second or third year of life were more likely to have a low score on a developmental measure, but the proportion with High Risk status was smaller than among infants with substantiated maltreatment. For children in the third year of life, shortly after the time of investigation, the proportions with either High or Lower Risk is smaller than for infants (see Exhibit 2). This finding demonstrates that high levels of risk are associated with maltreated infants being designated as substantiated, compared to toddlers.

Exhibit 2.
Measured Delay and Risk (DRIGs) by Age at Baseline for Children with Substantiated Cases of Maltreatment

Measured Delay and Risk (DRIGs) by Age at Baseline for Children with Substantiated Cases of Maltreatment. See text for explanation.

Source:  NSCAW.
Note:  These are weighted percentages.

Infants and Toddlers Entering Part C and Risk Status.  Children entering Part C services were found to be at higher risk than children younger than three years of age in the general population (National Household Education Survey [NHES], 1999) in some, but not all areas (Hebbeler, Spiker, Mallik, Scarborough, & Simeonsson, 2003). Approximately 17% of children entering Part C have reasons for eligibility that describe a biomedical or environmental risk factor associated with developmental delay, though almost all of these reasons are biomedical in nature, rather than environmental risk (Scarborough, Hebbeler, & Spiker, 2006). Another indicator of the risk experienced by infants and toddlers with disabilities entering Part C services is reflected in that 7% were in foster care  a rate far in excess of the rates of children in foster care (< 1%) of comparable age in the general population (US DHHS, 2007). Information was available to compare some of the demographic characteristics of substantiated infants and toddlers with children the same age entering Part C, and those in the general population (see Exhibit 3).

 

Exhibit 3.
Percentages of Infants and Toddlers with Selected Demographic Characteristics
Demographic Characteristic Substantiated Maltreatment
(NSCAW)
1999-2000
Part C
(NEILS)
1997-1998
General Population
(NHES)
1999
Minority status 58 47 39
Single caregiver 48 15 15
Poverty 46 32 24
Less than high school education 29 16 17
Four or more children in the home 14 8 8
Source: NSCAW; Hebbeler et al., 2003 for NEILS & National Household Education Survey (NHES).

When the poverty level of the families of infants and toddlers entering Part C services is compared with infants and toddlers with substantiated cases of maltreatment, several differences are apparent (see Exhibit 4).  Though the proportion of very poor families is similar in the two populations, the proportion between 51% and 100% of poverty is almost three times as large among maltreated children, and the proportion of Part C children above 200% of the poverty level is greater (50% vs. 29%). The most striking difference may be in the receipt of Temporary Assistance for Needy Families (TANF) in that almost twice as many Part C families (42% vs. 23%) are recipients. TANF provides low-income families with financial assistance and work opportunities by offering states block grants to deliver their welfare programs.  Reasons for this difference may be due to TANF eligibility, but it may also be related to families voluntary involvement with social services.

 

Exhibit 4.
Percentage of Maltreated Infants and Toddlers and
Income Level Compared to Entrants to Part C Services
Poverty Level Substantiated Maltreatment Part C
At or below 50% 19 18
Between 51% and 100% 27 11
Between 101% and 200% 26 22
Over 200% 29 50
TANF recipient 23 42
Sources: NSCAW and NEILS.

Implications

Based on these findings, there is a reason to be concerned that many of these young, maltreated children will continue to lag behind their non-maltreated peers developmentally and will not be school-ready upon entrance to kindergarten or first grade. Risk factors such as poverty and maltreatment are known to have a negative influence on childrens development (English et al., 2005; McLoyd, 1998). The findings here provide additional evidence for the negative developmental effects of the previously discussed risk factors.

However, the effects of risk are not necessarily determinable in infants and toddlers, and become more apparent as age-expected developmental competencies become more complex. As a result, services, such as those provided for by Part C, may help offset these risks if provided in the first year of life. Additional services, such as income assistance and parent training might also reduce risk and likelihood of eventual developmental problems (National Scientific Council on the Developing Child, 2007).

There is movement among children between the DRIGs categories. This may be because some risks are potentially transient (e.g., transitional poverty, single parenthood) while addressing others might raise new issues (e.g., removing an abusive parent from the home may mean a child now has a single caregiver and more exposure to poverty). As a result, children classified as Lower Risk at the 36-month follow-up may have been in the High Risk group or experienced a measured delay at some point.

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