Developmental Status and Early Intervention Service Needs of Maltreated Children. Finding #5: Maltreated children between 24 to 36 months of the age have relatively high levels of behavior problems reported by their caregivers

04/01/2008

Previous Research

Maltreated children between 24 to 36 months of the age appear to have an increased occurrence of behavior problems as reported by their caregivers using the Child Behavior Checklist (CBCL) (Achenbach, 1991; Stahmer et al., 2005).  It is not clear whether maltreating caregivers experience their childrens age-expected behavior as more problematic or whether the children have, in fact, more problematic behavior.  Recent evidence that compares the ratings of maltreating parents to those of independent observers suggests that maltreating parents are more harsh raters of their childrens behavior (Lau, Valeri, McCarty, & Weisz, 2006).

Despite the high frequency of temperamental or behavioral concerns in children with developmental delay of various etiologies, behavioral difficulties are rarely used to describe eligibility for Part C services (Hebbeler et al., 2001).  An elevated frequency of behavior problems associated with developmental delay has been described.  Studies found that over 40% of children between 4 and 18 years of age with mild intellectual disability could be classified as having severe emotional or behavioral disorders (Einfeld & Tonge, 1996; Gillberg, Perrson, Grufman, & Themner, 1986; Rutter, Tizard, & Whitmore, 1970).[3]

A childs behavior and development are strongly related.  The transactional model of development (Sameroff, 1995) illustrates how the child and the caregiving environment are mutually affected by interaction, e.g. the developing child is influenced by stimuli from the environment and, in turn, provides feedback to the environment that partly determines what future stimuli he or she will receive.  As a result, the childs behavior and development play a reciprocal role.  For example, a baby quick to smile and respond to caregivers may receive more positive, developmentally important stimuli than a child who is more withdrawn or less responsive.  The transactional model recognizes difficulties that caregivers experience with children as a disturbance in the relationship, not as a problem within the child.

Prior research specific to occurrence of behavior problems in young, maltreated children is relatively scarce.  NSCAW research on children entering the study found that 27% of 2- and 3-year-olds had behavior problems reported by their caregivers compared to 5% of the general population (Administration for Children and Families, 2006). Stahmer et al. (2005), also using NSCAW data, found that 26% of 2-year-olds and 32% of 3- to 5-year-olds had serious behavior problems as assessed by the CBCL. Other research on young children entering out-of-home care indicates that this rate could be between 33% and 39% for children entering foster care (Reams, 1999; Urquiza, Wirtz, Peterson, & Singer, 1994). In sum, among maltreated toddlers, behavior problems seem more common than in the general population. These findings provide a basis for further analysis pertaining to young children substantiated for maltreatment.

Study Findings

Using the CBCL,[4] behavior problems are classified into one of two categories. First, behavior problems may be externalizing which are difficult behaviors such as physical aggression. Behavior may also be classified as internalizing. These behaviors include less interpersonal problems such as depressive or anxious symptoms. The behavioral characteristics are not mutually exclusive so a child may have both.

Children with behavior problems emerge as a relatively common phenomenon among this group (see Exhibit 11). Almost one in three children 2- to 3-years-old at the time of initial baseline data collection was reported to have a behavior problem. This is much higher than would be expected in the general population, which would have about 8% with an externalizing or internalizing score. This number drops slightly to about 1 in 4 by the 36-month follow-up, by which time all children in NSCAW would have exited the Part C system.

Exhibit 11.
Internalizing, Externalizing, and Any Behavior Problems in Maltreated Children 2 Years of Age and Older
at Baseline and 18- and 36-Month Follow-Up

Exhibit 11. Internalizing, Externalizing, and Any Behavior Problems in Maltreated Children 2 Years of Age and Older at Baseline and 18- and 36-Month Follow-Up. See text for explanation.

Source:  NSCAW.  Caregiver completes the CBCL.

These behavior problems are quite constant. About 70% of children who were reported by caregivers as having behavior problems at baseline were still having behavior problems at the 36-month follow-up.

Children with behavior problems were not found to be different from children without behavior problems in several areas. For example, children with behavior problems were placed into out-of-home living arrangements no more often than those without behavior problems. Similarly, the distribution of risk and measured delay was similar among children with and without behavior problems.

A key finding is that very young maltreated children were commonly reported by their caregivers to have both internalizing and externalizing problems (as seen in Exhibit 11).

Implications

Young, maltreated children are commonly reported by their caregivers to demonstrate behavior problems. Children at least two years of age are typically reported to have both internalizing and externalizing behavior problems. As a result, child welfare and Part C providers may find these families challenging to work with unless efforts are made to help caregivers learn how to manage problem behaviors. The ratings may suggest serious family dysfunction in which the children are the identified symptom of a troubled family system. The ratings of child behavior may indicate unreasonable behavioral expectations or inability to provide appropriate limits to their children, or to reflect chaos and strife in the life of the caregivers of maltreated toddlers (Scarborough & Poon, 2004). Harrington, Black, Starr and Dubowitz (1998) posit that caregivers living in poverty who ascribe behavior problems to their neglected children may be asking for help, particularly with child-rearing and family functioning. Child-centered interventions will likely be inadequate to remediate these behavioral ratings. Service providers will need to address problems in the aversive caregiverto-child interaction to effect a positive change. Part C providers specifically need tools for responding to the individual behavioral needs of these children and families (Scarborough, Hebbeler, Spiker, & Simeonsson, 2007).

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