The impact of child maltreatment on expressive syntax at 60 months

Effects of placement type on the language developmental trajectories of maltreated children from infancy to early childhood

This study describes the developmental trajectories of language skills in infants with substantiated maltreatment histories over a 5-year period and evaluates the effect of three different custodial placements on their language trajectories over time: in-home (remaining in the care of the biological parent/parents), nonkin foster care, and nonparental kinship care. Participants included 963 infants reported to child protective services prior to their first birthday and whose maltreatment was substantiated. Results from covariate-controlled growth modeling revealed no significant placement effects. Across all groups, children's auditory and expressive communication scores decreased significantly from Wave 1 (intake) in the infants' first year to Wave 4, when children were about 3.5 years of age, then improved to baseline levels by Wave 5, when children were about 6 years old. Despite these fluctuations, children's average language scores in each placement group remained below the population mean at each wave of the study.

Trauma in early childhood: Empirical evidence and clinical implications

Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young children's response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.

Language and cognitive outcomes in internationally adopted children

This study focuses on the association between language skills and core cognitive processes relative to the duration of institutionalization in children adopted from orphanages abroad. Participants in the adoptive group (n = 46) had arrived in the United States between the ages of 2 and 84 months (mean = 24 months), and had been living in the United States for 1–9 years. Drawing on both experimental and standardized assessments, language skills of the international adoptees differed as a function of length of time spent in an institution and from those of 24 nonadopted controls. Top-down cognitive assessments including measures of explicit memory and cognitive control differed between adopted and nonadopted children, yet differences between groups in bottom-up implicit learning processes were unremarkable. Based on the present findings, we propose a speculative model linking language and cognitive changes to underlying neural circuitry alterations that reflect the impact of chronic stress, due to adoptees' experience of noncontingent, nonindividualized caregiving. Thus, the present study provides support for a relationship between domain-general cognitive processes and language acquisition, and describes a potential mechanism by which language skills are affected by institutionalization.

Declarative memory in abused and neglected infants

To summarize, all children interacted with the experimenter and actively participated in the imitation task. There was evidence of improvement in performance from baseline to recall as would be expected with attention to, and memory for, the actions that were modeled by the experimenter. All participants evidenced a decrease in performance as the difficulty of the task increased, as would be expected. When the maltreated children were compared to the nonmaltreated children in a 2-group design, there was no statistically significant difference in performance. However, when the maltreated group was divided into two subtypes of either neglected or abused, and performance was compared in a 3-group design, it was revealed that the neglected children experienced deficits in performance relative to abused children. For production of target actions, the neglected children's performance trended toward significance when compared to the nonmaltreated children's performance. However, there was no significant difference between the performance of the abused children and the nonmaltreated children for either production of target actions or productions of ordered pairs. The children in this longitudinal study were assessed previously at 12 months of age in a mother-child play situation (Valentino et al., 2006). Interactions during structured play between mother and child were evaluated for maternal directives and child responses. Interestingly, the difference in social interactions that was most reliable was the finding that the abused children imitated their mothers more often than did the nonmaltreated children. There was no difference between the imitative behaviors of the neglected children and the abused or nonmaltreated children. The researchers note that by imitating their mothers, the abused children might be attempting to prevent further abusive incidents. Limit setting behaviors of the mothers in response to child initiations were positively related to the children's imitative behaviors. Thus, it would appear that maternal negative feedback to child-initiated behaviors is related to an increase in imitative behaviors that are most likely met with positive reinforcement. The continued pursuit of this positivity may impede the development of self-initiated behaviors; delayed development of self-initiated behavior has been linked to disorders of social competence (Landry, Smith, Miller-Loncar, & Swank, 1998). However, imitation has long been known to be a mechanism of learning (Piaget, 1962) and has become an accepted tool for assessment of declarative memory (Bauer, 2004). Whereas the adaptation to abuse posited by Valentino et al. (2006) may be detrimental to social development, our data for this same sample indicate that the reliance on imitative behavior exhibited by the abused children may afford them an advantage at 21 months of age in imitation paradigms. The neglected children are thus at a disadvantage relative to the abused children in the study reported here in that they were not reinforced by mothers for imitative behavior. It is important to note that all children in this sample were from low-income homes. Scores on these events for both target actions and ordered pairs are higher in samples of higher SES children (e.g., Bauer et al., 2000). Thus, the low SES of the families affected performance across the groups. It is possible that the factor responsible for the difference between the abused group and the neglected group is resilience in the face of poverty. Resilience is the ability to recover following a traumatic event or adversity (Masten, 2001), and has been related to child characteristics, such as general intelligence (Masten et al., 1988). It has been proposed that neural plasticity may be responsible for this recovery (Cicchetti & Curtis, 2006). Alternatively, as has been detailed earlier in this chapter, the advantage afforded abused children could arise from the strengthening of neural pathways. It would be adaptive to develop exceptional event memory so as to avoid the events that lead to abuse. Mechanisms of plasticity are responsible for the laying down of memories (Aimone, Wiles, & Gage, 2006). Thus, the higher performance seen in the abused group could be related to a preservation of brain plasticity that facilitates resilience in the face of poverty, stress, and/or trauma. Plasticity in the brains of the neglected children may be lost due to the lack of stimulation, leaving them more vulnerable to the stress of poverty and neglect. In conclusion, maltreated children have often been studied as a single group. However, it is becoming clear from research conducted by our group and others that the subtypes of maltreatment may have different developmental sequelae. It is important that we understand the differential pathways involved in the development of abused versus neglected children. As discussed in other chapters of this volume, the imitation paradigm has emerged as a valuable tool in the identification of at-risk infants and toddlers. With the data reported here, it is evident that data from the elicited imitation procedure utilized herein differentiates between the subtypes of maltreatment. Research must be conducted to further elucidate the correlates of resilience in toddlers who have been abused. A longitudinal investigation would enable investigation of the questions of continuity of the observed increase in imitative behavior and whether increased imitation has a detrimental social effect while exerting a bolstering cognitive effect.

Abused and neglected children in court: knowledge and attitudes

OBJECTIVE

After maltreated children are taken into protective custody, dependency courts determine the children's placements. Many, if not most, maltreated children never attend their dependency court hearings. We had the rare opportunity to interview children in a jurisdiction where children regularly attend their detention hearings in dependency court. Our main goals were to assess maltreated children's knowledge and attitudes about their court experiences and identify predictors thereof. We also examined if the maltreated children desired greater participation in dependency court decisions.

METHODS

Immediately after attending their dependency court hearings, 7- to 10-year-olds were interviewed about their knowledge of, attitudes concerning, and participation in dependency court. Information was also extracted from the children's dependency court files.

RESULTS

Lack of understanding and negative attitudes were common. Age predicted court knowledge, and age, anxiety, court knowledge, abuse type, and criminal court referral predicted attitudes. Qualitative findings included that a substantial minority of children did not feel believed or listened to, and most children wanted to return home.

CONCLUSIONS

This research is relevant to current debates about the extent to which children should be involved in legal decisions. The results suggest that maltreated children may profit from greater understanding of dependency court. Moreover, the findings indicate that children often wish to have greater influence in dependency court decisions.

POLICY IMPLICATIONS

Professionals should consider providing children involved in dependency court hearings with age-appropriate information about the legal proceedings. Children may also benefit in dependency hearings from the opportunity, directly or indirectly (through their attorneys), to give voice to their wishes and needs.

Clinical implications of traumatic stress from birth to age five

Children aged birth to five years are exposed to a disproportionately increased amount of potentially traumatic events compared to older children. This review examines the prevalence of traumatic exposure in the birth-to-five age range, the indicators and diagnostic criteria of early traumatic stress, and the contextual issues associated with the experience of early trauma. The article also selectively reviews the impact of trauma on the biological, emotional, social, and cognitive functioning of young children's development along with some promising clinical treatment and service interventions that target the parent-child relationship as a vehicle of trauma recovery. Despite extensive documentation of the negative impact of trauma on the normal development of young children, research, clinical, and policy efforts to address the psychological repercussions of early victimization remain remarkably limited. Future directions in research and clinical practice as well as implications for policy are discussed.

Language delay in severely neglected children: a cumulative or specific effect of risk factors?

OBJECTIVES

This research sought to determine if the language delay (LD) of severely neglected children under 3 years old was better explained by a cumulative risk model or by the specificity of risk factors. The objective was also to identify the risk factors with the strongest impact on LD among various biological, psychological, and environmental factors.

METHODS

Sixty-eight severely neglected children and their mothers participated in this cross-sectional study. Children were between 2 and 36 months of age. Data included information about the child's language development and biological, psychological, and environmental risk factors.

RESULTS

Prevalence of LD is significantly higher in this subgroup of children than in the population as a whole. Although we observed that the risk of LD significantly increased with an increase in the cumulative count of the presence of the child's biological-psychological risk factors, the one-by-one analysis of the individual factors revealed that the cumulative effect mainly reflected the specific impact of the child's cognitive development. When we considered also the environmental risk factors, multivariate logistic regression established that cognitive development, the mother's own physical and emotional abuse experience as a child, and the mother's low acceptability level towards her child are linked to LD in severely neglected children.

CONCLUSIONS

Language development is the result of a complex interaction between risk factors. LD in severely neglected children is better explained by the specificity of risk factors than by the cumulative risk model.

PRACTICE IMPLICATIONS

Most prevention and early intervention programs promote and target an increase in the quantity and quality of language stimulation offered to the child. Our results suggest that particular attention should be given to other environmental factors, specifically the mother's psychological availability and her sensitivity towards the child. It is essential to suggest interventions targeting various ecological dimensions of neglectful mothers to help break the intergenerational neglect transmission cycle. It is also important to develop government policies and ensure that efforts among the various response networks are concerted since in-depth changes to neglect situations can only come about when all interested parties become involved.

Child maltreatment and memory

Exposure to childhood trauma, especially child maltreatment, has important implications for memory of emotionally distressing experiences. These implications stem from cognitive, socio-emotional, mental health, and neurobiological consequences of maltreatment and can be at least partially explained by current theories concerning the effects of childhood trauma. In this review, two main hypotheses are advanced: (a) Maltreatment in childhood is associated with especially robust memory for emotionally distressing material in many individuals, but (b) maltreatment can impair memory for such material in individuals who defensively avoid it. Support for these hypotheses comes from research on child abuse victims' memory and suggestibility regarding distressing but nonabusive events, memory for child abuse itself, and autobiographical memory. However, more direct investigations are needed to test precisely when and how childhood trauma affects memory for emotionally significant, distressing experiences. Legal implications and future directions are discussed.

Maltreated infants and toddlers: predictors of developmental delay

OBJECTIVE

The aim of this study was to examine the relationship of child, caregiver, and maltreatment characteristics at the time of the investigation with low scores on developmental measures obtained 18 and 36 months after substantiation in a nationally representative sample of maltreated infants and toddlers.

METHOD

A proxy for developmental delay was constructed based on a criterion of 2 or more scores > or = 1 SD below the mean in the domains of adaptive behavior, cognition or communication at each assessment time point. Twenty-three percent of children were classified as having developmental delay, 26% with inconsistent low scores, and 51% with no low scores. An ordered logistic regression was conducted to determine factors associated with low scores.

RESULTS

Case worker report of special needs at the time of the investigation, living in continuous poverty, and with caregiver characteristics of cognitive impairment and not having a high school education were associated with low scores. Failure to provide and "other" types of maltreatment, which included sexual abuse and abandonment, were more highly associated with low scores 18- and 36-month postinvestigation. A notable finding was that 15% of children were <6% height/weight. Parameter estimates from an ordered logistic regression are presented to explain the increased likelihood of low scores.

CONCLUSION

Characteristics associated with low scores and the developmental delay proxy are identifiable at the time of investigation of maltreatment of infants and toddlers, emphasizing the urgency of providing early intervention developmental services to avoid developmental delay and to maximize outcomes in this highly vulnerable population.

Maltreatment risk, self-regulation, and maladjustment in at-risk children

OBJECTIVE

The present project examined the relationships among early maternal maltreatment risk, children's self-regulation, and later development. It was expected that early maltreatment risk would impact children's emerging self-regulation which in turn, would foster pre-academic delays and behavioral problems.

METHOD

The project used structural equation modeling to examine the relationship between early maltreatment risk in 169 primiparous adolescent mothers and the subsequent development of their children in pre-academic and behavioral domains at 5 years of age. Maltreatment risk was assessed by two evaluation tools: (1) a multi-measure index of parenting attitudes, abuse potential, and knowledge and expectations about child development, and (2) an abbreviated version of the multi-measure index consisting of only 12 items. In addition, cognitive and emotional regulation at age 3, as assessed by maternal reports of regulatory behaviors and a newly created observational measure, was evaluated as a potential mediator of development at 5.

RESULTS

Findings revealed that maternal maltreatment risk was associated with lower levels of children's regulation, which in turn significantly predicted pre-academic skills and behavior problems. Incorporating direct paths from maltreatment risk to each of the children's outcomes did not significantly improve model fit indices.

CONCLUSIONS

Results suggest that self-regulation was a key process variable in the relationship between maltreatment risk and children's development. The findings support targeting self-regulatory abilities to halt the progression of developmental difficulties often found in maltreated children.

PRACTICE IMPLICATIONS

The present study identified self-regulation as a mechanism for transmitting the effects of maltreatment risk to multiple domains of children's functioning; these findings have important implications for intervention programs. Intervention programs that focus on fostering self-regulation in home and preschool settings should enhance developmental outcomes. Previous research has shown the utility of targeting self-regulation in reducing the frequency and intensity of students' anger (Beck, R., & Fernandez, E. (1998). Cognitive-behavioral self-regulation of the frequency, duration, and intensity of anger. Journal of Psychopathology and Behavioral Assessment, 20, 217-229.). Within the context of maltreatment intervention, these programs have considerable utility. By tailoring programs to strengthen dysfunctional regulation processes common to maltreated children, cognitive and behavioral functioning should be enhanced.

Special health care needs among children in the child welfare system

OBJECTIVE

The aim of this study was to determine levels of special health care need among children in the child welfare system and how these needs may affect children's functioning.

METHODS

Data were from the National Survey of Child and Adolescent Well-being, a national probability study of children investigated for child maltreatment. The sample consisted of 5496 children aged 0 to 15 years at baseline. For analysis, we used descriptive statistics to determine special health care needs and children's functioning from baseline to 3-year follow-up. Logistic regression was used to examine correlates of special health care needs.

RESULTS

At any point in the study period, approximately one third of the children were identified as having special health care needs. Overall, across 3 years of follow-up data, 50.3% of the children were identified as having special health care needs. Boys were significantly more likely than girls to have had special health care needs, and children aged 0 to 2 years at baseline were significantly less likely to have had special health care needs than older children. Adopted and foster children were significantly more likely to have had special health care needs than children never placed out of the home. The most commonly reported type of chronic health condition was asthma. The most commonly reported type of special need was a learning disability.

CONCLUSIONS

Special health care needs are prevalent among children in the child welfare system. Many children with special health care needs have cognitive, language, adaptive, social, or behavioral functional impairments. Mechanisms are needed to ensure that this vulnerable population has access to and receives coordinated health and related social services.

Sensitive, stimulating caregiving predicts cognitive and behavioral resilience in neurodevelopmentally at-risk infants

Although neurodevelopmental impairment is a risk factor for poor cognitive and behavioral outcomes, associations between early and later functioning are only moderate in magnitude, and it is likely that other factors intervene to modify this trajectory. The current study tested the hypothesis that sensitive, stimulating caregiving would promote positive behavioral and cognitive outcomes among children who were at risk based on the results of a neurodevelopmental screener and a temperament inventory. The sample comprised 1,720 infants and toddlers from the National Survey of Child and Adolescent Well-Being, a longitudinal study of children who were involved with child welfare services. Children were first assessed between 3 and 24 months of age and subsequently 18 months later. Children who experienced improvements in the amount of sensitive, stimulating caregiving they received had positive cognitive and behavioral outcomes 18 months later, despite early levels of neurodevelopmental risk. The association between changes in caregiving quality and changes in children's functioning was stronger for children who were removed from the care of their biological parents before the follow-up assessment than for children who remained in the care of biological parents, suggesting a causal role for caregiving quality on children's outcomes.

A State of Double Jeopardy: Impact of Prenatal Alcohol Exposure and Adverse Environments on the Social Communicative Abilities of School-Age Children With Fetal Alcohol Spectrum Disorder

Purpose

This article is a retrospective examination of environmental risk, language performance, and narrative discourse data from a clinical database of school-age children with fetal alcohol spectrum disorder (FASD).

Method

A case-defined diagnostic approach for measuring and reporting the full spectrum of disabilities in children with prenatal alcohol exposure is presented. Demographic, environmental, language, and social communication (as reflected by narrative discourse) data are reported for a large cohort of children with FASD between the ages of 6;0 (years;months) and 12;0.

Results

Children with FASD are a heterogeneous group with varying levels of compromise. The data demonstrate a substantial comorbidity between the effects of prenatal alcohol exposure and adverse caregiving environments. The data further reveal that school-age children with FASD often exhibit clinically meaningful deficits in language and social communication.

Clinical Implication

Children with FASD may be particularly vulnerable to language and social communication deficits as a result of prenatal alcohol exposure and atypical or adverse social interactive experiences. Comprehensive assessment is recommended. Dynamic and functional assessment paradigms may document the language and social communicative deficits in children with FASD and other clinical populations with complex neurodevelopmental profiles.

[Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists]

BACKGROUND

This work presents the results of an epidemiological survey about the professional experience of Speech-Language Pathologists and Audiologists of Rio de Janeiro (Brazil) with children and adolescents who are victims of domestic violence.

AIM

To understand the occurrence of child abuse and neglect of children and adolescents treated by speech-language pathologists, characterizing the victims according to: most affected age group, gender, form of violence, aggressor, most frequent speech-language complaint, how the abuse was identified and follow-up.

METHOD

500 self-administered mail surveys were sent to a random sample of professional living in Rio de Janeiro. The survey forms were identified only by numbers to assure anonymity.

RESULTS

224 completed surveys were mailed back. 54 respondents indicated exposure to at least one incident of abuse. The majority of victims were children, the main abuser was the mother, and physical violence was the most frequent form of abuse. The main speech disorder was late language development. In most cases, the victim himself told the therapist about the abuse--through verbal expression or other means of expression such as drawings, story telling, dramatizing or playing. As the majority of the victims abandoned speech-language therapy, it was not possible to follow-up the cases.

CONCLUSION

Due to the importance if this issue and the limited Brazilian literature about Speech-Language and Hearing Sciences and child abuse, it is paramount to invest in the training of speech-language pathologists. It is the duty of speech-language pathologists to expose this complex problem and to give voice to children who are victims of violence, understanding that behind a speech-language complaint there might be a cry for help.

Translational research on early language development: Current challenges and future directions

There is a pressing need for the early and accurate identification of young children at risk for language and other developmental disabilities and the provision of timely, age-appropriate intervention, as mandated by Part C of the Individuals with Disabilities Education Act. Research has shown that early intervention is effective for many language impaired children in different etiological groups, and can reduce the functional impact of persistent disorders on children and their families. Yet, the accurate identification of infants and toddlers at risk for language impairment remains elusive, especially for late-talking children without obvious genetic or neurological conditions. In this paper, the need for translational research on basic processes in early language development in typical and atypical populations and the contextual factors that affect them are discussed, along with current challenges and future directions for its successful implementation. Implications of this research for clinical evidence-based practice are also considered.

Prenatal cocaine exposure and children's language functioning at 6 and 9.5 years: moderating effects of child age, birthweight, and gender

OBJECTIVE

To evaluate whether prenatal cocaine exposure (PCE), or the interaction between PCE and contextual variables, is associated with children's language at age 6 and 9.5 years, adjusting for relevant covariates.

METHODS

Analyses were based on 160 low-income, urban children from a prospective study who completed a standardized language assessment at 6 and 9.5 years. PCE was determined using neonatal meconium assays and maternal self-report.

RESULTS

Significant interaction effects of PCE on language outcomes were found in multivariate longitudinal analyses using generalized estimating equations (GEE). Children with PCE had lower receptive language than unexposed children at 6 but not at 9.5 years, lower expressive language if they had lower birthweight, and lower expressive and total language if they were female. Other risk (e.g., violence exposure) and protective factors (e.g., preschool experience) were related to language outcomes regardless of PCE status.

CONCLUSIONS

Age, birthweight, and gender moderated the relation between PCE and school-aged children's language.

Child maltreatment, child protection and mental health

PURPOSE OF REVIEW

This review summarizes advances in our understanding of child maltreatment and the implications thereof for physical, psychological and social development, with special emphasis on mental health aspects.

RECENT FINDINGS

Methodological problems persist. These may be related in part to an over-emphasis on type of maltreatment, to the detriment of consideration of degree and extent of maltreatment. They may also be related to inadequate application of a comprehensive model of maltreatment and its consequences. Recent studies underline the inter-relatedness and cross-over between different types of child maltreatment and family violence. Research also underlines the extent to which child maltreatment is a major public health crisis internationally. Effects are seen on physical health and development as well as mental health, and it is becoming increasingly evident that these outcomes are inextricably linked to one another. There are encouraging signs that certain interventions are effective.

SUMMARY

There is a need for a more sophisticated model of child maltreatment that includes not only degree but also the extent to which basic developmental needs are overridden when children are maltreated, and that includes children's responses to maltreatment as a mediating influence. More studies are needed of samples of children who have been maltreated in order to gain a better understanding of how maltreatment distorts the trajectory of normal development. Crucially, we need more research on intervention, including both case management and psychological treatment approaches.