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Identifiable emotional, behavioural and developmental features in children

 

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

0-20 months

(eight studies 1-8)

  • Assessment of attachment status, evaluated by Strange Situation 9, comparing neglected with abused and / or control children 1,2,4
    • Neglected children showed avoidant attachment 2,4
    • Neglected children also showed more insecure-disorganised attachment 4
  • Neglected children did not show any difference in their play complexity from controls, although play was strongly influenced by cognitive function performance 8
  • In interactions with their mother, children demonstrated passive and withdrawn behaviour 3
  • Children with neglect and failure to thrive (FTT) had a lower developmental quotient than those with neglect or FTT alone 5
  • Language delay was particularly prominent in toddlers whose mothers suffered from depression 6
    • One study did not demonstrate delayed cognitive play abilities in neglected / emotionally abused one year old infants in comparison to controls 7

 

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References

  1. Cicchetti D, Rogosch FA, Toth SL. Fostering secure attachment in infants in maltreating families through preventive interventions. Development and psychopathology. 2006;18(3):623-649 [Pubmed]
  2. Crittenden PM. Maltreated infants: vulnerability and resilience. Journal of Child Psychology and Psychiatry. 1985;26(1):85-96 [Pubmed]
  3. Crittenden PM, DiLalla DL. Compulsive compliance: the development of an inhibitory coping strategy in infancy. Journal of Abnormal Child Psychology. 1988;16(5):585-599 [Pubmed]
  4. Lamb ME, Gaensbauer TJ, Malkin CM, Schultz LA. The effects of child maltreatment on security of infant-adult attachment. Infant Behavior Development. 1985;8(1):35-45 [Abstract provided by American Psychological Association PsycNET]
  5. Mackner LM, Starr RHJ, Black MM. The cumulative effect of neglect and failure to thrive on cognitive functioning. Child Abuse and Neglect. 1997;21(7):691-700 [Pubmed]
  6. Sylvestre A, Mérette C. Language delay in severely neglected children: a cumulative or specific effect of risk factors? Child Abuse and Neglect. 2010;34(6):414-428 [Pubmed]
  7. Valentino K, Cicchetti D, Toth SL, Rogosch FA. Mother-child play and emerging social behaviors among infants from maltreating families. Developmental Psychology 2006;42(3):474-485 [Pubmed]
  8. Valentino K, Cicchetti D, Toth SL, Rogosch FA. Mother-child play and maltreatment: a longitudinal analysis of emerging social behavior from infancy to toddlerhood. Developmental Psychology. 2011;47(5):1280-1294 [Pubmed]

  9. Ainsworth MD, Blehar MC, Waters E, Wall S. Patterns of attachment: A psychological study of the Strange Situation. Hillsdale, NJ: Erlbaum. 1978 [Book details provided by Google Books]

20-30 months

(five studies 1-5)

  • Evaluation of neglected toddlers during play demonstrated greater negativity than seen in controls 3

  • Neglected children demonstrated less positive social interaction in comparison to abused children or controls 2.  Neglected children were also the most passive, and spent more time alone than the other two groups.

  • With increasing test difficulty, neglected children showed greater memory deficits than physically abused children or controls 1
  • Again there was no difference between controls and neglected children on play complexity, however play was strongly influenced by cognitive function performance 4
  • A longitudinal study of toddlers showed that neglect children exhibited more internalising behaviours 5. Some toddlers had co-existent internalising and externalising features, which were correlated to parenting style

 

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References

  1. Cheatham CL, Larkina M, Bauer PJ, Toth SL, Cicchetti D. Declarative memory in abused and neglected infants. Advances in child development and behavior. 2010;38:161-182 [Pubmed]
  2. Crittenden PM. Children's strategies for coping with adverse home environments: an interpretation using attachment theory. Child Abuse and Neglect. 1992;16(3):329-343 [Pubmed]
  3. DiLalla DL, Crittenden PM. Dimensions of maltreated children's home behavior: A factor analytic approach. Infant Behavior and Development. 1990;13(4):439-460 [Abstract provided by Science Direct]
  4. Valentino K, Cicchetti D, Toth SL, Rogosch FA. Mother-child play and maltreatment: a longitudinal analysis of emerging social behavior from infancy to toddlerhood. Developmental Psychology. 2011;47(5):1280-1294 [Pubmed]

  5. Woodruff, K. Assessing developmental pathways of young children investigated for neglect and predictors of persistent problems. University of Maryland, Baltimore. Social Work. Ph.D. 2012 [Available from University of Maryland Digital Archive]

3-4 years

(five studies 1-5)

  • Developmental delay, in particular language delay, was apparent in the neglected children in comparison to physically abused children or controls 1,2
    • Receptive language (auditory comprehension quotient) and expressive language development (verbal ability quotient) were particularly delayed 1,2
    • The neglected children showed the lowest scores on auditory and verbal scores 2
  • In observing play, both free and with parents, the neglected toddlers had a greater negative affect than physically abused children or controls 4
  • There was no demonstrable difference in discriminating emotions between emotionally abused, physically abused or neglected children.  An allowance was made for intelligence quotient (IQ).  However, all of these groups showed less ability to discriminate emotions than those with normal IQ 3
  • One study found that children exhibited slightly elevated externalising behavour over time, aged 2-3 and 5-6 years. Some children exhibited externalising and internalising behaviour 5

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References

  1. Allen RE, Oliver JM. The effects of child maltreatment on language development. Child Abuse and Neglect. 1982;6(3):299-305 [Pubmed]
  2. Culp RE, Watkins RV, Lawrence H, Letts D, Kelly DJ, Rice ML. Maltreated children's language and speech development: abused, neglected, and abused and neglected. First Language. 1991;11(33):377-389 [Abstract provided by Sage Journals]
  3. Frodi A, Smetana J. Abused, neglected, and nonmaltreated preschoolers' ability to discriminate emotions in others: the effects of IQ. Child Abuse and Neglect. 1984;8(4):459-465 [Pubmed]
  4. Koenig AL, Cicchetti D, Rogosch FA. Child compliance / noncompliance and maternal contributors to internalization in maltreating and nonmaltreating dyads. Child Development. 2000;71(4):1018-1032 [Pubmed]

  5. Woodruff, K. Assessing developmental pathways of young children investigated for neglect and predictors of persistent problems. University of Maryland, Baltimore. Social Work. Ph.D. 2012 [Available from University of Maryland Digital Archive]

4-6 years

(15 studies 1-15)

  • Language delay becomes more evident as children grow older, with neglected children demonstrating more syntactic delays and producing less complex language than controls.  The children also showed reduced vocabulary 1
    • Maltreated girls showed a greater language delay than maltreated boys 1
    • It is notable that the maternal verbal IQ was lower amongst the neglectful mothers, in comparison to controls 1
  • Neglectful children showed the least number of social interactions in comparison to controls and abused children 2
    • Neglected children also showed cognitive deficits and disruptive behaviour 2
    • Teachers rated neglected children’s behaviour as worse than the controls and abused children 2
  • Neglected children showed an increase in conduct problems in comparison to abused children and controls (as rated by mothers) 8
  • The neglected children’s perception of others showed they were less likely to expect parents to relieve their distress or to relive distress in others, in comparison to abused children or controls 5
  • Neglected children were more likely to demonstrate undercontrolled / ambivalent emotional responses to simulated inter-adult aggression 6
  • Neglected children had more difficulty discriminating emotional expressions (particularly between angry, sad and fearful expressions) than physically abused children or controls. Neglected children also had a predilection for selecting sad faces 7
  • Emotional knowledge, based on labelling, recognising and matching to situations was examined in the context of harsh punitive parenting among neglected and control children. Punitive parenting did not have an impact, however the more severe the neglect, the poorer the child’s emotional knowledge 12
  • Low IQ has an influence on emotional knowledge 12
  • Neglected children showed low self-esteem and the lowest scores on positive self-representation in comparison to controls, physically or sexually abused children 13
  • In assessing attachment, the neglected children demonstrated more avoidant attachment and more disorganised markers, specifically more frightening markers than controls.  Overall, neglected children were more insecurely attached than controls 11,14
    • Neglected children depicted their mother as being less available to them than controls 14
    • Neglected children perceived their relationship with their mothers to be less fulfilling, safe and reliable 11
  • Neglected children were more likely to perceive others as hurt, sad or anxious than physically abused children or controls.  They perceived themselves as opposing or angry towards others and had a tendency to view themselves as anxious and ashamed 15
  • Neglected children showed more dissociation than controls, which was linked to the chronicity of the neglect.  Neglected children had poor peer relationships in comparison to controls 4
  • Studies of moral development demonstrated that neglected children showed more cheating and less rule-compatible behaviour than controls 3
  • In evaluating children’s responses to their own and other children’s ‘moral transgressions’ (the appropriateness of hitting, kicking, or biting another child, causing another child psychological distress, not listening to the teacher or keeping quiet during nap time, or leaving class without permission) neglected children perceived themselves and others as equally deserving of punishment for transgressions 10
  • A measure of physiological regulatory capacity, respiratory sinus arrhythmia (RSA) was performed on children prior to and during a parent-child interaction 9. The majority of children showed suppression of the RSA when moving from baseline to interacting with their mothers, but there was no difference between neglected children and controls 9

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References

  1. Eigsti IM, Cicchetti D. The impact of child maltreatment on expressive syntax at 60 months. Developmental Science. 2004;7(1):88-102 [Pubmed]
  2. Hoffman-Plotkin D, Twentyman CT. A multimodal assessment of behavioral and cognitive deficits in abused and neglected preschoolers. Child Development. 1984;55(3):794-802 [Pubmed]
  3. Koenig AL, Cicchetti D, Rogosch FA. Moral development: the association between maltreatment and young children's prosocial behaviors and moral transgressions. Social Development. 2004;13(1):87-106 [Abstract provided by Wiley Online]
  4. Macfie J, Cicchetti D, Toth SL. Dissociation in maltreated versus nonmaltreated preschool-aged children. Child Abuse and Neglect. 2001;25(9):1253-1267 [Pubmed]
  5. Macfie J, Toth SL, Rogosch FA, Robinson J, Emde RN, Cicchetti D. Effect of maltreatment on preschoolers' narrative representations of responses to relieve distress and of role reversal. Developmental Psychology. 1999;35(2):460-465 [Pubmed]
  6. Maughan A, Cicchetti D. Impact of child maltreatment and interadult violence on children's emotion regulation abilities and socioemotional adjustment. Child Development. 2002;73(5):1525-1542 [Pubmed]
  7. Pollak SD, Cicchetti D, Hornung K, Reed A. Recognizing emotion in faces: developmental effects of child abuse and neglect. Developmental Psychology. 2000;36(5):679-688 [Pubmed]
  8. Rohrbeck CA, Twentyman CT. Multimodal assessment of impulsiveness in abusing, neglecting, and nonmaltreating mothers and their preschool children. Journal of Consulting and Clinical Psychology. 1986;54(2):231-236 [Pubmed citation only]
  9. Skowron EA, Loken E, Gatzke-Kopp LM, Cipriano-Essel EA, Woehrle PL, Van Epps JJ, Gowda A, Ammerman RT. Mapping cardiac physiology and parenting processes in maltreating mother-child dyads. Journal of Family Psychology. 2011;25(5):663-674 [Pubmed]

  10. Smetana JG, Kelly M, Twentyman CT. Abused, neglected, and nonmaltreated children's conceptions of moral and social-conventional transgressions. Child Development. 1984;55(1):277-287 [Pubmed]

  11. Stronach EP, Toth SL, Rogosch F, Oshri A, Manly JT, Cicchetti D. Child maltreatment, attachment security, and internal representations of mother and mother-child relationships. Child Maltreatment. 2011;16(2):137-145 [Abstract available from SAGE]

  12. Sullivan MW, Carmody DP, Lewis M. How neglect and punitiveness influence emotion knowledge. Child Psychiatry and Human Development. 2010;41(3):285-298 [Pubmed]

  13. Toth SL, Cicchetti D, Macfie J, Emde RN. Representations of self and other in the narratives of neglected, physically abused, and sexually abused preschoolers. Development and Psychopathology. 1997;9(4):781-796 [Pubmed]
  14. Venet M, Bureau J, Gosselin C, Capuano F. Attachment representations in a sample of neglected preschool-age children. School Psychology International. 2007;28(3):264-293 [Abstract provided by Sage Journals]
  15. Waldinger RJ, Toth SL, Gerber A. Maltreatment and internal representations of relationships: Core relationship themes in the narratives of abused and neglected preschoolers. Social Development. 2001;10(1):41-58 [Abstract provided by Wiley Online]

The manifestation of EBD child features through early childhood

(12 longitudinal cohort studies 1-12)

  • The attachment pattern demonstrated by neglected children changed from ambivalent-insecure in those aged 12 months to avoidant in those aged 18 months, however some are classified as ‘secure’ 4,6
    • Children who were anxiously attached at 1-18 months became angry, frustrated and non-compliant with more negative affect than controls by two years of age. The neglected children were worse at coping than both abused children and controls 6
    • The emotionally abused children were anxiously attached at 18 months and, by 24 months, showed more anger and frustration than controls 6
    • By 42 months, the neglected children showed more apathy / withdrawal and hyperactivity / distractibility 6
    • Crittenden et al showed how neglected children aged 12 months onwards displayed aggressive and resistant behaviour towards their carers, particularly up to 2.25 years of age 1
  • Psychological neglect at age three was significantly associated with internalising and externalising behaviour.  Neglect at age three did not predict changes in the child’s behaviour and development between the ages of three to five years.  Cognitive development was markedly impaired by five years of age 2
    • By five years of age, teachers noted neglected children experiencing difficult peer relationships 3
  • Children of physical or supervisory neglect evaluated from age 2 to 3 – 6 years were noted to have externalising behaviours and internalising behaviours 12
    • The variation over time in these features followed trajectories which were influenced by parenting style
  • Neglected children showed persistent cognitive delay from 18 – 36 months 9
  • Children who were neglected prior to the age of four showed greater language delay once aged over four years, compared to controls 7
  • Toth et al reported that neglected three to four year old children perceived their parents less positively over time and had more negative self-representations 11
  • The Mother Child Interaction Research project (known as the Minnesota study) evaluated developmental sequelae from children aged 3-24 months, separated into an emotionally abused cohort and a neglected cohort.  The emotionally abused children showed a lower developmental quotient by 24 months, compared to physically abused, neglected and control children.  The neglected children showed a declining function in development and play over time.  In addition, they were anxious / avoidant at 18 months, progressing to angry, frustrated and non-compliant by 24 months.  These children also had a low coping score 5
  • Further results from the Minnesota study focused on children from birth to six years of age.  Neglected children at 54 months of age showed greater dependency and by 64 months they showed more self-destructive, inattentive and overactive behaviour.  They were rated by teachers to be anxious, withdrawn, unpopular, aggressive and obsessive-compulsive in comparison to abused children and controls.  Teachers rated the children as lacking humour, showing little sensitivity and empathy, as well as being poorer at following directions and expressing themselves in comparison to control groups.  Emotionally abused children followed from age 18 – 42 months showed a mixed pattern of early behaviours, becoming less persistent and showing less enthusiasm for tasks than controls at 42 months 8
  • Evaluating neglected children aged four to five years showed poorer emotional knowledge over time, compared to controls, after controlling for IQ 10

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References

  1. Crittenden PM. Social networks, quality of child rearing, and child development. Child development. 1985;56(5):1299-1313 [Abstract provided by JSTOR]
  2. Dubowitz H, Papas MA, Black MM, Starr RHJ. Child neglect: outcomes in high-risk urban preschoolers. Pediatrics. 2002;109(6):1100-1107 [Pubmed]
  3. Dubowitz H, Pitts SC, Black MM. Measurement of three major subtypes of child neglect. Child Maltreatment. 2004;9(4):344-356 [Pubmed]
  4. Egeland B, Sroufe A. Attachment and early maltreatment. Child Development. 1981;52(1):44-52 [Pubmed]
  5. Egeland B, Sroufe A. Developmental sequelae of maltreatment in infancy. New Directions for Child and Adolescent Development. 1981(11):77-92 [Abstract provided by Wiley]
  6. Egeland B, Sroufe LA, Erickson M. The developmental consequence of different patterns of maltreatment. Child Abuse and Neglect. 1983;7(4):459-469 [Pubmed]
  7. English DJ, Thompson R, Graham JC, Briggs EC. Toward a definition of neglect in young children. Child Maltreatment. 2005;10(2):190-206 [Pubmed]
  8. Erickson MF, Egeland B, Pianta R. The effects of maltreatment on the development of young children. In: Cicchetti D, Carlson V, editors. Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect. New York: Cambridge University Press; 1989. p.647-684 [Abstract provided by American Psychological Association PsycNET]
  9. Scarborough AA, Lloyd EC, Barth RP. Maltreated infants and toddlers: predictors of developmental delay. Journal of Developmental and Behavioral Pediatrics. 2009;30(6):489-498 [Pubmed]
  10. Sullivan MW, Bennett DS, Carpenter K, Lewis M. Emotion knowledge in young neglected children. Child Maltreatment. 2008;13(3):301-306 [Abstract provided by Sage Journals]
  11. Toth SL, Cicchetti D, Macfie J, Maughan A, VanMeenen K. Narrative representations of caregivers and self in maltreated pre-schoolers. Attachment and Human Development 2000;2(3):271-305 [Pubmed]

 

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