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Emotional Features

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.


Ten studies (13 publications) addressed emotional features for neglected adolescents 1-12, 14 (overlapping data between 1&12 and 4-6)


Nine different tools were used  to assess emotional features: of these Youth Self-Report and Trauma Symptom Checklist were the most commonly used


Internalising Features (depression / anxiety / withdrawn / somatic complaints. We also included self esteem, symptoms of Post-Traumatic Stress Disorder (PTSD) and suicidality within this section)

  • Nine studies (12 publications) 1-9,11,12,14 explored these features in relation to neglect. The majority of studies identified an association between neglect and internalising features
  • Two comparative studies 12,14 identified that neglected adolescents exhibit more internalising features than controls; one of these specifically explored the relationship to physical neglect 12
  • A cross-sectional study of adolescents entering out-of-home care showed no association with internalising features 7
  • Four out of five non-comparative articles confirmed the association between internalising features and neglect 1,4-6. In two of these the association was only present for girls and not for boys 5,6
  • One study did not confirm any association 8


  • Two non-comparative studies exploring self-esteem among neglected adolescents entering out-of-home care found no association 2,3*
  • One found that no association between self-esteem and neglect was identified over a six month period 2. This study included a variety of forms of maltreatment and it was evident that a lower initial self-esteem score was related to a higher rate of improvement overall


  • Four studies explored depression in relation to neglect 2,7,9,11
  • While the results were mixed, three out of the four studies showed an association between neglect and depression 2,9,11
  • Two longitudinal studies explored depression among neglected adolescents; one of these showed an increased risk of depression before the age of 15 which was not apparent over 16 years 9. While there was no initial link between neglect and depression, over a 6 month period the neglected adolescents showed less improvement in their depression scores than other maltreatment groups 2. In both studies, these young people were assessed while remaining in out-of-home care
  • A case-series showed that the neglected adolescents did exhibit depression although this was less severe than found with other forms of maltreatment 11
  • A cross-sectional study, also looking at children in out-of-home care, found no association between physical neglect and depression 7

Suicidal Ideation

  • One study of adolescents aged 16 years who were either at risk of maltreatment or who had been maltreated showed no association between suicidal ideation and neglect 8

Symptoms of PTSD

  • The neglected adolescents did exhibit PTSD symptoms, although these were less severe than in other forms of maltreatment 11


Externalising Features (aggression / hostility / delinquent behaviour)

  • Five studies (7 publications) addressed the relationship between neglect and externalising behaviour 3-7,9,10
  • One comparative study did highlight an association between adolescent neglect and delinquent behaviour over the age of 16 years 9
  • A longitudinal study of adolescents found an association between neglect and delinquency for boys but not for girls 10
  • A cross-sectional assessment of adolescents found no association between neglect and a tool measuring lying and cheating 3
  • One study found an association between neglect and oppositional conduct disorder, but the relationship was mitigated by gender, ethnicity and living situation 7
  • Two studies found no association between neglect and externalising features 5,6. Of interest in one study with substantiated neglect, 29.4% of adolescents denied being neglected and overall describe their experience of neglect being less severe than the agencies’ reports 6
  • One study explored mediators and moderators of the impact of neglect and noted that those who blamed themselves had higher associations with emotional features. Those who blamed the parent who neglected them and were self-excusing, experienced less emotional features of neglect and this was more strongly correlated among boys than girls 4


Emotional Maltreatment

Five studies (seven publications) addressed emotional features for emotionally maltreated adolescents 1,3,5,6,8,12,13 (overlapping data between 1&12 and 5&6)

Four different tools were used  to assess emotional features: the Trauma Symptom Checklist was the most commonly used


Internalising Features (depression / anxiety / withdrawn / somatic complaints. We also included self esteem, symptoms of Post-Traumatic Stress Disorder (PTSD) and suicidality within this section)

  • Five studies (seven publications) 1,3,5,6,8,12,13 explored these features in relation to emotional maltreatment. The majority of studies identified an association between emotional maltreatment and internalising features
  • One comparative study found the emotionally abused adolescents experienced more internalising symptoms 12.  This was supported by non-comparative studies of emotional maltreatment 1,5,6,13
  • In girls with multiple forms of maltreatment, the presence of psychological maltreatment increased the association of internalising features 5
  • Emotionally maltreated adolescents showed the most significant rates of internalising features within all forms of maltreatment 6


  • Self-esteem was not significantly impacted by emotional maltreatment 3

Suicidal Ideation

  • Amongst adolescents who experienced psychological abuse, suicidal ideation was significantly more common (OR 3.66, 95%, CI 1.80-7.44) 8.  The impact of psychological abuse on suicidal ideation was mediated by psychological distress and risky behaviour

Externalising Features (aggression / hostility / delinquent behaviour)

Two studies (three publications) addressed the relationship between emotional maltreatment and externalising behaviour 3,5,6

  • These studies were non-comparative; one study showed an association between emotional maltreatment and externalising features 5,6, whilst the other did not 3
  • There was no gender association between externalising features and psychological maltreatment


 *confirmed by correspondence with the author

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  1. Goldstein AL, Wekerle C, Tonmyr L, Thornton T, Waechter R, Pereira J, Chung R. The relationship between post-traumatic stress symptoms and substance use among adolescents involved with child welfare: implications for emerging adulthood. International Journal of Mental Health and Addiction. 2011;9(5):507-524 [Abstract available from Springer Link]

  2. Hibbard RA, Spence C, Tzeng OC, Zollinger T, Orr DP. Child abuse and mental health among adolescents in dependent care. The Journal of Adolescent Health. 1992;13(2):121-127 [Pubmed]

  3. Kools S, Paul SM, Norbeck JS, Robbins NR. Dimensions of health in young people in foster care. International Journal of Adolescent Medicine and Health. 2009;21(2):221-233 [Pubmed]

  4. McGee RA, Wolfe DA, Olson J. Multiple maltreatment, attribution of blame, and adjustment among adolescents. Development and Psychopathology. 2001;13(4):827-846 [Pubmed]

  5. McGee RA, Wolfe DA, Wilson SK. Multiple maltreatment experiences and adolescent behavior problems: adolescents' perspectives. Development and Psychopathology. 1997;9(1):131-149 [Pubmed]

  6. McGee RA, Wolfe DA, Yuen SA, Wilson SK, Carnochan J. The measurement of maltreatment: a comparison of approaches. Child Abuse & Neglect. 1995;19(2):233-249 [Pubmed]

  7. McMillen JC, Zima BT, Scott LD, Jr, Auslander WF, Munson MR, Ollie MT, Spitznagel EL. Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child and Adolescent Psychiatry. 2005;44(1):88-95 [Pubmed]

  8. Thompson R, Proctor LJ, English DJ, Dubowitz H, Narasimhan S, Everson MD. Suicidal ideation in adolescence: examining the role of recent adverse experiences. Journal of Adolescence. 2012;35(1):175-186 [Pubmed]

  9. Thornberry TP, Ireland TO, Smith CA. The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes. Development and Psychopathology. 2001;13(4):957-979 [Pubmed]

  10. Tyler KA, Johnson KA, Brownridge DA. A longitudinal study of the effects of child maltreatment on later outcomes among high-risk adolescents. Journal of Youth and Adolescence. 2008;37(5):506-521 [Abstract available from Springer Link]

  11. Wechsler-Zimring A, Kearney CA. Posttraumatic stress and related symptoms among neglected and physically and sexually maltreated adolescents. Journal of Traumatic Stress. 2011;24(5):601-604 [Pubmed]

  12. Wekerle C, Leung E, Wall AM, MacMillan H, Boyle M, Trocme N, Waechter R. The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth. Child Abuse & Neglect. 2009;33(1):45-58 [Pubmed]

  13. Wekerle C, Wolfe DA, Hawkins DL, Pittman AL, Glickman A, Lovald BE. Childhood maltreatment, posttraumatic stress symptomatology, and adolescent dating violence: considering the value of adolescent perceptions of abuse and a trauma mediational model. Development and Psychopathology. 2001;13(4):847-871 [Pubmed]

  14. Williamson JM, Borduin CM, Howe BA. The ecology of adolescent maltreatment: a multilevel examination of adolescent physical abuse, sexual abuse, and neglect. Journal of Consulting and Clinical Psychology. 1991;59(3):449-457 [Pubmed]


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