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Risky Behaviour

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.


Substance Use

Four studies addressed risky behaviours in neglected or emotionally maltreated adolescents relating to alcohol, tobacco or substance misuse 1,5-7; only two of these studies were comparative with non-maltreated controls 1,5


Five different tools were used in these studies, although only two of these tools were previously validated; Diagnostic Interview Schedule for Children & Adolescents, Diagnostic Interview Schedule for DSM-IV (modified)


  • Four studies explored the use of marijuana, cocaine, crack, heroin, amphetamines, hallucinogens or multiple drug use.  In two comparative studies, substance misuse was more common amongst neglected adolescents than controls 1,5
  • This was not supported by two non-comparative studies where current and lifetime substance misuse was no higher amongst the neglected adolescents than those with other forms of maltreatment 6,7.  In the latter two studies the adolescents were either involved with child welfare 6 or in residential care 7 which may have potentially influenced their responses
  • Among three studies examining alcohol and tobacco use 5-7 one comparative study did identify that neglected adolescents were significantly more likely to exhibit alcohol related problems 5 
  • The two non-comparative studies of young people in out-of-home care or involved with child welfare did not show any association between alcohol and tobacco use and neglect 6,7
  • One comparative study found no association between emotional maltreatment and substance misuse 1
  • A non-comparative study found no difference in substance misuse amongst emotionally maltreated adolescents in comparison to those experiencing other forms of maltreatment 5


Sexual Risk Taking Behaviour

Two studies 2,5, explored the effects of neglect on sexual risk taking behaviour; only one of these studies was comparative 5. No study explored the impact of emotional maltreatment on sexual risk taking behaviour


No standardised tools were used in either of these studies


  • There was only a small sample size of relevance in the comparative study (34 neglected, 4 emotionally abused adolescents) but this showed that neglect was associated with an increased rate of teenage pregnancy 5
  • In a study of neglected youth compared to other forms of maltreatment, there was no explicit association with teenage pregnancy. However it is notable that 35% of neglected youth were aged less than 13 years at first “consensual” intercourse, and 65% had first “consensual” intercourse between the ages of 13 and 16 years 2


Other Risk Taking Behaviour

Two non-comparative studies 3,4 explored the effects of neglect and emotional maltreatment on risk taking behaviour


Two different tools were used; Child Health and Illness Profile – Adolescent Information was used in one study 3, whilst an Index derived from LONGSCAN measures was used in the second 4


  • One study explored gang activities, arrest, physical assault, in addition to illicit substance misuse and unprotected sex and combined these all into one measure of “risky behaviour” 4. This study found an association between either neglect or emotional maltreatment and “risky behaviour” 
  • In the other study, the tool which was used measured characteristics and risky behaviours which increased the risk of illness and injury; no association was found between this and either neglect or emotional maltreatment 3
  • It is notable that Thompson et al was a much larger study with 75 neglected adolescents and 258 emotionally abused 4; Kools et al had 56 neglected and 29 emotionally abused adolescents 3

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  1. Aarons GA, Monn AR, Hazen AL, Connelly CD, Leslie LK, Landsverk JA, Hough RL, Brown SA. Substance involvement among youths in child welfare: the role of common and unique risk factors. The American Journal of Orthopsychiatry. 2008;78(3):340-349 [Pubmed]

  2. James S, Montgomery SB, Leslie LK, Zhang J. Sexual risk behaviors among youth in the child welfare system. Children and Youth Services Review. 2009;31(9):990-1000 [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. 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]

  5. 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]

  6. Traube DE, James S, Zhang J, Landsverk J. A national study of risk and protective factors for substance use among youth in the child welfare system. Addictive Behaviors. 2012;37(5):641-650 [Pubmed]

  7. Vaughn MG, Ollie MT, McMillen JC, Scott L Jr, Munson MR. Substance use and abuse among older youth in foster care. Addictive Behaviors. 2007;32(9):1929-1935 [Pubmed]


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