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High rate of mental health problems found in children investigated for maltreatment
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A significant number of children who remain in their homes after an investigation by US child welfare agencies for maltreatment had elevated scores on several mental health symptom measures, data showed.
Sarah McCue Horwitz, PhD, associate director of the Center for Policy, Outcomes and Prevention at Stanford University School of Medicine, and colleagues examined the prevalence and predictors of mental health problems and services use in 1,117 children aged 12 to 36 months who had been investigated for maltreatment. Data were obtained from the second National Survey of Child and Adolescent Well-Being, a longitudinal study of youth aged 0 to 17.5 years referred to US child welfare agencies.
Children aged 12 to 18 months were assessed using the Brief Infant-Toddler Social and Emotional Assessment Scales (BITSEA), and children aged 19 to 36 months were assessed using the Child Behavior Checklist (CBCL). Sociodemographic data, social services, developmental and health data were also collected on children and caregivers.
More than 40.2% of each age group showed severe to moderate delays in daily living skills, and 20.1% of children aged 12 to 18 months and 39.7% of children aged 19 to 36 months (P≤.05) showed delays in socialization. Results also showed that 34.6% of children aged 12 to 18 months had problem behaviors, and 20.9% had low social competence. Among children aged 19 to 36 months, 10% scored above the CBCL clinical cutoff.
Black children were less likely than white children to have elevated scores on the BITSEA Problem Scale, according to researchers, and children living with a caregiver who was never married had 5.64 times higher odds of elevated problem scores (95% CI, 2.17-14.66). Children with a history of child welfare service had 4.09 (95% CI, 1.65-10.15) times higher the odds of having low social competence vs. children who had no such history. Children who lived with a depressed caregiver had 2.87 (95% CI, 1.05-7.87) times the odds of scoring above the clinical cutoff on the CBCL vs. children who did not live with a depressed caregiver.
Approximately 16% of both age groups had at least one chronic medical condition, and approximately 24% had a history of social services. More than 85% of families had one or more major risks on the Family Risk Score.
According to researchers, previous studies have focused on children in foster care, but there is a lack of data on those who remain in their homes after an investigation for maltreatment despite data showing that children who remain at home have levels of mental health problems as high as children placed in foster care.
“Regardless of limitations, these data show a high rate of [mental health] problems in the very young across placement types,” the researchers wrote, “and, despite multiple federal and state policies to support services to address these [mental health] issues and data showing that early intervention has a positive influence on children’s development, there is surprisingly little service use for these children who come to the attention of their local child welfare agency. If young children already confronting the burden of living in a family suspected of maltreatment are to thrive, it is imperative that they receive needed services for their problems.”
Disclosure: The researchers report no relevant financial disclosures.
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Robert Sege, MD, PhD
This report published in the Journal of the American Academy of Child and Adolescent Psychiatry confirms the large burden of untreated mental health and developmental needs of maltreated toddlers, based on the results of an authoritative large national sample. Forty percent of the children showed severe to moderate delays and more than one-third of the children (36.4%) had behavioral problems; one in five (20.9%) had low social competence. Only 2.2% of the children with these identified problems received any mental health services, and only 17% had parent training.
The finding of developmental and mental health problems in this report substantiates previous work on infant brain development, which has shown changes in brain architecture due to toxic stress. These children need and deserve mental health and developmental services. The long-term consequences of these untreated conditions are both tragic and expensive.
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