Heterogeneous Behavioral Pathways of Young Children Investigated for Neglect and Predictors of Persistent Problems

Background and Purpose:  Young neglected children are at high risk for behavior problems, yet little is known about the diverse behavioral pathways of these children or the predictors of persistent behavior problems.  Behavioral problems and maltreatment are associated with adverse short-term and long term outcomes, which are detrimental to the individual children and costly to society. In order to ensure that young neglected children achieve optimal well-being, child welfare practitioners and policy-makers need to understand the developmental pathways that neglected children follow over time, identify the children most at risk of following problematic pathways, and implement services that will best avert behavioral and developmental problems and their negative consequences.  The purpose of this study was to identify subgroups of children following different behavioral trajectories, describe these groups and predictors of membership, and explore whether or not receipt of child welfare services (CWS) is associated with behavioral pathways in a nationally representative sample of young children whose families were investigated for child maltreatment.

Methods: A sample of 2- and 3-year-olds reported for neglect who remained home (n=236) were selected from the National Survey of Child and Adolescent Well-being (NSCAW). Externalizing and internalizing behaviors, measured by the Child Behavior Checklist (Achenbach, 1991, 1992), were examined over time using latent class growth analysis to assess the optimal number of classes of children following distinct trajectories. Using weighted data, bivariate and multivariate analyses were used to describe the children and identify predictors of group membership from the caregiving environment and CWS. 

Results:  Four subgroups of children following distinct externalizing behavior paths and two subgroups following distinct internalizing behavior paths were identified.  Most children scored in normal range, but one in seven (14.7%) exhibited borderline clinical externalizing behaviors at age 2 or 3 and followed a worsening path into clinical range over five or six years. A small group (0.5%) exhibited high levels of externalizing problems that remained in clinical range over time. Two-thirds (66.1%) consistently demonstrate normal-range internalizing behaviors during these five or six years, while the other third (33.9%) exhibit borderline clinical behaviors.

Parent-reported physically assaultive behaviors and non-minority status predicted membership in the persistent externalizing problem and borderline clinical internalizing behavior groups.  Lower household income also predicted membership in the persistent externalizing problem groups.  Neither outcome of investigation (i.e. substantiation status) nor receipt of services predicted membership.

Conclusion and Implications: Children reported for neglect should be screened for behavior problems in order to ensure referral for early intervention to meet the children’s needs.  Referral based on substantiation status, required by CAPTA, is not adequate to identify children with behavioral needs.  Two affordable, very brief methods of screening will be discussed.  Children most at risk can be referred to early intervention, special education, or early mental health services for more thorough screening, evaluation, and treatment.  In order to avert persistent and worsening problems, screening and referral must be followed by effective interventions.  More research is needed to understand how behavioral interventions can help avert problems among young children involved with child welfare services.