Heterogeneity in Developmental Trajectories of Internalizing Behavior Problems Among Children Who Have Experienced Early Childhood Maltreatment

Background/Purpose: Child maltreatment continues to be one of the major social problems in the United States. Early childhood maltreatment has long lasting negative effects on developmental outcomes across multiple domains, including behavior problems (Norman et al., 2012). Although research documents that child maltreatment is associated with a greater level of internalizing behaviors, such as social withdrawal, anxiety and depression (Bolger & Patterson, 2001), much less is known about the long-term effects of maltreatment on internalizing behaviors. Furthermore, there is a lack of knowledge about the nature of heterogeneity in developmental trajectories of internalizing behavior problems among young maltreatment victims. A better understanding of heterogeneity in developmental outcome is critical to establishing effective interventions to address the consequences of early child maltreatment. The purpose of the present study is to identify various developmental trajectory patterns of internalizing behavior problems among children who have experienced early childhood maltreatment and to examine the role of child maltreatment characteristics (i.e., type, severity, timing) in determining these patterns.

Methods: A secondary data analysis was conducted using data from the National Survey of Child and Adolescent Well-being. A total of 541 children (ages 4-5) reported to Child Protective Services (CPS) for maltreatment were included in the study. Growth Mixture Modeling (GMM) and multinomial logistic regression were performed to investigate heterogeneous trajectories of internalizing behaviors and to identify significant predictors of the identified trajectories. The Child Behavior Checklist (CBCL, caregiver report) was used to assess children’s internalizing behavior problems at four time points (T1: baseline, T2:1 year follow-up, T3: 2.5 year follow-up, T4:6.5year follow-up). Child maltreatment variables (type, severity, timing) were reported by CPS workers.  

Results:  The GMM analyses identified three distinctive internalizing trajectory patterns (i.e., consistently low, increasing, decreasing) of maltreated children. A majority of the maltreated children (78.7%) followed the consistently low internalizing behavioral trajectory, 12.8% of the children followed the increasing internalizing behavioral trajectory and 8.6% of the children followed the decreasing internalizing behavioral trajectory. Multinomial logistic regression indicated that children who were experiencing a more severe level of harm from maltreatment were 3.2 times more likely to follow the increasing internalizing behavioral trajectory than children who were experiencing less severe harm. Additionally, although marginally significant (p=.06), children who experienced neglect/emotional abuse were more likely to follow the decreasing internalizing trajectory when compared to children who experienced physical/sexual abuse.

Conclusions and Implications: This study adds to the current knowledge base of child maltreatment research by providing empirical evidence for heterogeneity in developmental trajectories of internalizing behavior problems among young maltreated children. The study findings suggest that providing early intervention for children who were rated by CPS workers as experiencing a severe level of harm from maltreatment may be effective in avoiding increased internalizing behavior problems over time in this high-risk population.  Study results of different factors predicting different trajectory patterns highlight the importance of individualized early intervention efforts in order to most effectively serve these vulnerable children.