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Child maltreatment is a continued and pervasive public health problem in the United States. Beyond the psychological ramifications, there are neurodevelopmental outcomes that may significantly impact a child’s present and future functioning. Maltreatment may impact brain maturation and development, alter physiological and stress response systems, and create deficits in cognition, emotion regulation and behavior. Studies that explore these outcomes are proliferating. However, no systematic review has consolidated findings concerning the neurodevelopmental outcomes for child welfare involved adolescents. Youth in the child welfare system may be particularly vulnerable to these consequences due to severity of abuse and co-occurring chronic stressors such as poverty, instability, and discrimination. Understanding neurodevelopmental outcomes for these adolescents will provide a more complete problem conceptualization for intervention and policy development. This systematic review will examine the current scientific literature regarding neurodevelopmental outcomes for adolescents in the child welfare system.
Methods:
A protocol was adapted from Cochrane Collaboration guidelines and other expert resources (ie. Campbell Collection, PRISMA and AMSTAR standards) to develop a priori inclusion/exclusion criteria and conduct a systematic review of English language literature. General inclusion criteria include adolescent participants aged 13 to 19, experimental or quasi experimental design, participant history of child maltreatment, and child welfare service involvement. Inclusion criteria for neurodevelopmental outcome includes neuropsychological findings, brain structure or function, inflammation and stress regulation biomarkers. Six bibliographic databases were searched using predefined search strings developed with a social science reference librarian. Grey literature was also examined by electronically searching databases of dissertations, theses, and conference proceedings. Data from included studies were tabled and analyzed.
Results:
After removal of duplicates, over 6,000 abstracts were identified for title/abstract review and 55 articles were selected for full text review. 6 articles met all inclusion criteria and were included in our analyses. Outcome study targets varied widely including brain function in relation to emotion regulation, cognitive processing, memory and autonomic nervous system hyporesponsivity. Results generally suggest worse neurodevelopmental outcomes for maltreated adolescents in the child welfare system. However, studies had small sample sizes and typically failed to examine type and timing of maltreatment. All but two studies examined maltreated adolescents with current psychiatric symptoms precluding conclusions about the direct link between maltreatment and neurodevelopmental outcomes.
Conclusions and Implications:
Results indicate that despite a large body of research on neurodevelopmental outcomes of child maltreatment, few empirical studies currently exist which examine these outcomes for maltreated child welfare-involved adolescents. Due to this population’s increased risk, more research is needed to examine neurodevelopmental outcomes in this population. Identification of these outcomes will allow social workers to provide better assessment and treatment services to child-welfare involved youth. Further, it will ultimately lead to the development of more comprehensive and effective interventions to better serve this vulnerable population.