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The link between child maltreatment and mental, behavioral, and developmental disorders (MBDD) is well documented. Childhood maltreatment increases the risk of developing MBDD, while children with MBDD are also at greater risk of experiencing maltreatment. Although national health surveys have reported rising MBDD rates, especially during the pandemic, they fail to capture the experiences of children reported to child protective services (CPS), who face even higher risks. This gap is concerning, as one in three American children is expected to have CPS contact by age 18, with even higher rates among some ethnic groups. This study used administrative data to address this gap and inform policy and practice.
Methods
This study analyzed linked records from the National Child Abuse and Neglect Data System (NCANDS) and the Adoption and Foster Care Analysis and Reporting System (AFCARS). While both datasets include nationwide CPS reports and foster care records, data quality varies by state and year. The sample was derived by examining data reliability at the county/state/year levels across six MBDD measures: emotional disturbance, behavioral problems, alcohol abuse, drug abuse, learning disabilities, and intellectual disabilities. The final sample included records from 2016 to 2021, with 21 states providing plausible data for drug use, 20 states for emotional disturbance and behavioral problems, 14 states for learning disabilities, 10 states for intellectual disabilities, and 8 states for alcohol use. Each measure included between 350,000 and 450,000 children.
Results
The prevalence of MBDD among CPS-involved children remained relatively stable before the pandemic (2016–2019) but declined during the pandemic (2020–2021), likely due to school closures and service disruptions, as nationwide CPS reports dropped by approximately 10%. Prevalence of MBDD varied considerably across states and developmental stages. Among adolescents (aged 12–17), boys had significantly higher proportions than girls for behavioral problems (1.89%–42.45%), learning disabilities (0.67%–22.69%), and intellectual disabilities (0.28%–7.03%). In the eight states with reliable adolescent substance use data, drug abuse (1.09%–13.76%) among CPS-involved children were two to three times higher than alcohol abuse and exceeded proportions among children not involved in CPS. The prevalence of prenatal drug exposure (3.52%–45.10%) was two to four times higher than that of alcohol exposure. MBDD prevalence was particularly high among children in foster care, with about one in four foster children aged 15–17 removed solely due to behavioral problems.
Conclusions and Implications
The key takeaways from the study are as follows. First, MBDD identification among CPS-involved children varies by state, reflecting differences in policy definitions and data entry practices. Second, while boys and girls have equal chances of CPS involvement, boys are more likely to exhibit behavioral and developmental disorders, highlighting the need for tailored services. Finally, further research is needed to assess the effectiveness of prevention and treatment strategies for both prenatal drug exposure and adolescent drug abuse among CPS-involved children, as these issues are associated with severe outcomes.