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Human Immunodeficiency Virus...

PEDIATRICS Vol. 109 No. 6 June 2002, pp. 1100-1107

Child Neglect: Outcomes in High-Risk Urban Preschoolers

Howard Dubowitz, MD, MS*, Mia A. Papas, MS*, Maureen M. Black, PhD* and Raymond H. Starr, Jr, PhD{ddagger}

* Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
{ddagger} Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland

--> Background. Limited longitudinal research has been conducted on the impact of neglect on children’s health and well-being. There is a need to consider the impact of specific subtypes of neglect on children’s functioning. In addition, there is interest in examining the cumulative effect of experiencing >1 subtype of neglect.

Objective. To examine the individual and cumulative relationships among physical, psychological, and environmental neglect and children’s behavior and development at age 3, and the impact on changes in children’s behavior and development between ages 3 and 5.

Methods. One hundred thirty-six children and their primary caregivers participating in a prospective longitudinal study of children’s development and maltreatment were assessed when the children were aged 3 and 5 years. The children were recruited from primary care clinics because of failure to thrive, risk for human immunodeficiency virus, or as a comparison group. Evaluations were conducted in laboratory and home settings using observations, maternal self-report, and standardized testing of the children. Scores on physical, psychological, and environmental neglect were combined into a Cumulative Neglect Index. Regression analyses were run to examine the association of specific subtypes of neglect and of cumulative neglect with children’s functioning at age 3, controlling for group, sociodemographic risk, and maternal depression. The analyses were repeated examining the impact on child outcomes at age 5, controlling for the above 3 variables as well as the children’s cognitive development and behavior at age 3.

Results. Of the subtypes of neglect at age 3, only psychological neglect was significantly associated with increased internalizing and externalizing behavior problems at age 3; the Cumulative Neglect Index was associated with internalizing problems. None of the neglect subtypes or cumulative neglect were predictive of changes in children’s behavior and development between ages 3 and 5. Cognitive development of the entire sample was impaired at age 5, averaging 0.85 standard deviations below the norm, and their average externalizing behavior score was significantly problematic with an average of 0.60 standard deviations above the norm.

Conclusions. In the context of poverty where many preschool children have poor cognitive development and increased behavior problems, psychological neglect is significantly related to reported behavior problems. Children who experienced multiple types of neglect had increased internalizing problems. Neglect did not explain changes in children’s behavior or development between ages 3 and 5. There is a need for pediatricians to identify and address child neglect, particularly psychological neglect, as early as possible. Pediatricians should also screen for maternal depression.

Key Words: child neglect • behavior • development • poverty

Abbreviations: CPS, child protective services • AFDC, Aid to Families With Dependent Children • FTT, failure to thrive • HIV, human immunodeficiency virus • SD, standard deviation • HOME, Home Observation for Measurement of the Environment • CWBS, Child Well Being Scales • CBCL, Child Behavior Checklist

Received for publication Oct 23, 2001; Accepted Jan 24, 2002.




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