MENU TITLE: In the Wake of Childhood Maltreatment.
Series: OJJDP
Published: August 1997
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In the Wake of Childhood Maltreatment

Barbara Tatem Kelley, Terence P. Thornberry,
Ph.D., and Carolyn A. Smith, Ph.D.

Juvenile Justice Bulletin

Youth Development Series

NCJ 165257

------------------------------

U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency 
Prevention

------------------------------

From the Administrator

The victimization of the weak by the strong -- in
this case, of children by adults -- is one of the
most shameful constants in human history.
Unfortunately, contemporary American society is
not immune from this repugnant behavior. The
National Committee to Prevent Child Abuse
estimates that 1 million children suffered
maltreatment in the United States in 1995 alone.
Because countless cases of suspected child abuse
and neglect remain unreported, the actual number
of abused and neglected children is unknown. What
is known, however, is that maltreatment in
childhood increases the risk of problems in
adolescence, including juvenile delinquency, drug
use, poor performance in school, teen pregnancy,
and emotional and mental health disorders. 

In the Wake of Childhood Maltreatment explores the
connections between childhood maltreatment and
subsequent problem behaviors. The findings of the
Rochester Youth Development Study reported in this
Bulletin are particularly valuable because they
come from a general population sample, which
allowed the researchers to examine how maltreated
youth differ from the general adolescent
population. The study results provide helpful
insights into the cost survivors of childhood
maltreatment often pay -- a cost that is always
too high. 

Shay Bilchik
Administrator 

------------------------------

This Bulletin is part of the Office of Juvenile
Justice and Delinquency Prevention (OJJDP) Youth
Development Series, which presents findings from
the Program of Research on the Causes and
Correlates of Delinquency. Teams at the University
at Albany, State University of New York; the
University of Colorado; and the University of
Pittsburgh collaborated extensively in designing
the studies. At study sites in Rochester, New
York; Denver, Colorado; and Pittsburgh,
Pennsylvania, the three research teams have
interviewed 4,000 participants at regular
intervals for nearly a decade, recording their
lives in detail. Findings to date indicate that
preventing delinquency requires accurate
identification of the risk factors that increase
the likelihood of delinquent behavior and the
protective factors that enhance positive
adolescent development. 

This Bulletin presents findings on the
relationship between childhood maltreatment and
subsequent adolescent problem behaviors in the
Rochester Youth Development Study. The researchers
found that the subjects who had experienced
maltreatment during childhood were significantly
more likely to display a variety of problem
behaviors during adolescence, including serious
and violent delinquency, teen pregnancy, drug use,
low academic achievement, and mental health
problems. Also, a history of childhood
maltreatment appeared to be a significant risk
factor for the development of multiple problems in
adolescence.

Throughout history, the lives of some children
have been diminished by their exposure to various
forms of maltreatment, such as physical abuse,
neglect, and sexual exploitation. As a new century
approaches, Americans need not look beyond their
own backyards to see the faces of children
subjected to maltreatment, most often at the hands
of parents and other caretakers.

------------------------------

National Estimates of Child Maltreatment

How extensive is the problem of child maltreatment
in the United States? This cannot be determined
with certainty, because a substantial but unknown
proportion of child maltreatment cases are never
brought to the attention of State and local Child
Protective Services. Therefore, the following
national estimates of officially reported and
substantiated cases of child maltreatment
undoubtedly undercount the actual number of
victimized children. The following estimates were
derived from annual surveys of all 50 States and
the District of Columbia conducted since 1986 by
the National Committee to Prevent Child Abuse
(NCPCA) (Lung and Daro, 1996). 

First, how many cases of maltreatment of children
are reported in the United States? In 1995, NCPCA
estimated that:

o There were 3,111,000 children reported to Child
Protective Services as alleged victims of
maltreatment.

o Reports have steadily risen over the past
decade, with a 49% increase from 1986 to 1995. 

o Forty-six out of every one thousand American
children (under 18 years old) were victims of
reported child maltreatment in 1995, reflecting
fairly steady growth from the reported rate of 33
per 1,000 children in 1986.

Second, how many reports were substantiated? NCPCA
estimated that:

o Approximately 1 million children were found to
be victims of maltreatment each year from 1992
through 1995.

o Fifteen of every one thousand children were
substantiated victims of child maltreatment in
each of these years.

o About one-third of the reports of child
maltreatment were confirmed.

o Of the substantiated 1995 reports, 54% involved
neglect, 25% physical abuse, 11% sexual abuse, 3%
emotional maltreatment, and the remainder involved
other forms of maltreatment. (The breakdown of
reported 1995 cases was essentially identical.)

Third, how often do children die as a result of
abuse or neglect? NCPCA cautions that the number
of fatalities officially recorded as child
maltreatment is considered an undercount of the
actual incidence. The NCPCA survey estimates that:

o During the past 10 years, more than three
children died each day as a result of parental
maltreatment.

o Abuse is the most common cause of death (48%),
followed by neglect (37%) and a combination of
abuse and neglect (15%).

o The majority of victims (85%) are under age 5,
and nearly half (45%) of the victims never reach
their first birthday.

In a 1995 report, the U.S. Advisory Board on Child
Abuse and Neglect concluded that the most
realistic estimate of annual child deaths from
abuse and neglect, known and unknown, is about
2,000 (or some 5 children every day) (U.S.
Department of Health and Human Services,
Administration for Children and Families, 1995).

The focus of this Bulletin is not on the victims
whose lives are tragically ended as a direct
result of child abuse and neglect. Rather, it
concentrates on the majority of child maltreatment
victims who have experienced maltreatment during
critical stages of child development.

------------------------------

Adolescent Consequences of Child Maltreatment

In addition to the immediate and short-term harm
of child maltreatment, there are long-term
ramifications of childhood victimization. Research
has shown that the consequences of child
maltreatment extend into adolescence and beyond
(Widom, 1994). Survivors of child maltreatment
experience many problems in the course of
adolescent development. A variety of negative
teenage outcomes, such as delinquency, pregnancy,
alcohol and drug abuse, school failure, and
emotional and mental health problems, have been
identified. 

Many researchers have utilized convenience samples
of incarcerated delinquents, drug rehabilitation
clients, pregnant teenagers, or institutionalized
mental patients to conduct retrospective analyses
of child maltreatment. Such studies have generally
concluded that these troubled populations more
frequently report histories of child maltreatment
than would be expected in the general population. 

Several methodological limitations affect the
confidence that can be placed in the conclusions
drawn from these types of studies, however. Few
studies establish an adequate comparison group in
their samples or measure an adequate range of risk
factors, protective factors, and problem
behaviors.

------------------------------

Rochester Youth Development Study

The Rochester Youth Development Study, conducted
by researchers at the University at Albany, State
University of New York, is one of three
collaborative longitudinal projects under OJJDP's
Program of Research on the Causes and Correlates
of Delinquency. To determine how maltreated youth
differ from the general adolescent population, the
researchers asked:

o What is the range and extent of problems found
among adolescents who were maltreated as children,
compared with those who were not? 

o To what extent is child maltreatment a risk
factor for the development of multiple problems in
adolescence?

The researchers found that maltreatment during
childhood significantly increased the risk for a
variety of adolescent problem behaviors, including
delinquency, teen pregnancy, drug use, low
academic achievement, and mental health problems.

Also, youth who had been victims of child
maltreatment were more likely than nonmaltreated
youth to exhibit multiple problem behaviors. 

Subsequent analyses are planned to address
additional research questions:

o What key risk factors appear to increase the
likelihood that a maltreated child will become a
troubled youth?

o What protective factors serve to enhance youth
resilience despite a history of child
maltreatment?

This research clearly has implications for policy
and intervention efforts that target those
challenging cases of adolescents who have problems
in more than one area of life. The findings should
be of interest to all persons in a position to
prevent child maltreatment and to those who could
intervene in the lives of victimized children and
youth. Therefore, this Bulletin is intended not
only for policymakers and practitioners but also
for parents, who are in the best position to
protect and nurture their children's development.

------------------------------

Overview of the Study Design 

The Rochester investigation of maltreatment
outcomes was designed to consider several
different domains of adolescent problem behavior
utilizing a general population sample. Specific
problem areas that are measured include:

o Moderate, serious, and violent delinquency.

o Teen pregnancy.

o Drug use.

o Low academic achievement.

o Mental health problems. 

Sample 

The sample of 1,000 youth (75% boys and 25% girls)
was drawn from public school students attending
seventh and eighth grade in Rochester, New York,
in spring 1988. African-Americans make up the
majority of the sample (68%), while 17% are
Hispanic and 15% are white. This sample was
stratified to proportionally overrepresent those
students considered at high risk for delinquency
and drug use, based upon both their gender and
their residence in high-crime neighborhoods.
However, all data analyses presented here have
been statistically weighted to represent the
general cohort of all seventh and eighth graders
in the Rochester public schools. 

Data Collection 

Researchers commenced data collection in spring
1988 by privately interviewing youth and their
primary caretakers. The interviews were repeated
every 6 months. (Each 6-month period is referred
to as a "wave.") This report uses interview data
collected in waves two through eight. At wave two,
the subjects were in the fall semester of the
eighth or ninth grade and were 14 years old, on
average. At wave eight, they were in the fall
semester of 11th or 12th grade and were 17 years
old. In addition to data collected in face-to-face
interviews, data were collected from the Rochester
public schools, Police Department, Department of
Social Services, and other agencies that had
contact with the subjects.

------------------------------

Assessment of Maltreatment 

Data on maltreatment were obtained from Child
Protective Services records of the Monroe County
Department of Social Services, the county of
residence for all subjects at the start of the
project. For each subject, the researchers
recorded any instance of substantiated abuse or
maltreatment from birth through 1992. For the
purposes of this analysis, the term "child" refers
to someone who has not had his or her 12th
birthday. The researchers established this cutoff
so they could more accurately assess the impact of
maltreatment during childhood on subsequent
adolescent behavioral outcomes. This analysis does
not explore the separate but related topic of
adolescent maltreatment (Garbarino, 1989), which
may have continued from childhood or begun after
age 12. 

The term "child maltreatment" encompasses a fairly
broad spectrum of abuse and neglect scenarios. For
the purposes of this analysis, maltreatment
included seven subtypes: physical abuse, sexual
abuse, physical neglect, lack of supervision,
emotional maltreatment, educational maltreatment,
and moral-legal maltreatment. The researchers
utilized the maltreatment classification and
5-point severity rating scales developed by
Cicchetti and Barnett (1991) to code the
maltreatment case records. Table 1 contains
definitions of maltreatment subtypes and examples
from the severity rating scales of the least and
most serious types of cases (Barnett et al.,
1993).

The researchers recognize that reliance on
substantiated records of maltreatment is likely to
produce conservative estimates of the prevalence
and frequency of this often undetected or
unreported type of victimization. Furthermore,
although most of the sample youth had resided in
Monroe County since birth, a small proportion had
not. The researchers also expect there may be a
few child maltreatment victims lacking Monroe
County records who have been inaccurately
categorized as nonmaltreated in this sample. Any
bias that results from this misclassification
would be quite small and would work against the
study hypothesis. That is, it would make it
harder, not easier, to find that early
maltreatment is related to later delinquency.

------------------------------

Prevalence of Child Maltreatment

Of the total sample of 1,000 youth, 14% have a
child maltreatment record and 86% do not. These
subjects were maltreated in a total of 219
separate incidents (an average of 1.5 incidents
per maltreated subject). This rate is somewhat
higher than prevalence rates reported in national
data (U.S. Department of Health and Human
Services, National Center on Child Abuse and
Neglect, 1997) and is probably related to the
urban population of youth in the sample.

The 219 separate incidents of maltreatment
constitute a large enough number to investigate
the adolescent outcomes of maltreatment as a
whole. However, the researchers did not attempt to
separate the outcomes of the seven specific
subtypes of maltreatment, as the number of
incidents in each subtype was insufficient for
meaningful statistical analysis. Furthermore, many
of the victims were subjected to more than one
type of maltreatment.

Recent research provides some indications that the
overall experience of maltreatment, rather than
the specific subtype, is what has the greatest
impact on adolescent outcomes. For instance, in
Widom's (1996) study of a larger sample of 1,575
court cases of child maltreatment, the experience
of neglect appeared to be as damaging as physical
abuse. Child victims of neglect were almost as
likely as physically abused victims to be arrested
for violent crimes as teenagers and young adults.
Both neglect and abuse victims were more likely to
be arrested for and involved in violent crimes
than members of the matched nonmaltreated control
group. 

Table 2 presents the prevalence of maltreatment
for major demographic subgroups in the Rochester
study. There are no statistically significant
differences in the prevalence of maltreatment by
sex or race. Unfortunately, the total number of
maltreatment incidents was not large enough to
allow for sex-by-race comparisons. (Throughout
this discussion "statistical significance" is
defined as the probability that the observed
relationship would occur strictly by chance less
than 5% of the time (probability, or p < .05).)
There are, however, significant differences by
social class and family structure. Twenty percent
of youth reared in disadvantaged families -- those
in which the principal wage earner was unemployed,
welfare was received, or income was below the
poverty level -- were victims of maltreatment,
while only 8% of the nondisadvantaged respondents
were maltreated. The largest difference observed
is in family structure. Only 3% of the boys and
girls who resided with both biological parents at
the beginning of the Rochester study (spring 1988)
had a history of maltreatment, but 19% of those in
other family situations had been maltreated. 

This demographic information serves as a backdrop
for examining the central issue of this analysis -
-the relationship between earlier maltreatment and
the development of adolescent problem behaviors.

------------------------------

Maltreatment and Delinquency

It is commonly observed in research literature
that "lives containing delinquent behavior often
seem to contain maltreatment as well" (Garbarino
and Plantz, 1985). Most research on the
relationship of maltreatment to delinquency either
relied exclusively on official records to measure
delinquency or used retrospective designs
requiring subjects to recall their juvenile
misdeeds. Results have varied regarding whether a
maltreated individual is more likely to engage in
specific categories of delinquency such as minor,
serious, or violent crimes. 

Measurement of Delinquency

The Rochester researchers distinguished their
study from previous investigations of the
relationship of maltreatment to delinquency by
utilizing a general population sample with
measurement of official records of delinquency
(both "current" self-reported offenses). (See
Smith and Thornberry (1995) for a detailed
presentation of these results.)

The official measure of delinquency is based on
the number of times each subject had an official
contact with police as a juvenile or an arrest as
an adult. Official contacts include cases in which
the juvenile was "warned and released" by the
police and an official record of the event was
maintained and cases in which the juvenile was
referred to family court. Data were collected from
the files of the Rochester Police Department,
which maintains a registry of all such contacts
from all police agencies in Monroe County. The
official data cover the time from the subject's
first official contact through 1992, when the
subjects averaged 17 years of age.

Self-reported delinquency was assessed in the
face-to-face interviews. At each of seven
interview waves, the subjects were asked to report
their delinquent activities for the previous 6
months (the period between interviews). Prior to
analyzing these data, the researchers screened out
any reports of trivial actions that would be
ignored by local law enforcement officials. In
this analysis, the researchers examine responses
by youth to questions that were assigned to five
categories of delinquency: minor, moderate,
serious, violent, and general. Table 3 lists the
actual interview questions. In the table, the
minor, moderate, and serious items are mutually
exclusive; the general delinquency index includes
all of these items and is, therefore, not included
in the table. The violent offenses are also
categorized in either the moderate or the serious
index.

Findings Regarding the Prevalence of Delinquency

Based upon examination of official police records
and self-reports, maltreated children in this
sample were significantly more likely to become
involved in delinquency at some time. Figure 1
displays the relationship between prevalence rates
for child maltreatment and delinquency. While 32%
of the nonmaltreated youth have official records
of delinquency, a history of maltreatment raises
this figure to 45%. Maltreated youth also give
higher self-reports of having been involved (at
any time) in each delinquency category: minor,
moderate, serious, violent, and general.

The researchers further analyzed the prevalence
data, controlling for the following variables
generally considered to influence delinquency
rates: the subject's sex, race/ethnicity, family
disadvantage, family structure, and mobility. In
other words, the researchers wanted to see if the
effect of maltreatment on delinquency outcomes was
spurious and would be "washed out" if the
maltreated subjects were comparable to the
nonmaltreated subjects along these variables. With
these variables held constant, maltreated youth
still displayed significantly higher prevalence
rates of delinquency in terms of three measures:
official records, self-reported moderate
delinquency, and self-reported violence.

Findings Regarding the Frequency of Delinquency

Do maltreated subjects commit delinquent acts more
often than nonmaltreated subjects? In all of the
measured categories -- that is, official records
and self-reports (minor, moderate, serious,
violent, and general) -- maltreated subjects
engaged in delinquent activities significantly
more frequently. 

Again, the researchers controlled for sex,
race/ethnicity, family disadvantage, family
structure, and mobility. Even with these controls
in place, maltreated subjects displayed
significantly higher frequencies of delinquency in
the following four measures: official records and
moderate, serious, and violent self-reported
delinquency. 

With the control variables held constant, the
researchers concluded that childhood maltreatment
is a significant and nonspurious risk factor for
officially recognized delinquency, violent
self-reported delinquency, and moderate
self-reported delinquency. Maltreatment is
inconsistently related to serious delinquency,
being a significant predictor for the frequency
but not for the prevalence of serious delinquency.
Finally, childhood maltreatment is not a
significant risk factor for minor delinquency or
general delinquency, the overall index containing
the full range of delinquency. In short,
maltreatment appears to be a risk factor for the
more serious, but not the less serious, forms of
delinquency. 

Variations in the Maltreatment Experience and
Delinquency Outcomes

To this point, maltreatment has been measured as a
simple dichotomy, comparing adolescents who had
official records of maltreatment as children with
those who did not. This measure ignores the fact
that maltreatment can vary along such dimensions
as frequency, severity, duration, and type. The
researchers hypothesize that children exposed to
more extreme maltreatment will have higher rates
of delinquency than children exposed to less
extreme maltreatment. Therefore, whatever causal
mechanisms link early maltreatment to later
delinquency ought to be strongest as the
frequency, severity, duration, and variety of
maltreatment increase.

To test this hypothesis, the researchers
identified the top third of their maltreated
sample along each of the following four
dimensions:

o Number of maltreatment incidents.

o Severity of all incidents.

o Duration of all incidents.

o Number of subtypes of maltreatment across all
incidents. 

These more-maltreated subjects were then compared
with the remaining less-maltreated subjects and
the nonmaltreated subjects.

The strongest support for the hypothesis was found
in analyzing official records of the frequency of
delinquency outcomes. For each of the four
dimensions cited above, there were significant
increases in officially recorded delinquency when
comparing the nonmaltreated subjects with the
less-maltreated subjects and when comparing the
less-maltreated subjects with the more-maltreated
subjects. The more-maltreated subjects were
arrested about twice as often as the
less-maltreated subjects along each of the four
dimensions.

In terms of frequency of self-reported serious and
violent crime, the researchers observed
incremental increases from nonmaltreated subjects
to less-maltreated subjects to more-maltreated
subjects across all four dimensions of
maltreatment: frequency, severity, duration, and
variety. Significant increases appear between the
nonmaltreated subjects and more-maltreated
subjects. However, the distinctions between the
less-maltreated and more-maltreated subjects are
fairly modest in terms of self-reported serious
and violent crime. 

Overall, the Rochester study data confirm the
general finding that there is a relationship
between childhood maltreatment and later
delinquency. Furthermore, this analysis offers
some support for the strength of the relationship
between childhood maltreatment and later serious
or violent delinquency, which increases as the
seriousness of the maltreatment increases.

------------------------------

Maltreatment and Teen Pregnancy

Vobejda (1996) reports that, according to the
National Center for Health Statistics, births to
teenage mothers increased in every State from the
mid-1980's until 1990. Beginning in 1991, rates
have dropped in 46 States, with national birth
rates for teenage mothers declining for 4 straight
years. The number of births per 1,000 girls ages
15 to 19 has fallen from 62 in 1991 to 57 in 1995.
Nevertheless, birth rates for teenage mothers
remain much higher in the United States than in
other industrialized nations.

Experiencing pregnancy as a teenager has serious
and often deleterious consequences on the lives of
both the young mother and her baby. Teenage
mothers and fathers are usually ill equipped to
provide effective parenting and often draw heavily
upon the resources of their extended families and
communities. For teenage parents raised in
dysfunctional or abusive families, parenting
problems may be even more evident, and family
support limited. Therefore, it is important to
identify risk factors associated with teen
pregnancy.

Research on the effects of maltreatment on child
development suggests a number of pathways through
which maltreatment could heighten the risk for
teen pregnancy (Smith, 1996a). Although studies
following maltreated children have not generally
found evidence linking maltreatment with
subsequent teen pregnancies, a small body of
retrospective research with pregnant girls
suggests that a high proportion of them have
histories of abuse. 

Most researchers have focused on investigating the
link between childhood sexual abuse and teen
pregnancy, hypothesizing that the trauma of this
particular type of maltreatment may lead to sexual
preoccupation, precocious sexual behavior, and
sexual offending. However, many victims of
childhood maltreatment are exposed to multiple
types of maltreatment. This implies that
researchers should not focus solely on sexual
abuse but should examine the broad range of
maltreatment experiences, resulting developmental
disruptions, and possible links to teen pregnancy.

The few studies directly exploring the
relationship between childhood maltreatment and
subsequent teen pregnancy all have drawn samples
on the basis of maltreatment or pregnancy. The
Rochester study provides a unique opportunity to
examine the link between childhood maltreatment
and teen pregnancy among a general population
sample. 

Measurement of Teen Pregnancy

Teen pregnancy, for the purposes of this
discussion, refers to subjects' self-reports of
having been pregnant at any time. If female
subjects answered positively in any interview in
waves five (when the average age was 15.3 years)
through nine (when the average age was 17.3
years), the female subjects were classified as
having been pregnant. Male subjects were asked if
they had ever made a female pregnant. Thus, in
this presentation, teen pregnancy involves
subjects' reports of pregnancies up to the average
age of 17.3 years (high school age).

Findings Regarding the Prevalence of Teen
Pregnancy

For the purposes of this analysis, males and
females were separated. 

Maltreated boys did not report higher rates of
impregnating girls than nonmaltreated boys.
Precursors of teen fatherhood merit further
inquiry, as this experience is likely to have
negative consequences in the lives of the fathers
and their children. Researchers in the Rochester
study are examining a broader range of factors
that appear to increase the risk of adolescent
fatherhood (Smith, 1996b; Thornberry et al.,
forthcoming). 

The balance of this discussion focuses on the
findings regarding pregnancy outcomes among the
female subjects. Rates of teen pregnancy are
significantly higher among girls with a history of
childhood maltreatment. The prevalence of
pregnancy among maltreated girls is 52% compared
with 34% among nonmaltreated girls. The risk of
becoming pregnant is therefore approximately 50%
higher among high school girls who experience
maltreatment during their childhood. These
prevalence rates are shown in figure 2 (which also
highlights key findings regarding self-reported
serious delinquency, violence, drug use, lower
grade point averages (GPA's), and mental health
problems).

A Closer Look at Maltreatment Subtypes and
Pregnancy

It is interesting to note several key findings
from the extended analysis of this topic conducted
by Smith (1996a) utilizing Rochester study data.
Approximately one-half of the maltreated females
(21 out of 40) had been exposed to more than one
type of maltreatment. In this general population
sample, meaningful comparisons of pregnancy
outcomes could not be conducted across
maltreatment subtypes. There were simply too few
"single-type" maltreatment cases. For example,
among the five sexually abused female subjects,
four became pregnant as teenagers; however, three
were also exposed to other forms of maltreatment.
Therefore, it cannot be determined from these data
whether it is sexual abuse or other forms of abuse
that increase the risk of pregnancy in female
adolescents. 

Girls exposed to multiple types of maltreatment
are significantly more likely to become pregnant
than girls who experienced one type of
maltreatment. In addition to maltreatment per se,
it may be the range of developmental domains
affected by maltreatment that is associated with
pregnancy risk. Fortunately, not all maltreated
girls report pregnancies. Maltreated teenage girls
who become pregnant are more likely to display a
constellation of risk factors in early
adolescence, including early substance use, early
sexual intimacy, and poor academic performance. 

------------------------------

Maltreatment and Other Problem Behaviors

The most complete analysis of the consequences of
maltreatment using the Rochester data has been
conducted with delinquency and teen pregnancy as
the outcome variables. As discussed above, the
analyses examine different forms of delinquency,
evaluate the role of confounding variables, and
address different dimensions of maltreatment.

Recently, the researchers on the Rochester project
have begun to explore the relationship of
childhood maltreatment to other adolescent outcome
variables, but not yet in as much detail as for
the delinquency and pregnancy analyses. For these
other outcomes, more complete multivariate models
will be tested in the future. Following are
highlights of the analyses conducted to date on
the relationship of maltreatment to drug use, low
academic achievement, and mental health problems. 

------------------------------

Maltreatment and Drug Use 

The catalysts for the onset of drug abuse in
adolescence are many. Teenage drug users
frequently cite the following current problems in
their lives: peer pressure to use drugs,
difficulties in school, rebellion against adult
authority, lack of impulse control, desire for
immediate gratification, and low self-esteem. When
researchers (Dembo et al., 1992) interviewed
teenage drug users about earlier childhood
experiences, the youth frequently reported
histories of physical child abuse and sexual
victimization. Dembo concluded that developmental
damage caused by child maltreatment increases the
likelihood of adolescent drug use and other
problem behaviors.

A number of explanations have been offered as to
why a maltreated child would use drugs in
subsequent years (Ireland and Widom, 1994). For
instance, the maltreated victims may seek escape
from the harsh realities of their lives, even
after the abuse has ended. Those feeling socially
isolated might be willing to use drugs in order to
be part of a group. Other victims may seek to
alleviate suffering from low self-esteem or mental
disorders by self-medicating. 

Although reasonable rationales have been put forth
as to why maltreatment victims would use drugs,
the research on this issue is inconclusive. When
Ireland and Widom (1994) reviewed the literature,
they found both ambiguous and conflicting
findings. Research designs typically are
cross-sectional, rather than longitudinal, so it
is difficult to draw any causal inferences. There
are few adequate control or comparison groups.
Many studies have focused on adult female samples,
and there is evidence that gender may affect the
drug-use outcomes of child maltreatment. 

The impact of child maltreatment on drug use may
not be fully realized until the adult years. In
Ireland and Widom's (1994) study, after
controlling for relevant demographic variables,
child maltreatment was a significant predictor of
adult, but not juvenile, arrests for alcohol
and/or other drug-related offenses. 

The Rochester longitudinal design provides an
excellent opportunity to measure self-reported
drug use among a general population sample of
adolescents. The researchers can now examine
whether childhood maltreatment predicts adolescent
drug use. As the subjects age, the researchers
will be able to assess whether the drug-related
consequences of child maltreatment extend into or
emerge during adulthood. 

Measurement of Drug Use 

The Rochester study conducted face-to-face
interviews to assess drug use. At each of seven
interview waves, the subjects were asked to report
their drug use during the previous 6 months. Table
4 provides the 10 interview items for drug use.
The drug-use index does not include alcohol or
cigarette use.

Findings Regarding the Prevalence of Drug Use 

Youth with a history of childhood maltreatment are
more likely to use drugs than nonmaltreated
subjects. Based upon self-reports, 43% of the
Rochester study adolescents who were maltreated as
children have used drugs, compared with 32% of
those who were not maltreated. Thus, the risk of
using drugs is about one-third higher among youth
who have a maltreatment history. These drug-use
rates are displayed in figure 2.

------------------------------

Maltreatment and Low Academic Achievement 

Does the childhood experience of maltreatment
increase the likelihood of academic difficulties
and failure during middle school? Some research
has been conducted on adolescent learning
problems, school failure, and truancy among abused
populations (Malinosky-Rummell and Hansen, 1993).
Several studies have noted that maltreated
children and adolescents exhibit intellectual and
academic delays and lower scores on tests of
intelligence. Considerably more is known about the
immediate childhood consequences of maltreatment
on academic success than about the long-term
adolescent and adult outcomes.

Because the experience of maltreatment can delay
or disrupt normal child development, research
literature often emphasizes that maltreated
children exhibit problems in concentration and
achievement in school. Researchers (Erickson et
al., 1989) examined the kindergarten experience of
maltreated and nonmaltreated children. Maltreated
children displayed a host of difficulties in
adapting to the social environment and task
demands of school. For instance, children who were
maltreated were significantly more likely than
their nonmaltreated peers to need special
assistance, create classroom disturbances, perform
poorly, and comprehend less and to be inattentive,
overactive, unpopular, and aggressive. 

Do such negative outcomes continue to impede
academic success in adolescent years? Due to the
sequential nature of the academic learning
process, it is likely that maltreated children who
never mastered basic skills would have difficulty
applying these skills to the more complex tasks
found in middle school curriculums. Furthermore,
adolescents with a history of maltreatment might
have less personal capacity to meet social
challenges in the middle school setting. 

There are indications (Smith, 1996a) that girls
with histories of child maltreatment are less
likely to become pregnant if they aspire to and
achieve academic success. Other researchers
(Zingraff et al., 1994) have noted that adequate
school performance appears to substantially reduce
the risk of delinquency among maltreated children.
Performing well at school may indeed be key to
adolescent resilience following childhood
maltreatment. 

Measurement of Academic Achievement 

To assess how well subjects performed at school,
researchers computed their cumulative GPA's from
1986 to 1989 Rochester City School District
records. In 1989, the mean age was 14.4 years, and
subjects were in the spring semester of either the
eighth or ninth grade. Therefore, the cumulative
GPA is basically a measure of a student's grades
during middle or junior high school. In this
analysis, a GPA of less than 2.0 (less than "C")
is categorized as low.

Findings Regarding Academic Achievement 

The Rochester study shows that school achievement
by maltreated children is significantly lower than
that of youth who do not have a history of
childhood maltreatment. Poor grades are evident
among 33% of the maltreated group, compared with
23% in the group who were not maltreated. The
prevalence rates for low GPA's are presented in
figure 2. 

According to the study, then, students performing
poorly in middle school are considered at
increased risk for continued academic failure in
high school, low educational aspirations,
premature school dropout, and reduced educational
and economic opportunities. The Rochester
researchers plan additional data collection and
analysis to compare the high school experiences of
maltreated youth with those of nonmaltreated
youth.

------------------------------

Maltreatment and Mental Health Problems 

In considering the possible links between
maltreatment and subsequent mental health
problems, it is useful to employ a developmental
approach to psychopathology (Cicchetti, 1989).
Psychopathology occurs when there is a lack of
integration of the various social, emotional, and
cognitive competencies that underlie healthy or
normal adaptation at a particular level of child
and adolescent development. Interruption of
healthy childhood development by maltreatment may
ultimately lead to much larger disturbances at
subsequent developmental stages. The timing,
chronicity, and severity of the maltreatment are
critical factors in assessing their potential
impact on an individual child's psychosocial
development. 

Healthy development requires nurturing,
encouragement, supervision, and support by parents
or other primary caretakers. Obviously, a child
traumatized by maltreatment, particularly chronic
and severe maltreatment within the family setting,
suffers (at minimum) a temporary setback in his or
her positive psychological development. More is
known about short-term consequences than long-term
consequences of maltreatment, particularly in
instances where Child Protective Services are
notified and mental health assessments are
conducted. 

Although each child responds differently to life
circumstances and maltreatment experiences, child
victims often have a wide range of maladaptive
emotional and interpersonal symptoms in common.
The negative attributes associated with this
victimized population include anxiety,
inattentiveness, impulsiveness, anger, aggression,
passivity, withdrawal, depression,
self-destructiveness, obsessive-compulsive
behavior, and unpopularity (Erickson et al.,
1989). Such child victims are further described as
lacking self-confidence, empathy, and perhaps most
telling, joy.

What is known about the long-term consequences of
child maltreatment for victims in adolescence?
Maltreatment has been linked to a number of mental
health problems among adolescents, including
increased self-destructive and suicidal behavior,
fewer interpersonal competencies, and more mood
disorders, such as anxiety and depression
(Malinosky-Rummell and Hansen, 1993; Downs, 1993).
For at least some victims, the impact of childhood
maltreatment extends beyond adolescence, as
documented by both researchers and clinicians
working with adults with alcoholism and mental
illness. 

Measurement of Mental Health Problems 

In the Rochester study, parents were asked to
assess whether their children exhibited certain
emotional and behavioral responses symptomatic of
mental illness. The Rochester study investigators
collaborated with their colleagues at the
Pittsburgh Causes and Correlates of Delinquency
study site to develop a shortened version of the
Achenbach Child Behavior Checklist without
compromising the reliability and validity of the
longer, 118-item form. The abbreviated checklist
was advantageous in terms of reducing longitudinal
survey costs, interview time, and subject
attrition (Lizotte et al., 1992). The shortened
behavioral checklist adopted for use at Rochester
includes seven scales that fall under one of two
broad dimensions:

(1) Externalizing syndrome -- aggressive,
delinquent, hostile/withdrawn, and hyperactive.

(2) Internalizing syndrome -- immature, somatic
(physical) complaints, and uncommunicative.

As shown in table 5, quite a few of the behaviors
included in this checklist are not particularly
uncommon among adolescents. What is of clinical
concern is not an occasional positive response but
rather a significant loading on a particular scale
or syndrome. The checklist is typically used as a
diagnostic tool to identify subjects who fall at
the behavioral extremes on these scales. For the
purposes of this analysis, adolescents who score
in the top 10% on either the externalizing or
internalizing syndrome scale are counted as having
problems suggesting psychopathology and/or
behavioral disturbances. 

Findings Regarding Mental Health Problems

Mental health problems that affect teenagers
include externalized conduct problems such as
aggressive, hostile, and hyperactive behavior and
internalized problems such as social isolation,
anxiety, and physical distress. One might expect
such symptoms to be linked with prior
maltreatment, as indeed figure 2 suggests. Of
subjects whose parents report the highest number
of either externalizing or internalizing problems,
15% of nonmaltreated teenagers are in this group,
compared with 26% of the maltreated teens.

------------------------------

Maltreatment and Multiple Problem Behaviors 

Thus far, this Bulletin has attempted to sort out
or isolate specific problem areas in the lives of
adolescents. Traditionally, this is the way
research on adolescent problems has been
conducted. It is now time to consider the process
of youth development from a holistic perspective.
Some teenagers have multiple and overlapping
problems that increase the likelihood that they
will not be able to make successful transitions to
adult roles and responsibilities. 

Youth who become involved in the juvenile justice
system often carry more baggage than just their
presenting offenses. Researchers conducted a
longitudinal examination of the troubled
lifestyles of juveniles originally held in a
Florida detention facility (Dembo et al., 1991).
Among this high-risk sample, multiple problems
were the norm, rather than the exception. The
majority of the detained youth came from
physically abusive homes, engaged in delinquency
and drug abuse, and experienced academic
difficulties or school failure.

Assessment of Multiple Problem Behaviors 

This analysis looks at whether childhood
maltreatment is a risk factor for having multiple
problems during adolescence and utilizes
measurement procedures previously described for
the following five categories of negative
outcomes:

o Serious delinquency.

o Teen pregnancy.

o Drug use.

o Low academic achievement.

o Mental health problems.

Findings Regarding Multiple Problem Behaviors 

Figure 3 illustrates the proportion of maltreated
youth and nonmaltreated youth with no negative
outcomes, one to two negative outcomes, or three
or more negative outcomes.

First, the figure shows that a lower proportion of
maltreated youth than nonmaltreated youth have no
problem outcomes. Still, it is somewhat
encouraging to see that more than one-fourth (28%)
of youth with histories of childhood maltreatment
are not presenting any negative adolescent
outcomes, as measured in this analysis. In
contrast, 40% of the nonmaltreated youth fall into
this category; they are more likely to progress
through adolescence unscathed by serious problems.

Next, maltreated youth (40%) and nonmaltreated
youth (42%) are almost equally likely to have only
one or two problems. This suggests that many
youngsters, not just those who have official
records of childhood maltreatment, have a problem
in some area of their lives.

Finally, the figure depicts the group of most
concern -- youth experiencing three or more of the
five problem areas examined here. Maltreatment is
a significant risk factor for multiple problem
outcomes. Of the maltreated youth, 32% have three
or more negative outcomes, compared with only 18%
in the nonmaltreated group. The risk of multiple
negative outcomes increases by nearly 80% among
the maltreated subjects. 

------------------------------

Summary and Discussion 

In the past few decades, increasing attention has
been paid to the phenomenon of child maltreatment
and its long-term impact on youth development. A
growing body of research suggests that being
maltreated as a child increases the chances of a
variety of developmental problems during
childhood, adolescence, and adulthood. This
presentation of the Rochester study data has
examined the consequences of childhood
maltreatment in terms of subsequent adolescent
problem behaviors. 

Overall, these results indicate that having a
history of childhood maltreatment serious enough
to warrant official intervention by Child
Protective Services increases the likelihood of
problems during adolescent development.
Specifically, subjects with a history of
maltreatment were more likely to engage in serious
and violent delinquency, use drugs, perform poorly
in school, display symptoms of mental illness, and
(for girls) become pregnant. Childhood
maltreatment is associated with an increased risk
of at least 25% for each of these investigated
outcomes. Any one of these problems jeopardizes a
teenager's potential for making a successful
transition to adulthood. 

Maltreatment diminishes the likelihood that
children will come through adolescence with no
serious problems. Moreover, a history of childhood
maltreatment nearly doubles the risk that
teenagers will experience multiple problems during
adolescence.

In view of the link between maltreatment and
various problem outcomes, it is critical for
practitioners and researchers to consider youth
holistically, across a range of areas in which
maltreatment may be manifested developmentally.
This is particularly critical for youth who are
already experiencing multiple problems.
Implementation of a holistic intervention approach
will necessitate a high level of coordination
among service systems, targeting maltreated
children and families and working with teenagers
experiencing several related problems.

Obviously, not every possible adverse outcome was
detected or assessed in this presentation of the
Rochester data. For instance, alcohol use, school
truancy, school dropout incidents, serious
conflicts with parents, running away from home,
and teenage parents' maltreatment of their own
children were not included in this analysis of
adolescent problem behaviors. Practitioners and
researchers are urged to consider assessment of a
full spectrum of adolescent consequences when
dealing with victims of maltreatment. 

The Rochester research strengthens and clarifies
the empirical link between maltreatment and later
problem behaviors among a general population
sample of teens. However, these data do not imply
that maltreatment leads directly or inevitably to
later problems. An important theoretical and
practical issue for future research is the
identification of the pathways connecting early
maltreatment to various adolescent problem
behaviors.

Such pathways may be affected by intervening
factors, including the emergence of protective
factors and the provision of effective services.
There is evidence of great variation in official
responses to maltreated children and their
families, within and across jurisdictions, ranging
from no service provision to placement of children
outside the home (Lung and Daro, 1996).
Information on service responses and other
intervening factors is vital to the enhancement of
efforts to accurately assess and effectively deal
with maltreatment victims.

When researchers look for indicators that increase
the risk of negative outcomes for maltreated
youth, they should also identify protective
factors or buffers that boost resiliency. As noted
in the presentation of findings, 28% of maltreated
subjects had no detected problem. This is the most
encouraging finding: long-term developmental
damage does not appear to be inevitable, as
assessed across five problem areas. This finding
is important. If the processes that lead to
resilience can be identified, youth-serving
professionals will be in a better position to
develop effective intervention programs for other
maltreated youth. In doing so, it will be
important to consider factors such as the
following:

o The developmental stage(s) at which
victimization occurred.

o Variations in the frequency, severity, duration,
and type of maltreatment.

o The relationship of the victim to the
victimizer.

o The question of whether maltreatment was
reported and, if so, the agency's response.

o The range of developmental areas affected by
experiences of maltreatment.

With a better understanding of how maltreatment
disrupts or derails healthy development in
children and adolescents, those who work with
young people will be far better positioned to help
guide them onto productive pathways to the future.
Practitioners providing such guidance represent
fields such as Child Protective Services,
education, pediatrics, juvenile justice, substance
abuse treatment, and mental health. These
practitioners are urged to foster two
interdisciplinary approaches: 

o A comprehensive assessment of troubled
adolescents to determine if a history of
maltreatment continues to negatively impact their
lives.

o Individualized treatment of victimized youth to
strengthen protective factors that help minimize
their involvement in detrimental behaviors. 

As maltreated children grow older, their status as
victims may be overlooked as their behavior
becomes more disruptive and problematic. There is
evidence that some institutionalized delinquent
and substance-abusing youth may have experienced
considerable trauma in connection with early
maltreatment (Dembo et al., 1992). When a child
victim becomes a juvenile offender, legitimate
concerns about protecting public safety and
holding youth accountable for their behavior can
easily overshadow issues of continued trauma from
childhood maltreatment. As the Nation seeks to
provide a balanced approach to juvenile justice,
policymakers, practitioners, and the public must
recognize that a punitive response such as secure
detention or incarceration may place the youth at
risk of further victimization. Punitive responses
also may exacerbate previous emotional and
developmental problems resulting from
maltreatment. In this connection, it is
particularly important to provide comprehensive
assessment services to identify problem areas and
develop responsive services for juveniles. 

Practitioners attempting to design and implement
effective individualized treatment plans must
consider the context of the victim's family and
community environment. As noted by Briscoe (1995):

 . . . if we understand that a child who is not
 nurtured is a child who never learns to trust, 
 never develops empathy, never accepts 
 responsibility for his behavior, and hurts others
 with impunity, then we will figure out a way
 to collaboratively make children and families a
 priority and support and empower them to take
 responsibility to rear healthy and productive
 children. 

Traditionally, less emphasis has been placed on
preventing child maltreatment than reporting and
intervening in these cases. Rather than merely
responding to reports of child maltreatment, Child
Protective Services must also dedicate their
resources to screening and developing resources
(preferably those that begin during the prenatal
period) for at-risk parents. 

Educating all future parents, not just those at
high risk for maltreating their children, should
be a national priority. The United States
currently places more emphasis on educating and
licensing drivers than on preparing the next
generation of parents. Few new parents are fully
cognizant of just how much time and energy are
involved in nurturing newborns. Many parents lack
familiarity with the normal difficulties and
stresses inherent in the care and supervision of
developing infants, children, and adolescents.
Parents should be advised that stress factors such
as financial concerns, fatigue, alcohol
consumption, and drug use can reduce their
tolerance for normal infant and child behavior and
increase their propensity to abuse their children.
To prevent child maltreatment, parents need to
understand not only the immediate but also the
long-term consequences of their actions.

Furthermore, parents must recognize that their
dependents need extensive adult supervision and
care for the duration of their childhood. Social
and work-related commitments do not relieve a
parent of the responsibility to provide adequate
nurturing and supervision. The task of raising a
child is particularly difficult for parents who
are isolated and lack an extended family or social
network from which to draw support. Merely
educating parents about their responsibilities
will not suffice -- communities must also develop
adequate resources, such as affordable and
accessible daycare, to support parents' efforts to
provide the emotional, social, and physical
support their children need. 

Admittedly, some mothers and fathers will not be
receptive to even the most intensive support and
training, perhaps because of their own lack of
maturity, mental illness, alcoholism, drug
addiction, criminal involvement, or history of
abuse. In certain instances, the best interests of
a child would necessitate at least temporary
removal from the biological parents, before the
child's normal development is severely compromised
by maltreatment.

While far more is known about the symptoms of
maltreatment than ways to deal with it, research
is providing more information about both.
Ultimately, the degree to which the Nation
safeguards children's futures will be measured in
terms of how effectively society responds to abuse
and neglect when it occurs and how committed the
American people are to prevention in the first
place.

------------------------------

References

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Briscoe, J. 1995. Cycle of violence and the cost
of child abuse and neglect. Texas Youth Commission
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Cicchetti, D. 1989. How research on child
maltreatment has informed the study of child
development: Perspectives from developmental
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the Causes and Consequences of Child Abuse and
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------------------------------

Points of view or opinions expressed in this
document are those of the author(s) and do not
necessarily represent the official position or
policies of OJJDP or the U.S. Department of
Justice.

------------------------------

Acknowledgments

This Bulletin was prepared by Barbara Tatem
Kelley, M.A., an independent consultant with
extensive experience in juvenile justice research
and program development; Terence P. Thornberry,
Ph.D., Professor and former Dean at the School of
Criminal Justice, University at Albany, State
University of New York; and Carolyn A. Smith,
Ph.D., Assistant Professor at the School of Social
Welfare, University at Albany, State University of
New York. Dr. Thornberry is Director of the
Rochester Youth Development Study; Dr. Smith is
coprincipal investigator of the study.

The authors would like to express appreciation to
their colleagues on the Rochester Youth
Development Study. Particular thanks are due to
the Monroe County Department of Social Services,
especially the Commissioner, Diane Larter, and the
Research Director, Daniel Ross, for providing
access to the records on maltreatment and for
helping us properly interpret the data. We would
also like to thank Dante Cicchetti of the
University of Rochester for his advice about
measuring maltreatment. Most important, of course,
we thank the participants in the Rochester Youth
Development Study for sharing so much of their
time with us over the years.

------------------------------

The Office of Juvenile Justice and Delinquency
Prevention is a component of the Office of Justice
Programs, which also includes the Bureau of
Justice Assistance, the Bureau of Justice
Statistics, the National Institute of Justice, and
the Office for Victims of Crime.