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5. Children's Development, Functioning, and Behavior

Whereas previous NSCAW findings (U.S. Department of Health and Human Services Administration for Children and Families [U.S. DHHS ACF], 2003) and other research have described the behavior of children in foster care (e.g., Landsverk, 1997), little is known about the well-being of children at the entrance into the child welfare system (CWS). This chapter discusses the well-being of children involved with CWS by examining a variety of measures designed to assess physical, cognitive, and emotional development. These data offer long-awaited information about the functioning of children, nationally, as they first enter child welfare services. The purpose of this chapter is to provide a broad overview of child well-being. (Future NSCAW reports will delve into various aspects of well-being in more detail.) The analysis begins with a description of the well-being of younger children—their physical attributes as well as their performance on several standardized measures—and then describes the cognitive functioning, adaptive and social functioning, and emotional and behavioral well-being of older children.

A child's involvement with CWS can affect and be affected by his or her well-being, so we pay careful attention to how children within the system differ from children in the general population, as well as how they differ from one another. Although well-being indicators such as physical growth, mental health, and involvement in delinquent activities may be closely tied to safety or permanency, the findings here are meant simply to describe the functioning of the children at baseline; more detailed analyses, and particularly longitudinal analyses, will be needed to begin to better describe the associations among features of safety, permanence, and well-being. presented for informational purposes.

NSCAW data collection utilizes numerous standardized measures of children's functioning. Multiple measures are included to be sure that the important developmental domains are covered for each age group. Further, these measures provide some level of comparability, via standardized scores, with populations on which the measures were normed and, for some measures, scores that indicate that a child is “at risk” or in a “clinical” range. In concept, this allows us to compare the NSCAW sample with children in the general population. This comparability is restricted, however, by the characteristics of the populations that have been used to norm the instruments. Insofar as the NSCAW populations may be incomparable to instrument norms because they reflect children from a different era, racial/ethnic group, or income group, results must be viewed with some caution. The measurement package also includes measures made for, or adapted to, NSCAW. These include extant measures tailored to fit the requirements of computerized administration in NSCAW; time constraints also led to additional modifications. These adaptations have been detailed in Chapter 2 but are noted again to ensure the optimal interpretation of data from these NSCAW-specific measures.

We begin with a description of the standardized measures for the youngest children. After describing the performance of the children on each of the measures, we routinely compare children on the basis of age, race/ethnicity, and service setting. At times, when age is closely circumscribed by the measure and there is reason to look at possible differences in gender, we also compare scores for girls and boys. We compare children on the basis of race/ethnicity because of the ongoing and important debate about the role of race in receiving child welfare services. Understanding baseline differences in performance will help us to understand changes that may or may not occur, which may also help us understand some of the dynamics leading to greater and longer involvements in child welfare services for Black families.

Because some of the debate about racial differences centers on the cultural appropriateness of assessments, we have made an effort to examine this issue. Although it is beyond the scope of this report to review the scholarly literature on the application of these measures with children of different ethnic groups, we have endeavored to understand whether NSCAW field representatives (i.e., interviewers) had different results when they were assessing children who were culturally similar or different to them. For those measures that required a substantial amount of rater involvement (i.e., the BDI and BINS), we tested to see if children or households had substantially different scores depending on whether they were rated by African American, White, or Hispanic interviewers. These findings are provided below.

Presumably, children are selected into various child welfare service conditions or settings because of differences in their characteristics and service needs; it is informative, then, for service planning and policy making purposes, to be able to describe these potential differences. Generally, the results for a given measure are presented in order to distinguish between children residing in five service settings: in-home following the investigation (with and without child welfare services) and those placed out-of-home (and currently in nonkinship foster care, kinship care, or group care). Interpreting comparisons between the two in-home placement conditions and comparisons based on placement types is complex. Because a median of 150 days passed between the beginning of the investigations from these most recent maltreatment allegations and the interviews in which the standardized measures were obtained, the child may have been in several different service settings prior to the assessment. Similarly, there might have been a change in whether or not a child's case was open. These “mixed” experiences with service settings limit the precision of the comparisons presented in the data tables.

Because race/ethnicity, service setting, and age are sometimes associated, the treatment of each measure concludes with a multivariate analysis that controls for a few background characteristics to explain the performance on the measure. These analyses are by no means intended to control for all possible explanations of the developmental measure and are only intended to confirm whether or not the bivariate relationships hold despite the associations between the variables of concern. We have also added gender to these analyses because—although not correlated with race or age—there is compelling developmental literature about the association between gender, risks (e.g., child maltreatment) and protective factors (e.g., services), and development.

Evidence from smaller, localized studies often shows that abused and neglected children are at risk for many untoward outcomes, including elevated rates of delinquency, sexual activity, and substance abuse. The relationships among types of maltreatment, onset of maltreatment, and onset of high-risk behaviors and the association between receipt of services and the reduction of risk of untoward outcomes are complex, and a full exploration of them is beyond the scope of this report. A thorough description of the relationships among these phenomena at entrance into CWS will provide the basis for understanding what services may be needed, from the earliest months of child welfare involvement.

5.1 Well-Being of Young Children

One of the ways that abuse and neglect manifests in children is through delayed or unusual physical development. Concerns about a child's development may be the rationale for the child abuse investigation or may be associated with the decision about service provision. This is likely to be particularly true for infants and very young children because their growth occurs at a faster rate than in later years, and growth problems can more rapidly become a threat to their safety and well-being. Studies have shown that neglect and certain physical attributes such as below-normal weight gain (i.e., failure to thrive) are associated with delayed cognitive development in younger children (Mackner, Starr, & Black, 1997), as well as behavior problems and poor school functioning in older children (Kerr, Black, & Krishakumar, 2000). Maltreatment may also be associated with deficits in cognitive, emotional, and behavioral development. Children with a history of abuse or neglect are at risk for developmental delays (Singer et al., 2001) and behavior problems (Toth et al., 2000).

Emotional regulation is another aspect of the well-being of young children. Temperament is typically understood to be an intrinsic characteristic that shapes parent-child interaction from the first days of life (Seifer & Schiller, 1995). At later ages, the caregiver-child relationships that the child has experienced may also influence the child's temperament. These social experiences can, ultimately, be reflected in the child's biological and psychological make-up (Perry et al., 1995). A child's temperament has been shown to be somewhat predictive of future conduct, especially for boys with high activity levels and low levels of fear in infancy (Colder, Mott, & Berman, 2002).

This section presents information on the well-being of young children involved with CWS as it relates to physical, cognitive, and behavioral development. Bivariate and multivariate analyses include comparisons by age, gender, race/ethnicity, and service setting. Some comparisons to national norms are presented as well.

5.1.1 Height, Weight, Body Mass Index, and Head Circumference

Height, weight, and head circumference were obtained for children aged 3 and younger, while body mass index (BMI) is calculated only for children aged 2 to 3 years. (Utilizing BMI to screen children younger than age 2 for growth is not recommended by the Centers for Disease Control and Prevention [CDC].)

Height

Average height percentiles for children aged 3 and younger involved with CWS are presented in Table 5-1. In general, children in this population fall slightly below the 50th percentile with regard to height. One-year-olds are significantly shorter for their age than are children less than 1 year of age and children 2 to 3 years of age. The difference between 1-year-olds and children less than 1 year old is most exaggerated in the out-of-home subpopulation (p < .001). Bivariate analyses did not reveal any significant height differences based on gender, race/ethnicity, or child setting. A regression that controlled for age, gender, race/ethnicity, and child setting confirmed these results.

Table 5-1. Height Percentile for Children Aged 3 and Younger
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age < 1 50.7 a
(3.7)
57.1
(5.7)
38.8
(2.9)
50.9
(4.3)
44.6
(3.4)
57.4
(6.7)
--- 50.2 c
(4.5)
1 38.5 b
(3.6)
40.3
(4.6)
36.7
(4.8)
39.5
(3.8)
39.7
(7.0)
22.2
(5.0)
--- 30.2
(5.6)
2-3 53.0
(3.8)
55.6
(4.2)
46.7
(5.7)
52.9
(3.8)
40.1
(8.4)
66.7
(10.7)
--- 53.8
(8.8)
Gender Male 45.7
(3.0)
47.0
(3.7)
42.6
(4.1)
45.6
(3.0)
40.4
(5.1)
55.7
(12.0)
--- 46.2
(6.7)
Female 50.1
(3.3)
53.7
(4.3)
41.4
(4.0)
50.5
(3.6)
45.3
(4.5)
50.0
(7.0)
--- 48.1
(5.1)
Race/ Ethnicity Black 43.8
(3.5)
43.9
(5.4)
40.4
(5.0)
42.6
(4.0)
44.1
(6.0)
56.9
(10.3)
27.6
(21.5)
49.7
(6.7)
White 51.1
(2.8)
54.4
(3.9)
42.8
(3.2)
51.0
(3.0)
41.5
(6.1)
61.7
(10.0)
--- 52.0
(7.4)
Hispanic 49.3
(3.9)
54.8
(4.5)
36.4
(5.2)
52.0
(4.3)
41.3
(7.7)
31.6
(8.1)
--- 37.0
(4.3)
Other 40.1
(7.3)
31.8
(9.2)
58.2
(10.9)
39.3
(8.9)
41.0
(8.0)
48.2
(25.0)
--- 44.5
(11.0)
TOTAL 47.8
(2.4)
50.2
(2.8)
42.1
(3.1)
47.9
(2.4)
42.3
(3.7)
52.5
(7.6)
31.2
(20.6)
47.1
(4.7)
^ Includes “other” out-of-home placement (back)

a Height percentiles are lower for 1-year-olds than for children less than 1 year of age (t = 2.8, p < .01) (back)

b Height percentiles are lower for 1-year-olds than for children age 2 to 3 (t = -2.7, p < .01) (back)

c Height percentiles are lower for 1-year-olds in out-of-home care than for children less than 1 year of age in out-of-home care (t = 3.8, p < .001) (back)

Weight

As with height, the mean weight of children involved with CWS is close to the 50th percentile (Table 5-2). An exception appears for children in group care who, on average, fall in the 20th percentile. This is significantly lower than children in nonkinship foster care and kinship foster care. Care should be taken in interpreting these results, however, as the sample size of children in group care was very small for this analysis (n = 11).

Table 5-2. Weight Percentile for Children Aged 3 and Younger
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age < 1 53.4
(1.8)
53.0
(3.0)
55.1
(2.4)
53.7
(2.2)
54.4
(3.5)
51.2
(3.3)
--- 52.6
(2.5)
1 50.8
(3.2)
51.7
(4.5)
48.4
(5.3)
50.9
(3.7)
50.2
(7.0)
48.8
(4.3)
--- 49.6
(3.8)
2-3 55.6
(2.5)
58.3
(2.9)
52.2
(4.9)
56.5
(2.7)
51.5
(6.2)
48.4
(11.4)
--- 48.5
(6.7)
Gender Male 52.9
(2.4)
54.1
(3.4)
49.4
(4.3)
52.7
(3.0)
53.7
(3.6)
56.1
(8.2)
--- 53.8
(4.3)
Female 54.4
(2.3)
56.0
(3.7)
55.4
(3.7)
55.8
(2.8)
51.3
(4.5)
45.0
(5.9)
--- 47.3
(3.9)
Race/ Ethnicity Black 50.3
(3.7)
55.4
(4.3)
44.2
(5.1)
51.3
(3.8)
51.4
(5.9)
40.6
(8.0)
19.3
(10.0)
45.8
(5.5)
White 57.3
(2.1)
58.6
(3.4)
55.3
(2.7)
57.7
(2.5)
54.0
(5.3)
57.5
(7.2)
--- 54.6
(5.0)
Hispanic 50.8
(4.4)
49.0
(6.3)
58.2
(5.2)
50.5
(5.5)
55.9
(3.3)
48.9
(3.4)
--- 52.5
(2.1)
Other 55.0
(6.7)
51.6
(10.1)
64.9
(10.2)
56.1
(8.0)
45.9
(6.4)
52.9
(7.6)
--- 49.9
(5.0)
TOTAL 53.6
(1.6)
55.0
(2.5)
51.9
(2.4)
54.1
(1.9)
52.7
(2.9)
49.6
(4.5)
20.4
(9.6)
50.6
(2.8)
^ Includes “other” out-of-home placement (back)

To expand on bivariate findings, a regression analysis of weight percentile, controlling for child age, gender, race/ethnicity, and setting, was run. Group care was used as the reference group for the setting variable in this model as it displayed the most striking differences from the other settings in the bivariate analysis and warranted confirmatory multivariate analyses. Results of the model confirmed the significant differences between children in group care and those in other out-of-home placement types, and further revealed that the mean weight percentile of children in group care is also significantly lower than that of children remaining at home, both without services (p < .001) and with services from the child welfare agency (Table 5-3). For all setting comparisons, children in group care are lower by approximately 30 percentile points.

Table 5-3. Regression Modeling Weight Percentile for Children Aged 3 and Younger
Characteristic Beta Coefficient (SE)
Age 2-3 (reference group)
<1 -2.07 (2.76)
1 -5.21 (3.93)
Gender Female (reference group)
Male -1.29 (3.44)
Race/ Ethnicity White (reference group)
Black -6.78 (4.14)
Hispanic -6.89 (5.17)
Other -2.65 (7.60)
Child Setting/Services Group care (reference group)
In-home, no services 32.69 (9.14)^^_i
In-home, services 29.21 (9.34)^_i
Foster home 31.37 (9.47)^^_ii
Kinship care 27.27 (8.35)^_ii
Multiple R2 is .02

* p ≤ .01, (back: ^_i, ^_ii)

** p ≤ .001 (back: ^_i, ^_ii)

Neither the bivariate nor the multivariate analysis indicated any significant differences in weight percentile based on child age, gender, or race/ethnicity.

Failure to thrive (FTT) in young children can be defined as weight below the 5th percentile (Drotar & Robinson, 2000; English, 1978; Raynor & Rudolph, 1996), although other definitions also consider the trajectory of weight loss. Overall, for the young children in this study, 11% meet this criterion of weight lower than 95% of all children. Although the proportion of children below the 5th percentile varies from 8% to 15% for various age, gender, race/ethnicity, and setting subpopulations in our study group, there are no significant differences within any of these characteristics. (Of young children in group care, 52% meet the FTT criterion; however, as mentioned previously, the sample size is extremely small.)

Body Mass Index

Body Mass Index (BMI), which takes both weight and height into account, is often considered a more accurate way to assess physical development and identify individuals who should be considered “overweight” or at risk for being overweight. CDC considers a child with a BMI between the 85th and 95th percentiles to be at risk of being overweight, and a child with a BMI greater than the 95th percentile to be overweight. Although expert guidelines do not exist to identify a child who is underweight, CDC indicates that analogous cutoffs may be used (i.e., less than the 5th percentile = underweight; 5th to 15th percentile = risk for underweight (Kuczmarski et al., 2000). A child with a BMI between the 16th and 84th percentile would be considered at an appropriate weight for their height.

In general, the mean BMI for 2- to 3-year-olds involved with CWS is close to average, with a few exceptions. As seen in Table 5-4, children in kinship foster care average a BMI percentile of just 32. This is significantly lower than the 61(st) percentile that is the average for children in nonkinship foster care. In addition, Hispanic children in out-of-home care average a significantly higher BMI percentile than Black children in out-of-home care.

Table 5-4. Body Mass Index Percentile for Children Aged 2 to 3 Years
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age 2 54.8
(3.4)
56.8
(4.4)
56.1
(4.5)
56.6
(3.3)
61.9
(7.7)
26.1
(8.9)
--- 46.6
(11.6)
3 51.3
(4.8)
52.9
(5.8)
50.9
(7.4)
52.3
(5.1)
59.0
(11.9)
37.7
(14.7)
--- 39.9
(11.5)
Gender Male 51.4
(5.5)
54.3
(7.0)
47.9
(7.4)
52.1
(5.5)
66.1
(5.4)
28.3
(11.0)
--- 46.4
(12.0)
Female 54.6
(4.1)
54.4
(5.7)
61.7
(5.2)
56.4
(4.3)
52.0
(11.7)
35.4
(13.5)
--- 40.8
(10.5)
Race/ Ethnicity Black 46.9
(7.0)
56.0
(7.7)
36.2
(8.3)
48.8
(7.3)
45.7
(11.9)
18.5
(12.1)
--- 31.2 b
(11.1)
White 54.8
(4.1)
55.4
(5.7)
61.3
(4.1)
57.5
(3.9)
60.0
(11.7)
30.8
(10.9)
--- 35.2
(10.7)
Hispanic 57.8
(8.0)
53.8
(10.2)
78.3
(8.5)
56.6
(9.2)
--- 35.5
(15.8)
--- 64.5
(7.3)
Other 53.8
(7.2)
38.5
(8.7)
67.3
(12.1)
48.5
(7.7)
--- --- --- ---
TOTAL 52.8
(3.5)
54.4
(4.1)
53.2
(4.6)
54.0
(3.4)
61.4 a
(6.7)
31.8
(9.1)
--- 44.1
(8.8)
^ Includes “other” out-of-home placement (back)

a BMI percentiles are higher for children in nonkinship foster care than for children in kinship foster care (t = 2.9, p < .01) (back)

b BMI percentiles are higher for Hispanic children in out-of-home care than for Black children in out-of-home care (t = 2.6, p ≤ .01) (back)


A regression controlling for child age, gender, race/ethnicity, and setting confirmed the differences in child setting found through the bivariate analyses. Kinship foster care was used as the reference group for the setting variable because, as with group care in the previous analysis, it displayed the most striking differences from the other settings in the bivariate findings. The model confirmed that the difference in mean BMI percentiles for children in kinship care and children remaining at home and not receiving child welfare services is significant, with children in kinship care having lower BMIs by over 20 percentile points (Table 5-5). Significant differences were not found with regard to any of the other characteristics examined.

Table 5-5. Regression Modeling BMI Percentile for Children Aged 2 to 3 Years
Characteristic Beta Coefficient (SE)
Age 3 (reference group)
2 3.58 (5.16)
Gender Female (reference group)
Male -3.98 (6.56)
Race/ Ethnicity White (reference group)
Black -8.90 (7.31)
Hispanic 2.07 (8.76)
Other -1.08 (8.90)
Child Setting/ Services Kinship care (reference group)
In-home, no services 23.05 (9.06) *_i
In-home, services 23.12 (9.30)
Foster home 28.68 (11.36) *_ii
Multiple R2 is .04

* p ≤ .01 (back: *_i, *_ii)

Using CDC definitions, only 41% of children aged 2 to 3 years involved with CWS are at an appropriate weight for their height. The remaining 59% are almost evenly split between being at risk for or overweight and being at risk for or underweight—about twice the expected rate in the general population. When we narrow the examination to children who are underweight or overweight, 17% of the children in this population are overweight—over 3 times the proportion that would be expected in the general population. Similarly, 15% of the children in this population are underweight—again, 3 times the proportion that would be expected in the general population. No significant differences were found with regard to the weight status variable based on child age, gender, race/ethnicity, or setting.

Head Circumference

The relationship between head circumference and development is complex, although Strathearn et al. (2001) recently showed a significant association between neglect, delayed cognitive development, and head growth among low birth weight babies. Specifically, the study indicated that low birth weight infants whose neglect was substantiated (as compared with infants who were not neglected) had a significantly smaller head circumference at 2 and 4 years but not at birth. In general, average head circumference for children aged 3 and younger in the population of children involved with CWS is somewhat below the 50th percentile. Most comparisons between types of service settings showed no differences, although children in nonkinship foster care have particularly small head circumferences, with a mean at the 37th percentile. This is significantly smaller (p < .001) than children in kinship care, whose mean is at the 57th percentile (Table 5-6).

Table 5-6. Head Circumference Percentile for Children Aged 3 and Younger
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home ^
Mean/ (SE)
Age < 1 43.9
(3.1)
42.9
(5.6)
44.5
(2.9)
43.5
(3.9)
43.6
(3.1)
46.9
(6.3)
--- 45.1
(3.5)
1 45.2
(3.8)
46.9
(4.8)
40.7
(5.2)
45.5
(4.0)
25.0
(5.6)
57.6
(8.5)
--- 42.5
(8.8)
2-3 47.9
(3.9)
43.3
(5.2)
55.4
(6.5)
47.2
(4.1)
33.9
(4.4)
77.2
(10.5)
--- 51.9
(11.2)
Gender Male 45.7
(3.0)
43.4
(4.5)
51.7
(4.8)
45.9
(3.3)
33.8
(3.3)
63.7
(9.9)
--- 45.1
(6.0)
Female 45.4
(3.3)
46.6
(4.7)
40.6
(3.8)
45.0
(3.7)
42.3
(5.8)
51.1
(4.5)
--- 47.2
(3.7)
Race/ Ethnicity Black 45.6
(3.1)
44.4
(6.2)
47.2
(6.2)
45.4
(3.6)
44.6
(4.8)
48.9
(7.9)
--- 46.1
(4.3)
White 44.6
(3.3)
44.4
(4.4)
43.3
(4.1)
44.1
(3.4)
26.2
(6.2)
66.9
(9.9)
--- 48.4
(9.0)
Hispanic 50.3
(5.8)
53.4
(8.7)
46.3
(4.2)
52.1
(7.4)
36.2
(4.4)
52.8
(10.5)
--- 43.9
(5.2)
Other 37.2
(8.6)
25.4
(8.1)
70.1
(12.7)
36.0
(10.3)
40.9
(6.2)
46.5
(8.2)
--- 43.3
(5.4)
TOTAL 45.6
(2.2)
45.0
(3.1)
46.6
(3.1)
45.4
(2.4)
37.2 a
(2.6)
56.5
(5.8)
--- 46.1
(3.9)
^ Includes “other” out-of-home placement (back)

a Head circumference percentiles are lower for children in nonkinship foster care than for children in kinship foster care (t = -3.4, p ≤ .001) (back)

Multivariate analyses controlling for child age, gender, race/ethnicity, and setting confirmed the differences between nonkinship and kinship foster care discussed above. Nonkinship foster care was used as the reference group for the setting variable to further explore the apparent differences between children in this setting and those in other settings. The model further indicated that children in nonkinship foster care also have smaller head circumferences on average than children remaining at home and receiving child welfare services, although the difference was just 10 percentile points as opposed to the 19 percentile difference between nonkinship and kinship foster care. There is a tendency for children in nonkinship foster care to also have smaller head circumferences than children remaining at home with no services (p = .03). Significant differences were not found with regard to any of the other characteristics examined (Table 5-7).

Table 5-7. Regression Modeling Head Circumference Percentile for Children Aged 3 and Younger
Characteristic Beta Coefficient (SE)
Age 2-3 (reference group)
<1 -4.28 (4.25)
1 -2.49 (5.27)
Gender Female (reference group)
Male .84 (4.38)
Race/ Ethnicity White (reference group)
Black 1.23 (4.43)
Hispanic 6.35 (6.70)
Other -6.65 (9.03)
Child Setting/ Services Foster home (reference group)
In-home, no services 7.87 (3.94)
In-home, services 9.74 (3.82) *_i
Kinship care 19.24 (6.00) *_ii
Multiple R2 is .02

* p ≤ .01 (back: *_i, *_ii)

In summary, the physical attributes of younger children involved with CWS, as detailed through measurements of height, weight, BMI, and head circumference, are similar to that of the general population, with some exceptions. Further analysis would be helpful to determine why 1-year-olds appear to be at smaller height percentiles than both their younger and older counterparts. In addition, although this analysis revealed that children in group care are at significantly lower weight percentiles than children in other settings, analysis on a larger sample size is necessary to confirm this. With regard to BMI, children in kinship foster care tend to be in lower percentiles. And while children in nonkinship foster care have above average BMIs, they have smaller head circumferences than children in other settings. Overall, the findings suggest that children in out-of-home placements tend to be at greater risk than the general population in terms of physical growth and development. This would be consistent with other findings (e.g., Barth & Blackwell, 1998) of high rates of deaths from congenital abnormalities among children in out-of-home care. Ultimately, the greatest value of the growth measures may be their use in looking at children who continue to have extreme scores over time or who drop from the normal range into the extreme sector.

5.1.2 Risk of Developmental Delay or Neurological Impairment: The Bayley Infant Neurodevelopmental Screener

The Bayley Infant Neurodevelopmental Screener (BINS) was used to assess the risk of developmental delay or neurological impairment in children from 3 to 24 months old. The results are shown in Table 5-8. More than half (53%) of all children from 3 to 24 months old whose families were investigated for maltreatment are classified by BINS as high risk for developmental delay or neurological impairment. This is very similar to the 56% of the clinical sample that was assessed with BINS and received this classification, as reported by the test publisher (Aylward, 1995). This is significantly higher, on the other hand, than the 14% of the normative nonclinical sample that was classified as high risk. Service setting is not significantly related to BINS scores.

Table 5-8. Proportion of Children with Low, Moderate, and High Risk for Developmental Delay or Neurological Impairment as Measured by BINS
Race/ Ethnicity Total Risk a In-Home Risk b Out-of-Home Risk
Low Moderate High Low Moderate High Low Moderate High
Percent / (SE)
Black 7.8
(2.4)
33.5
(4.5)
58.7
(4.7)
8.7
(2.8)
32.1
(5.3)
59.2
(5.6)
5.2
(1.7)
37.8
(5.0)
57.0
(4.7)
White 20.8
(3.3)
36.7
(4.5)
42.5
(3.6)
21.2
(3.8)
38.0
(5.0)
40.8
(4.0)
17.4
(5.0)
28.0
(6.7)
54.6
(6.4)
Hispanic 15.9
(7.2)
27.6
(6.3)
56.6
(7.2)
18.3
(7.9)
27.4
(7.4)
54.3
(8.1)
5.0
(3.3)
28.4
(6.5)
66.5
(6.1)
Other 13.4
(6.5)
12.9
(4.5)
73.7
(8.8)
11.9
(7.1)
14.3
(5.6)
73.8
(9.9)
21.2
(9.4)
6.1
(2.9)
72.7
(8.9)
TOTAL 15.4
(2.5)
32.0
(2.8)
52.6
(2.9)
16.5
(2.9)
32.4
(3.3)
51.1
(3.4)
9.9
(2.1)
30.3
(2.8)
59.8
(2.2)
a Black children are more likely than White children to be at high risk (X2 = 12.9, p < .01) (back)

b Black children remaining at home are more likely than White children remaining at home to be at high risk (X2 = 9.7, p < .01) (back)

Risk of developmental delay or neurological impairment as measured by BINS does differ when looking at the child's race/ethnicity. Both overall and within the in-home subpopulation, BINS categorizes a significantly higher proportion of Black children than White children as high risk. Conversely, BINS categorizes a significantly higher proportion of White children than Black children as low risk, both overall and within the in-home subpopulation.

Despite the bivariate results, a logistic regression modeling high risk of developmental delay or neurological impairment that controlled for gender, race/ethnicity, and child setting did not find a significant difference between Black and White children with regard to the proportion rated as high risk by BINS; in these analyses, there was only a tendency (p = .02) for Black children to be more likely to be categorized as high risk. The model did reveal a significant difference between White children and children of other races/ethnicities, with children of other races/ethnicities more likely to be categorized as high risk. The model confirmed bivariate results that child setting does not predict whether or not a child is at high risk and further indicated that gender is not a predictor (Table 5-9). Although the odds ratio (OR) and 95% confidence interval (CI) for children in foster care does not overlap with children living at home with no services, this difference (p = .04) does not meet the stricter test of significance at the p < .01 level that we have assumed for this study due to the many tests that we are conducting.

Table 5-9. Logistic Regression Modeling High Risk of Development Delay or Neurological Impairment as Measured by BINS
Characteristic OR 95% CI
Gender Female (reference group)
Male .82 .47, 1.45
Race/ Ethnicity White (reference group)
Black 1.90 1.10, 3.27
Hispanic 1.77 .95, 3.28
Other 3.55 * 1.35, 9.29
Child Setting/ Services In-home, no services (reference group)
In-home, services .98 .61, 1.58
Foster home 1.89 1.03, 3.49
Kinship care .86 .57, 1.30
Group home 4.93 .49, 49.74
Cox and Snell pseudo-R2 is .05

* p ≤ .01 (back)

Because of the subjective elements involved in BINS, we checked to determine if raters were consistent in their ratings of children, regardless of the race/ethnicity of the child and rater. White children were found to receive significantly lower scores from Hispanic interviewers than from White interviewers (p < .001). There was also a trend toward Black interviewers' scoring White children higher than did Hispanic interviewers (p = .03). Hispanic children were found to receive significantly lower scores from Black interviewers than from either Hispanic interviewers or White interviewers. Finally, children of other races/ethnicities were found to receive significantly lower scores from Black interviewers than from Hispanic interviewers (p < .001). There were no significant differences with regard to how Black and White interviewers scored Black or White children, which are the interviewer/child, race/ethnicity combinations that account for the majority of the NSCAW interviews. 16

To summarize, more than half of infants under the age of 2 years who are involved with CWS are at high risk for development delay or neurological impairment according to their assessment on BINS. This is far larger than the proportion of children this age at high risk in the general population. Further, assuming that the BINS is capturing risk equally across racial/ethnic groups, the findings indicate that Black infants under the age of 2 years who are involved with CWS may have a tendency to be at particularly high risk for developmental delay or neurological impairment.

5.1.3 Early Cognitive Development: The Battelle Developmental Inventory

The cognitive domain of the Battelle Developmental Inventory (BDI) was used to assess cognitive development in children aged 3 and younger. The results are shown in Table 5-10. In general, the mean T scores for the total cognitive domain for children whose families were investigated for maltreatment are close to one standard deviation under the normed mean (Mean = 50, SD = 10). Thirty-one percent of all children aged 3 and younger whose families were investigated for maltreatment have a T score on the total cognitive domain of the BDI that is lower than two standard deviations below the normed mean (i.e., < 30). Service setting is not significantly related to BDI scores. In addition, bivariate analyses indicated that mean BDI scores do not differ based on race/ethnicity.

Table 5-10. Cognitive Development Scores as Measured by BDI
Race/ Ethnicity TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Black 41.6
(1.2)
40.4
(2.0)
41.4
(1.3)
40.8
(1.5)
43.7
(1.9)
49.0
(3.5)
39.1
(2.8)
45.8
(1.9)
White 42.3
(1.1)
41.9
(1.6)
42.5
(1.0)
42.1
(1.2)
43.4
(2.2)
39.3
(3.4)
--- 41.8
(2.2)
Hispanic 39.7
(1.4)
37.8
(1.4)
42.7
(2.6)
38.6
(1.5)
46.4
(1.4)
43.5
(2.0)
--- 45.0
(1.5)
Other 43.6
(1.9)
43.5
(2.5)
45.4
(4.3)
44.0
(2.2)
41.9
(2.3)
37.1
(4.8)
--- 40.4
(2.6)
TOTAL 41.6
(0.9)
40.8
(1.1)
42.3
(0.9)
41.2
(1.0)
44.2
(1.0)
43.3
(2.1)
40.6
(3.3)
44.0
(1.2)
^ Includes “other” out-of-home placement (back)

BDI also includes subscales, each of which is also normed with a standard T distribution (Table 5-11). The mean score combined with the standard error fails to reach the test norm of 50 for any measure indicating that, on average, scores are substantially suppressed. The proportion of children with scores lower than two standard deviations below the mean (i.e., less than 30) ranges from 26% for Conceptual Development to 48% for Reasoning and Academic Skills.

Because of the subjective elements involved in scoring BDI, as with BINS, we checked to see if raters were consistent in their ratings of children, regardless of the race/ethnicity of the child and rater. Although there were some differences on the subtest scores, 17 there were no inconsistencies noted based on child and interviewer race/ethnicity when looking at the total BDI score.

Table 5-11. Overall Scores for BDI Subscales
BDI Subscale Mean(SE)
Perceptual Discrimination 38.5
(0.7)
Memory 40.2
(0.9)
Reasoning and Academic Skills 38.1
(0.8)
Conceptual Development 40.3
(0.9)

Based on measurements from BDI, children involved with CWS are at very high risk of having below-average cognitive development, with almost one-third scoring lower than two standard deviations below the mean on the overall measure. Multivariate analyses on BDI total scores did not show any significant differences between children of different racial/ethnic characteristics, gender, or settings, indicating that these results apply to children who have become involved with CWS regardless of gender, race/ethnicity, or setting.

5.1.4 Early Language Skills: The Preschool Language Scale-3

The Preschool Language Scale-3 (PLS-3) was used to measure language skills of children aged 5 years and younger. The results are shown in Table 5-12. In general, average scores for children whose families were investigated for maltreatment are below the normed mean but within one standard deviation (mean = 100, SD = 15). As shown in Table 5-13, overall mean scores for each of the subtests of the PLS-3 are also within one standard deviation. Yet 14% of all children aged 5 and younger whose families were investigated for maltreatment have a total score on PLS-3 that is lower than two standard deviations below the mean (i.e., < 70). Service setting is not significantly related to total PLS-3 scores on its own, although service setting associations do exist for some racial/ethnic and age groups.

Language skills, as measured by PLS-3, differ by age as well as by race/ethnicity. Overall, as well as within the in-home subpopulation, children younger than 1 have significantly higher scores than older preschoolers (p < .001). In addition, White children have significantly higher scores than both Black children (p < .001) and children of other races/ethnicities in both the total population and the in-home subpopulation. The only significant difference within the out-of-home subpopulation is for the comparison between children younger than 1 and children between the ages of 1 and 2; once again, the younger group has higher mean scores. This could be a function of testing procedures that lack equivalence across age groups or could be because younger children come to the attention of CWS with fewer language delays. The PLS-3 manual provides evidence for good reliability and validity for the total score at younger ages (Zimmerman, Steiner, and Pond, 1992); therefore, reliability and validity problems with PLS-3 at younger ages do not appear to explain age differences in language skills. PLS-3 subscales tap auditory and expressive language components. There appeared to be no meaningful difference between auditory and expressive scores suggesting that, overall, children assessed after an investigation for maltreatment have comparable abilities in each area.

A regression that modeled language skills as measured by PLS-3 and controlled for age, gender, race/ethnicity, and child setting confirmed bivariate results, indicating that of NSCAW children, those less than 1 year of age have the highest levels of language skills (12.30 points higher than children aged 1 to 2, p < .001; and 9.55 points higher than children aged 3 to 5, p < .001), as do White children (8.60 points higher than children of other races/ethnicities, p < .01; and 6.41 points higher than Black children, p < .001). The regression further indicated that males have significantly lower levels of language skills than females (on average males score 3.27 points lower than females, p < .01). The regression did not indicate that child setting predicts a child's preschool language skills (Table 5-14).

Table 5-12. Language Skills as Measured by PLS-3
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean /(SE)
Age < 1 99.2 a b
(1.5)
102.3
(2.5)
98.6
(1.4)
101.0 c d
(1.7)
93.2
(1.2)
96.0
(2.4)
--- 94.4 e
(1.2)
1-2 87.0
(1.1)
89.1
(1.5)
82.7
(1.6)
87.4
(1.2)
85.8
(2.7)
83.6
(3.0)
--- 84.9
(2.0)
3-5 90.3
(1.2)
90.3
(1.7)
89.9
(2.2)
90.2
(1.3)
82.1
(5.3)
98.2
(8.7)
--- 94.2
(6.9)
Race/ Ethnicity Black 87.2 f
(1.2)
87.7
(2.0)
86.3
(1.9)
87.2 h
(1.5)
88.7
(2.3)
88.9
(4.0)
91.8
(8.5)
88.7
(2.2)
White 94.1 g
(1.3)
94.6
(1.8)
92.5
(2.4)
94.0 i
(1.3)
88.0
(3.6)
100.3
(6.5)
--- 95.6
(4.8)
Hispanic 89.0
(1.7)
89.6
(2.2)
86.4
(3.2)
88.8
(2.0)
89.2
(1.3)
89.3
(4.7)
--- 89.2
(2.6)
Other 85.8
(2.4)
85.8
(3.2)
83.8
(4.3)
85.3
(2.7)
89.3
(3.7)
82.4
(4.4)
--- 87.5
(3.6)
TOTAL 90.7
(0.8)
91.3
(1.2)
89.1
(1.4)
90.6
(0.9)
88.6
(1.6)
93.4
(2.8)
92.9
(8.4)
91.3
(1.7)
^ Includes “other” out-of-home placement (back)

a Scores for children 1-2 years old are lower than scores for children less than 1 (t = 6.7, p < .001) (back)

b Scores for children 3-5 years old are lower than scores for children less than 1 (t = 4.7, p < .001) (back)

c Scores for children 1-2 years old remaining at home are lower than scores for children less than 1 remaining at home (t = 6.6, p < .001) (back)

d Scores for children 3-5 years old remaining at home are lower than scores for children less than 1 remaining at home (t = 5.3, p < .001) (back)

e Scores for children 1-2 years old in out-of-home placements are lower than scores for children less than 1 in out-of-home placements (t = 4.2, p < .001) (back)

f Scores for Black children are lower than scores for White children (t = -3.8, p < .001) (back)

g Scores for other race children are lower than scores for White children (t = 3.0, p < .01) (back)

h Scores for Black children remaining at home are lower than scores for White children remaining at home (t = -3.5, p < .001) (back)

i Scores for other race children remaining at home are lower than scores for White children remaining at home (t = 2.8, p < .01) (back)

Table 5-13. Overall Scores for PLS-3 Subscales
PLS-3 Subscale Mean(SE)
Auditory Comprehension 91.4
(0.8)
Expressive Communication 91.1
(0.8)

NSCAW preschoolers have language skills that are somewhat below average. Older preschoolers appear to have lower levels of language skills than infants, indicating that children who become involved with CWS are already falling behind. Systematic assessments and interventions to bolster acceptable language skills appear to be needed early on with this group of children. Black children and children of other races/ethnicities, as well as males, may need particular attention in this area, as PLS-3 indicates that their levels of language skills are much lower than those of their counterparts.

Table 5-14. Regression Modeling Language Skills as Measured by PLS-3
Characteristic Beta Coefficient (SE)
Age < 1 (reference group)
1-2 -12.30 (1.68) **_i
3-5 -9.55 (1.89) **_ii
Gender Female (reference group)
Male -3.27 (1.27)*_i
Race/ Ethnicity White (reference group)
Black -6.41 (1.73) **_iii
Hispanic -5.59 (2.28)
Other -8.60 (2.77)*_ii
Child Setting/ Services In-home, no services (reference group)
In-home, services -2.31 (1.96)
Foster home -4.55 (2.40)
Kinship care -.38 (3.18)
Group home .40 (10.58)
Multiple R2 is .09

* p ≤ .01, (back: *_i, *_ii)

** p < .001 (back: **_i, **_ii, **_iii)

5.1.5 Emotional Regulation: The Modified National Longitudinal Survey of Youth Temperament Scale

In our assessments, we included a temperament (emotional regulation) measure for children up to 3 years of age. The National Longitudinal Survey of Youth (NLSY) created temperament items from several existing instruments, including Rothbart's Infant Behavior Questionnaire, Campos and Kagan's compliance scale, and other items from Campos (Center for Human Resource Research, 2000; Briggs-Gowan et al., 2001; Hubert et al., 1982; Lengua, 2002; Lengua, West, & Sandler, 1998; Mathiesen & Sanson, 2000). To bring more objectivity to the assessment of temperament, NSCAW eliminated items recorded by the observer. The NSCAW instrument entirely comprises caregiver-reported items. The instrument can be understood to provide an indication—like the other caregiver-reported instruments—of the child's behavior from the perspective of the caregiver.

We computed mean scores for selected temperament scales; these are presented in Table 5-15. 18 We selected these scales based on their Cronbach's alpha scores. Several differences were found across service settings. Comparisons across settings showed that children under 1 year of age living at home had higher negative difficult/hedonic tone scores than children under 1 year of age living out of the home (p < .001). In addition, children who were 2 years old and living in nonkinship foster care were more compliant than 2-year-old children living in kinship foster care. Finally, 2-year-old children living in kinship foster care had higher insecure attachment scores than those living in nonkinship foster care (p ≤ .001). These results can best be compared with the results from NLSY; however, NLSY did not assess temperament on a sample similar to the NSCAW children. Therefore, comparisons must be made with caution. Mean insecure attachment scores for children aged 2 years were slightly higher in the NSCAW sample (22.7) than NLSY scores (19.7). However, mean compliance scores for children aged 2 years in the NSCAW sample (19.3) were slightly lower, or worse, than in the NLSY sample (22.1). Other mean scores were not available for the NLSY sample.

Although precise comparisons between NSCAW data and other national data are not possible, children whose families have been reported for maltreatment appear to exhibit more insecure attachment and lower compliance than children in the general population. Children living out of the home tend to have less difficult temperaments than children remaining in the home, and children in foster care tend to have less difficult temperaments than children in kinship care. Among children under 1 year of age, a difficult temperament is significantly more common in children who are living at home than among children living in an out-of-home placement. Among 2-year-old children living in out-of-home care, those in nonkinship foster care are rated as significantly more compliant and securely attached to caregivers than those in kinship foster care.

Table 5-15. Mean Temperament Scores from Selected Scales^
Age Temperament TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home ^^
Mean/ (SE)
Less than 1 year old Friendliness 15.6
(0.2)
15.8
(0.4)
15.4
(0.3)
15.7
(0.3)
15.4
(0.4)
15.1
(0.3)
--- 15.3
(0.3)
Difficulty 26.4
(0.3)
26.6
(0.5)
26.3
(0.7)
26.5
(0.4)
25.7
(0.6)
26.9
(1.0)
--- 26.3
(0.6)
Negative Hedonic Tone 29.4
(0.5)
30.5
(0.5)
29.5
(0.6)
30.2 a
(0.4)
27.3
(0.4)
27.9
(1.4)
--- 27.5
(0.7)
1 year old Friendliness 15.3
(0.3)
15.5
(0.4)
14.9
(0.3)
15.3
(0.3)
14.0
(1.2)
15.5
(0.3)
--- 14.8
(0.6)
Difficulty/ Hedonic 22.6
(0.7)
21.8
(0.9)
24.0
(0.7)
22.3
(0.8)
27.9
(2.5)
23.8
(1.3)
--- 25.6
(1.4)
2 years old Compliance 19.3
(0.7)
19.6
(0.8)
19.7
(1.1)
19.6
(0.7)
21.9 b
(1.4)
11.5
(3.1)
--- 17.6
(3.0)
Insecure Attachment 22.7
(0.4)
23.1
(0.6)
22.6
(1.1)
23.0
(0.4)
17.0 c
(0.9)
26.3
(2.5)
--- 20.9
(2.4)
^ Higher scores mean “more” of the attribute measured—this is positive on some scales (e.g., friendliness) and negative on others (e.g., difficult/hedonic) (back)

^^ Includes “other” out-of-home placement (back)

a Children under 1 year old living at home have higher negative hedonic tone scores than children under 1 year old living out of the home (t = 4.3, p < .001). (back)

b Children who are 2 years old living in foster care have higher compliance scores than children who are 2 years old living in kinship foster care (t = 3.1, p < .01). (back)

c Children who are 2 years old living in kinship foster care have higher insecure attachment scores than children who are 2 years old living in foster care (t = 3.4, p ≤ .001). (back)

5.1.6 Problem Behavior: The Child Behavior Checklist (2–3 years)

Behavior problems that begin early in a child's life function as strong predictors of continued and increasingly serious problem behaviors throughout childhood, adolescence, and into adulthood (Moffit et al., 1996). Total Problem Behaviors were measured using the caregiver-reported Child Behavior Checklist (CBCL). Overall, these 2- to 3-year-olds are reported as having approximately five times more problem behaviors (26% versus 5%) than the norm (Achenbach, 1992) (see Table 5-16). Caregiver reports reveal no statistically significant differences in the level of problem behavior by race/ethnicity or setting. Multivariate analyses controlling for race/ethnicity, gender, and setting confirmed bivariate findings.

Table 5-16. Caregiver Report of Clinical/Borderline Total Problem Behaviors (2 to 3 years) as Measured by the CBCL
Race/ Ethnicity TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Percent/ (SE)
Black 25.0
(4.7)
22.3
(5.1)
26.5
(10.1)
23.6
(5.0)
22.5
(11.9)
--- --- 45.0
(16.1)
White 27.8
(4.4)
28.1
(6.5)
30.2
(5.3)
29.8
(4.8)
--- --- --- 18.0
(8.8)
Hispanic 22.8
(8.5)
--- 18.4
(7.4)
14.9
(5.8)
--- --- --- ---
Other 27.9
(11.4)
--- --- --- --- --- --- ---
TOTAL 26.0
(2.5)
23.2
(3.5)
28.7
(4.6)
24.7
(2.6)
54.1
(17.6)
23.0
(10.3)
--- 37.3
(12.0)
^ Includes “other” out-of-home placement (back)

5.1.7 Discussion of Well-Being of Young Children

Young children involved with CWS are facing multiple developmental challenges. The majority of infants under the age of 2 years are at high risk for developmental delay or neurological impairment; approximately one-third of children aged 3 and under have below-average cognitive development, and approximately one-third of children aged 5 and under have below-average language skills. Unless addressed, the developmental deficits faced by young children in CWS place them at continued risk of poor academic achievement and associated risks, such as school failure and behavior problems with classmates (Kendall-Tackett & Eckenrode, 1996; Yoshikawa, 1994). Caregivers are already reporting serious behavioral difficulties for 2- to 3-year-olds. If unaddressed, the general characteristics of young children entering CWS—especially a difficult temperament and early initiation of problem behaviors (particularly aggressive behavior)—predict a greater likelihood of serious problem behaviors later in life (Office of Juvenile Justice and Delinquency Prevention, 2003).

5.2 Cognitive Functioning

Maltreatment can delay or disrupt normal developmental processes, thereby impacting academic achievement (Kelley, Thornberry, & Smith, 1997). Maltreated children tend to have lower mean math and English grades, and they repeat grades more frequently than nonmaltreated classmates (Kendall-Tackett & Eckenrode, 1996). By 4th grade, academic achievement is a good predictor of later behavior problems (Yoshikawa, 1994), and by age 13, boys with low achievement have three times the odds of delinquent behavior (Loeber, Farrington, Stouthamer-Loeber, & Van Kammen,1998). Poor academic performance in the early years is also a predictor of dropping out of school (Alexander, Entwistle, & Horsey, 1997), which portends additional untoward lifetime consequences (Cohen, 1998).

This section presents results of standardized assessments of children's cognitive abilities and achievement. Bivariate and multivariate analyses of verbal and nonverbal ability and reading and math achievement are presented. In addition, age, gender, race/ethnicity, and service setting comparisons are provided. Measurement norms are also presented to compare children involved with CWS to children in the general population.

5.2.1 Verbal and Nonverbal Ability: The Kaufman Brief Intelligence Test (K-BIT)

The Kaufman Brief Intelligence Test (K-BIT) was used to measure verbal (i.e., vocabulary) and nonverbal (i.e., matrices) intelligence of children aged 4 and older. Mean composite scores are shown in Table 5-17. In general, average composite scores for children whose families were investigated for maltreatment are below the normed mean but within one standard deviation (Mean = 100, SD = 15). Five percent of children aged 4 and older whose families were investigated for maltreatment have a composite score lower than two standard deviations below the mean (i.e., < 0), compared with approximately 2% of the sample used to norm K-BIT.

Children aged 11 and older have significantly lower composite scores on K-BIT than children aged 6 to 10. Composite scores also differ according to the child's race/ethnicity and by race/ethnicity within service setting. White children consistently have the highest composite scores—significantly higher than both Black children and Hispanic children overall (p < .001 for both) as well as within the in-home subpopulation (p < .001 for both), and significantly higher than Black children in the out-of-home subpopulation (Table 5-17). Service setting alone is not significantly related to composite K-BIT scores. A multivariate regression attempting to predict composite K-BIT scores, which controlled for age, gender, race/ethnicity, and child setting, confirmed the bivariate results. Specifically, children aged 11 and older are significantly more likely to have lower composite scores on K-BIT than children aged 6 to 10 (ß = 3.03, p < .01). In addition, White children are significantly more likely to have higher composite scores than both Black children (ß = –7.46, p < .001) and Hispanic children (ß = –5.85, p < .001), and they tend to have higher scores than children of other races/ethnicities (ß = –4.22, p = .04). The model did not reveal any significant differences based on child gender or setting.

Scores on the vocabulary and matrices subscales were also examined separately, as some racial/ethnic groups—particularly Hispanics—might be at a disadvantage with regard to the vocabulary subscale, which would in turn affect their composite score. 19 Results are shown in Tables 5-18 and 5-19. Although overall means for both subscales fall below the normed mean of 100, in general, children who have become involved with CWS appear to have somewhat higher nonverbal than verbal ability.

As with the composite scores, White children consistently have the highest vocabulary scores. Hispanic children again have lower scores than White children overall (p < .001), as well as within the in-home (p < .001) and out-of-home subpopulations. Also consistent with the composite scores, children aged 11 and older have significantly lower vocabulary scores overall than children aged 6 to 10.

Table 5-17. Verbal and Nonverbal Intelligence (Composite Score) as Measured by the K-BIT
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age 4-5 93.4
(1.0)
93.3
(1.3)
93.2
(1.9)
93.3
(1.1)
80.8
(6.8)
100.6
(4.7)
--- 94.5
(5.3)
6-10 95.5 a
(0.7)
95.9
(0.9)
94.3
(1.0)
95.5
(0.7)
93.8
(2.5)
95.6
(4.4)
100.2
(4.9)
95.3
(2.6)
11+ 92.7
(1.1)
93.1
(1.5)
92.1
(1.4)
92.8
(1.2)
93.6
(3.9)
90.7
(2.3)
91.9
(3.5)
92.1
(1.8)
Race/ Ethnicity Black 90.0 b
(0.8)
89.4
(1.0)
91.9
(1.6)
90.1 d
(0.9)
89.9
(2.7)
89.1
(1.6)
84.3
(2.9)
89.4 f
(1.4)
White 97.4 c
(0.9)
98.1
(1.1)
95.7
(1.0)
97.5 e
(0.9)
93.9
(2.8)
99.2
(4.3)
94.4
(4.1)
96.6
(2.3)
Hispanic 91.6
(1.2)
91.9
(1.5)
89.9
(1.6)
91.4
(1.2)
98.7
(5.5)
91.3
(2.9)
99.8
(7.8)
95.0
(3.4)
Other 93.6
(1.8)
95.4
(2.8)
89.3
(3.5)
93.7
(2.1)
90.5
(4.4)
88.6
(3.5)
99.3
(3.0)
92.6
(3.0)
TOTAL 94.1
(0.7)
94.5
(0.8)
93.2
(0.8)
94.1
(0.7)
92.6
(1.9)
94.6
(2.7)
94.0
(3.0)
93.8
(1.6)
^ Includes “other” out-of-home placement (back)

a Scores for children aged 11 and older are lower than scores for children aged 6 to 10 (t = 2.6, p ≤ .01) (back)

b Scores for Black children are lower than scores for White children (t = -6.7, p < .001) (back)

c Scores for Hispanic children are lower than scores for White children (t = 3.9, p < .001) (back)

d Scores for Black children remaining at home are lower than scores for White children remaining at home (t = -6.5, p < .001) (back)

e Scores for Hispanic children remaining at home are lower than scores for White children remaining at home (t = 4.0, p < .001) (back)

f Scores for Black children in out-of-home placements are lower than scores for White children in out-of-home placements (t = –2.9, p < .01) (back)

The possibility that Hispanic children may be at a disadvantage on the vocabulary subtest, which would in turn affect their composite K-BIT score, was confirmed on examination of the matrices subtest. Comparisons of nonverbal intelligence as measured by K-BIT between the various racial/ethnic groups yielded neither of the significant differences between Hispanic and White children that were present on comparison of the composite K-BIT scores. The significant differences between White and Black children (overall and in-home), however, remained.

The combined verbal and nonverbal intelligence, as well as the individual subtests, of children who become involved with CWS are below national norms. Black children score consistently lower than White children. Hispanic children who have become involved with CWS also score lower on the composite scale than White children in this population, both overall and within the in-home subpopulation, but this may be attributable to the lower verbal scores for this group.

Table 5-18. Verbal Intelligence as Measured by the K-BIT
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age 4-5 92.8
(1.1)
93.6
(1.2)
90.5
(2.3)
92.7
(1.1)
83.1
(4.8)
100.0
(5.1)
  94.7
(5.2)
6-10 93.3 a
(0.9)
93.9
(1.2)
91.9
(1.2)
93.5
(0.9)
89.2
(1.6)
93.3
(3.5)
98.1
(2.8)
91.9
(2.0)
11+ 89.8
(1.1)
90.1
(1.3)
90.0
(1.3)
90.0
(1.1)
90.2
(4.0)
87.9
(2.1)
83.3
(3.3)
88.3
(1.8)
Race/ Ethnicity Black 87.3 b
(0.9)
86.7
(1.2)
88.9
(1.6)
87.4 d
(1.1)
85.5
(2.8)
89.1
(1.9)
86.3
(2.7)
86.8 f
(1.5)
White 96.4 c
(0.9)
97.4
(1.1)
94.6
(1.1)
96.7 e
(0.9)
92.9
(2.5)
95.1
(3.9)
91.5
(4.0)
93.8 g
(1.9)
Hispanic 86.9
(1.1)
87.6
(1.3)
85.2
(2.0)
87.0
(1.2)
86.4
(1.4)
88.6
(4.8)
89.6
(9.1)
86.4
(2.0)
Other 91.7
(1.9)
93.5
(2.9)
88.0
(3.9)
92.0
(2.2)
87.2
(4.2)
90.0
(2.7)
95.9
(1.4)
89.6
(2.0)
TOTAL 91.9
(0.7)
92.6
(0.9)
90.9
(0.8)
92.1
(0.7)
89.1
(2.0)
92.4
(2.5)
90.9
(2.9)
90.5
(1.4)
^ Includes “other” out-of-home placement (back)

a Scores for children aged 11+ are lower than scores for children aged 6-10 (t = 3.1, p < .01) (back)

b Scores for Black children are lower than scores for White children (t = -8.2, p < .001) (back)

c Scores for Hispanic children are lower than scores for White children (t = 6.7, p < .001) (back)

d Scores for Black children remaining at home are lower than scores for White children remaining at home (t = -7.9, p < .001) (back)

e Scores for Hispanic children remaining at home are lower than scores for White children remaining at home (t = 6.5, p < .001) (back)

f Scores for Black children in out-of-home placements are lower than scores for White children in out-of-home placements (t = -3.3, p ≤ .001) (back)

g Scores for Hispanic children in out-of-home placements are lower than scores for White children in out-of-home placements (t = 3.2, p < .01) (back)

5.2.2 Reading and Mathematics Achievement: The Woodcock-McGrew-Werder Mini-Battery of Achievement (MBA)

The reading and mathematics sections of the Woodcock-McGrew-Werder Mini-Battery of Achievement (MBA) were administered to children aged 6 and older. The reading achievement scores are shown in Table 5-20; mathematics achievement scores are shown in Table 5-21. In general, the mean reading scores (98.2) and math scores (92.1) of children whose families were investigated for maltreatment are at or slightly below the normed mean of 100 and well within one standard deviation of 15 points. Five percent of the children in this population to whom MBA was administered have a reading score lower than two standard deviations below the mean (i.e., <70); 12% have a mathematics score at this level. This is an indication of a very serious learning deficit, as most educators consider a score that is 1.0 or 1.5 standard deviations below the norm to be meaningful, and it is considerably lower than the expected normative rate of 2.5%.

Table 5-19. Nonverbal Intelligence as Measured by K-BIT
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age 4-5 95.5
(1.4)
94.7
(2.0)
97.3
(2.1)
95.5
(1.4)
82.0
(7.9)
101.4
(4.0)
--- 95.6
(4.6)
6-10 98.4
(0.8)
98.5
(1.0)
97.6
(1.0)
98.3
(0.8)
99.5
(3.7)
98.6
(4.8)
102.8
(5.9)
99.6
(2.8)
11+ 96.8
(1.1)
97.2
(1.6)
95.5
(1.5)
96.7
(1.2)
98.2
(3.4)
95.2
(2.7)
97.1
(3.3)
97.5
(1.7)
Race/ Ethnicity Black 94.7 a
(0.9)
94.1
(1.3)
96.4
(1.7)
94.8 b
(1.0)
96.0
(2.4)
91.3
(2.1)
85.2
(3.7)
94.1
(1.6)
White 98.9
(0.9)
99.1
(1.1)
97.7
(1.2)
98.7
(0.9)
95.9
(2.8)
103.2
(4.2)
98.8
(3.6)
100.1
(2.4)
Hispanic 97.4
(1.6)
97.2
(2.0)
96.4
(1.0)
97.0
(1.6)
111.6
(9.4)
95.6
(1.3)
109.8
(5.3)
104.7
(5.4)
Other 96.6
(1.8)
98.1
(2.7)
92.6
(3.1)
96.6
(2.0)
95.6
(4.4)
89.3
(3.8)
103.5
(4.9)
97.2
(4.1)
TOTAL 97.3
(0.7)
97.4
(0.8)
96.7
(0.8)
97.2
(0.7)
97.5
(2.2)
97.8
(2.6)
98.5
(2.9)
98.3
(1.6)
^ Includes “other” out-of-home placement (back)

a Scores for Black children are lower than scores for White children (t = –3.2, p < .01) (back)

b Scores for Black children remaining at home are lower than scores for White children remaining at home (t = –2.8, p < .01) (back)

The mean reading and mathematics scores for children whose families were investigated for maltreatment are not associated with service setting. While the mean mathematics scores do not differ based on child's age, the mean reading scores do. Specifically, children aged 11 and older have significantly lower reading scores than children aged 6 to 10.

Although mean reading scores on MBA do not differ by race/ethnicity of the child, mean mathematics scores do. Overall, White children have significantly higher mathematics scores than Black children.

Regressions modeled reading and mathematics achievement as measured by MBA and controlled for age, gender, race/ethnicity, and service setting. Although age was not significant in the model of reading achievement, it was significant in the model of mathematics achievement, with children aged 6 to 10 scoring an average of 4.23 points higher than children aged 11 and older. Both results were contrary to the bivariate analyses, which showed age differences in the reading, but not the mathematics, achievement scores. Confirming the bivariate analyses, the model of mathematics achievement indicated that White children have higher levels of mathematics achievement than Black children (on average, 5.04 points higher) after controlling for other child and setting characteristics. Neither gender nor setting predicts a child's mathematics achievement, nor are any of the variables in the model strongly associated with a child's reading achievement (Table 5-22).

Table 5-20. Reading Achievement Scores as Measured by MBA
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age 6-10 100.2 a
(1.0)
100.4
(1.1)
98.3
(1.4)
99.9
(1.0)
98.1
(4.4)
100.4
(6.3)
89.3
(4.9)
98.5
(3.7)
11+ 96.9
(1.5)
96.7
(1.5)
96.4
(1.7)
96.6
(1.3)
99.8
(3.4)
93.6
(2.8)
98.0
(4.4)
95.0
(1.9)
Race/ Ethnicity Black 96.4
(1.1)
96.7
(1.4)
96.0
(1.5)
96.5
(1.2)
101.7
(2.9)
96.0
(2.7)
88.7
(2.3)
96.1
(2.7)
White 99.7
(1.2)
100.7
(1.5)
98.1
(1.5)
100.1
(1.2)
96.0
(2.9)
98.4
(7.5)
97.2
(6.3)
97.1
(3.4)
Hispanic 98.1
(1.8)
97.2
(2.3)
100.6
(1.8)
98.0
(1.8)
104.5
(5.5)
100.1
(5.8)
94.2
(11.9)
98.2
(4.7)
Other 96.7
(3.6)
98.6
(4.7)
92.9
(5.4)
96.9
(3.9)
92.4
(4.3)
96.6
(7.8)
100.9
(3.6)
94.8
(3.5)
TOTAL 98.2
(0.9)
98.9
(1.0)
97.3
(0.9)
98.5
(0.9)
98.8
(2.5)
97.5
(4.1)
96.0
(4.0)
96.7
(2.2)
^ Includes “other” out-of-home placement (back)

a Scores for children aged 11+ years old are lower than scores for children aged 6-10 years old (t = 2.5, p ≤ .01) (back)

Achievement in reading and mathematics is somewhat below average for children involved with CWS. It is, however, far closer to the test norms than other measures of behavior or social and adaptive skills and may represent a relative strength for these children. Also, children who have become involved with CWS have generally poorer math than reading achievement, with Black children and children aged 11 and older scoring particularly low in mathematics.

5.2.3 Discussion of Cognitive Functioning

A greater proportion of children involved with CWS than within the general population have below-average cognitive functioning—greater proportions of children have lower verbal and nonverbal abilities, as well as math and reading achievement scores. Non-white children have significantly lower functioning in several areas; however, the extent to which these differences are due to the cultural insensitivity of the instruments or actual group differences is somewhat unclear, although the lower scores on cognitive functioning still portend difficulties in achieving school success. Regardless of the precise causes of these lower scores, children in CWS are likely to need careful assessment and additional assistance to succeed in school.

Table 5-21. Mathematics Achievement Scores as Measured by MBA
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age 6-10 94.3
(1.2)
94.5
(1.6)
91.2
(1.6)
93.8
(1.3)
95.9
(4.7)
93.5
(4.9)
92.7
(4.7)
94.3
(3.0)
11+ 90.6
(1.7)
89.9
(1.7)
90.1
(1.6)
89.9
(1.3)
91.1
(3.4)
90.5
(2.0)
84.9
(2.5)
88.8
(2.2)
Race/ Ethnicity Black 89.4 a
(1.3)
88.6
(2.0)
91.5
(2.0)
89.5
(1.5)
95.9
(5.3)
87.5
(2.4)
81.9
(4.1)
88.8
(3.4)
White 94.5
(1.6)
95.6
(2.2)
91.4
(2.0)
94.5
(1.8)
92.8
(3.0)
96.5
(5.4)
87.4
(2.7)
94.1
(2.7)
Hispanic 89.7
(1.5)
89.7
(1.8)
89.4
(2.5)
89.6
(1.6)
96.5
(5.6)
89.9
(3.1)
85.0
(9.8)
90.7
(4.1)
Other 92.1
(1.8)
93.9
(2.7)
89.1
(2.5)
92.6
(1.9)
86.1
(3.6)
87.5
(4.0)
91.2
(7.6)
88.5
(2.6)
TOTAL 92.1
(0.9)
92.6
(1.2)
90.9
(1.0)
92.1
(0.9)
93.9
(3.0)
92.2
(3.2)
86.7
(2.2)
91.5
(1.9)
^ Includes “other” out-of-home placement (back)

a Scores for Black children are lower than scores for White children (t = -2.5, p≤.01) (back)

5.3 Adaptive and Social Functioning

A history of maltreatment can disrupt development of skills that children use to interact with others, such as problem-solving and communication. Maltreated children are more likely to have poor social skills than nonmaltreated children (Fantuzzo et al., 1998; Manly, Cicchetti, & Barnett, 1994). Maltreated children are also less attentive to relevant social cues, more biased toward attributing hostile intent, and less likely to generate competent solutions to interpersonal problems than nonmaltreated peers (Dodge, Bates, & Pettit, 1990; Fantuzzo et al., 1998). Such skill deficits hinder a child's ability to get along well with others, and children with poor social skills tend to be less well-liked by peers (Stormshak et al., 1999). Conversely, good social skills function as a protective factor against continued problem behaviors, even among seriously troubled youths (Vance et al., 2002).

Table 5-22. Regressions Modeling Reading and Mathematics Achievement as Measured by MBA
Characteristic Beta Coefficients(SE)
Reading Score ^ Mathematics Score^^
Age 11+ (reference group)
6-10 3.37 (1.40) 4.23*_i (1.67)
Gender Female (reference group)
Male -2.40 (1.17) -1.81 (1.96)
Race/ Ethnicity White (reference group)
Black -3.26(1.51) -5.04*_ii (2.00)
Hispanic -2.00 (2.19) -5.05 (2.33)
Other -3.08 (3.65) -2.55 (2.38)
Child Setting/ Services In-home, no services (reference group)
In-home, services -1.10 (1.04) -1.10 (1.39)
Foster home .04 (2.70) 1.49 (3.48)
Kinship care -1.58 (3.92) -.62 (3.22)
Group home -2.00 (4.19) -5.09 (2.26)
^ Multiple R2 is .02 (back)

^^ Multiple R2 is .02 (back)

* p ≤ .01 (back: *_i, *_ii)

In this section, results from standardized measures of daily living and social skills for children involved with CWS are compared by age, gender, race/ethnicity, and service setting. Normative sample comparisons are also presented.

5.3.1 Daily Living Skills: The Vineland Adaptive Behavior Scales Screener

Measures of adaptive behavior were developed to complement intelligence tests, since arguably the most important performance required of children is their ability to adapt successfully to the requirements of the environment (Butler, 1995). The daily living skills domain of the Vineland Adaptive Behavior Scales (VABS) Screener was administered to current caregivers of children aged 10 and younger. The results are shown in Table 5-23. Overall, approximately 10% of children aged 10 and younger whose families were investigated for maltreatment have low daily living skills as classified by the VABS Screener. This is about five times the proportion of the general population that would be expected to have this classification. Another one-fifth (20%) of NSCAW children have moderately low daily living skills, which is also more than the proportion of the general population that would be expected to have this classification (13%). Correspondingly, about 70% of children with CWS involvement have adequate to high daily living skills, which is less than the proportion of the general population that would be expected to have this classification (85%).

Table 5-23. Proportion of Children with Low, Moderately Low, and Adequate to High Daily Living Skills as Measured by the VABS Screener
  Total a b In-Home c d Out-of-Home e
Low Moderately Low Adequate to High Low Moderately Low Adequate to High Low Moderately Low Adequate to High
Percent/ (SE)
Age 0-2 6.3
(1.1)
18.9
(2.1)
74.8
(2.5)
5.6
(1.3)
18.4
(2.4)
76.1
(2.8)
9.7
(2.6)
21.6
(5.2)
68.7
(4.8)
3-5 14.4
(2.4)
29.1
(2.7)
56.5
(3.3)
14.3
(2.6)
29.5
(3.0)
56.2
(3.8)
14.9
(4.7)
23.4
(6.4)
61.7
(8.4)
6-10 8.7
(1.2)
15.7
(1.9)
75.6
(2.3)
7.3
(1.2)
14.8
(2.2)
78.0
(2.5)
21.8
(4.9)
23.8
(5.1)
54.4
(7.1)
Race/Ethnicity Black 6.4
(1.2)
17.1
(2.2)
76.6
(2.4)
6.3
(1.4)
15.6
(2.3)
78.2
(2.5)
7.3
(1.4)
27.3
(5.9)
65.5
(5.8)
White 9.8
(1.2)
23.1
(2.4)
67.1
(2.6)
8.3
(1.2)
24.0
(2.7)
67.7
(2.7)
22.5
(5.1)
16.0
(2.6)
61.5
(5.7)
Hispanic 14.1
(4.0)
16.5
(4.3)
69.3
(7.7)
14.0
(4.3)
14.8
(4.6)
71.2
(8.3)
15.8
(3.5)
33.1
(10.6)
51.2
(9.3)
Other 10.3
(3.4)
21.4
(6.1)
68.3
(6.3)
9.6
(3.6)
21.3
(6.7)
69.2
(6.9)
17.8
(9.2)
22.6
(9.1)
59.6
(11.1)
TOTAL 9.7
(1.1)
20.1
(1.5)
70.2
(2.0)
8.9
(1.1)
19.8
(1.7)
71.3
(2.3)
16.0
(2.4)
22.9
(3.5)
61.1
(4.3)
a Children aged 3-5 years old are more likely to have low daily living skills than children aged 0-2 years old (X2 = 17.7, p < .001) (back)

b Children aged 3-5 years old are more likely to have low daily living skills than children aged 6-10 years old (X2 = 20.6, p < .001) (back)

c Children aged 3-5 years old remaining at home are more likely to have low daily living skills than children aged 0-2 years old remaining at home (X2 = 15.2, p < .001) (back)

d Children aged 3-5 years old remaining at home are more likely to have low daily living skills than children aged 6-10 years old remaining at home (X2 = 23.5, p < .001) (back)

e White children in out-of-home placements are more likely to have low daily living skills than Black children in out-of-home placements (X2 = 12.5, p < .01) (back)

Bivariate analyses indicate that daily living skills differ based on both age and race/ethnicity. Overall, as well as within the in-home subpopulation, children between the ages of 3 and 5 have significantly lower levels of daily living skills than younger and older children (p < .001). Within the out-of-home subpopulation, White children are scored by their caregivers as having significantly lower levels of daily living skills than Black children. Service setting alone is not associated with level of daily living skills.

Logistic regression modeling low daily living skills and controlling for age, gender, race/ethnicity, and service setting (but omitting group care cases due to the low sample size) confirmed the results of the bivariate analyses. Children aged 3 to 5 are the most likely to have low daily living skills. The model also provided more information about the differences in daily living skills between CWS-involved children remaining at home and those in out-of-home care. Specifically, children living in nonkinship foster homes are significantly more likely to be rated as having low daily living skills than children remaining at home who have not received ongoing child welfare services (17% vs. 8%, p < .001). When nonkinship foster home is used as the reference group for the setting variable (not shown in table), these children are also significantly more likely to be rated as having low daily living skills than children remaining at home who have open child welfare services cases (17% vs. 11%, p < .01). There is also a trend that children living in kinship care are more likely to be rated as having low daily living skills than children remaining at home with no CWS (13% vs. 8%, p < .05) (Table 5-24).

Table 5-24. Logistic Regression Modeling Low Daily Living Skills as Measured by the VABS Screener
Characteristic OR 95% CI
Age 3-5 (reference group)
0-2 .36**_i .23, .56
6-10 .53* .34, .82
Gender Female (reference group)
Male 1.51 1.00, 2.27
Race/Ethnicity White (reference group)
Black .63 .40, 1.01
Hispanic 1.60 .85, 3.00
Other 1.21 .59, 2.52
Child Setting/ Services^ In-home, no services (reference group)
In-home, services 1.45 .81, 2.58
Foster home 3.03**_ii 1.62, 5.65
Kinship care 2.06 1.01, 4.18
Lower scores are indicated by higher odds ratios

Cox and Snell pseudo- R2 is .03

* p < .01, (back)

** p < .001 (back: **_i, **_ii)

^ Group home cases omitted due to small sample size (back)

To summarize, children involved with CWS are rated by their caregivers as having lower levels of daily living skills than children in the general population. This is particularly applicable to preschoolers, as opposed to infants or school-aged children. In addition, children in nonkinship foster homes are classified as having low daily living skills more frequently than children who remain at home, although there were no significant differences between scores of children in kinship care and children who remain at home. White children in out-of-home care are over three times as likely as Black children in out-of-home care to be classified as having low daily living skills.

5.3.2 Social Skills: The Social Skills Rating System (SSRS)

The Social Skills Rating System (SSRS) was administered to caregivers to assess their perceptions of the social skills of children aged 3 and older. 20 The results are shown in Table 5-25. The SSRS is interpreted such that children with scores within one standard deviation of the standardization sample mean, in either direction, are classified as having average social skills. Those with scores below or above one standard deviation from the mean are classified as having fewer or more social skills, respectively (Gresham & Elliott, 1990). Overall, 38% of NSCAW children are classified as having fewer social skills. This is over twice the proportion of the normative sample classified as having fewer social skills (16%). Similarly, the proportion of children in this population with more social skills according to the SSRS (7%) is less than half of the proportion of the normative sample classified as having more social skills (16%). Fewer of the NSCAW children, compared with the normative sample, have average social skills (55% vs. 68%, respectively).

Table 5-25. Proportion of Children with Fewer, Average, or More Social Skills as Measured by the SSRS
  Total In-Home Out-of-Home
Fewer Average More Fewer Average More Fewer Average More
Percent/(SE)
Age 3-5 40.2
(3.4)
52.0
(3.7)
7.8
(2.7)
40.0
(3.7)
52.1
(4.0)
7.9
(2.8)
41.9
(8.2)
51.2
(9.4)
6.9
(4.1)
6-10 38.5
(2.5)
54.3
(2.3)
7.2
(1.1)
37.1
(2.6)
55.4
(2.5)
7.5
(1.2)
51.4
(4.6)
44.2
(4.4)
4.4
(2.0)
11+ 33.8
(2.4)
59.8
(2.6)
6.5
(1.5)
33.3
(2.6)
59.9
(2.9)
6.8
(1.7)
36.8
(5.5)
59.2
(5.4)
4.1
(2.3)
Race/ Ethnicity Black 36.5
(3.0)
56.1
(2.8)
7.4
(1.9)
35.9
(3.2)
56.4
(3.0)
7.7
(2.1)
41.0
(4.9)
53.8
(5.3)
5.2
(2.1)
White 38.8
(2.2)
53.8
(2.4)
7.4
(1.4)
38.1
(2.4)
54.2
(2.6)
7.7
(1.6)
45.1
(5.9)
50.6
(5.8)
4.4
(2.1)
Hispanic 37.1
(2.7)
55.0
(3.2)
7.8
(1.8)
36.5
(2.9)
55.6
(3.4)
7.9
(1.9)
47.5
(9.9)
45.7
(11.2)
6.8
(5.7)
Other 33.6
(6.2)
63.6
(6.8)
2.8
(1.8)
31.9
(6.7)
65.1
(7.4)
3.1
(2.0)
50.5
(8.9)
49.3
(9.0)
0.3
(0.3)
TOTAL 37.5
(1.6)
55.4
(1.6)
7.1
(1.2)
36.8
(1.6)
55.8
(1.7)
7.4
(1.3)
44.3
(3.0)
51.0
(3.1)
4.6
(1.4)

Bivariate analyses indicate that social skills do not differ based on age, race/ethnicity, or service setting. This result was confirmed, for the most part, via a logistic regression that modeled social skills and controlled for age, gender, race/ethnicity, and child setting. While the model indicates that age, race/ethnicity, and gender cannot predict the level of social skills of a child who has become involved with CWS, it does suggest that child setting is related to social skills. Comparisons across the settings indicate that children in nonkinship foster homes are significantly more likely to be rated as having fewer social skills than those remaining at home who are not receiving ongoing child welfare services (57% vs. 35%, p < .001). The same result is found between children in nonkinship foster homes and those remaining at home with open child welfare cases (57% vs. 41%, p < .01) when nonkinship foster home is used as the reference group for the setting variable (not shown in table). After controlling for race/ethnicity, age, and gender, the odds of a child in nonkinship foster care having fewer social skills are about twice what they are for children living at home. Also, when nonkinship foster home is used as the reference group, there is a trend that children in nonkinship foster homes are more likely to be rated as having fewer social skills than those in kinship care (57% vs. 36%, p = .02) (Table 5-26).

Table 5-26. Logistic Regression Modeling Fewer Social Skills as Measured by the SSRS
Characteristic OR^_i 95% CI
Age 11+ (reference group)
3-5 1.41 .97, 2.06
6-10 1.31 1.01, 1.71
Gender Female (reference group)
Male .74 .50, 1.10
Race/ Ethnicity White (reference group)
Black .88 .65, 1.20
Hispanic .92 .68, 1.24
Other .81 .44, 1.49
Child Setting/Services^_ii In-home, no services (reference group)
In-home, services 1.31 .93, 1.86
Foster home 2.50* 1.62, 3.86
Kinship care 1.00 .60, 1.64
Group home care 1.56 .60, 4.08
^ Fewer social skills are indicated by higher odds ratios. (back: ^_i, ^_ii)

Cox and Snell pseudo- R2 is .02

* p < .001 (back)

5.3.3 Discussion of Adaptive and Social Functioning

Daily living and social skills of children involved with CWS are much lower than average. These results apply to children who have become involved with CWS, regardless of age, gender, or race/ethnicity. Children in nonkinship foster homes appear particularly likely to have both fewer social skills and low daily living skills. Caregivers' perceptions may factor into these findings, however, as foster parents may judge the social and daily living skills of their foster children more strictly than permanent caregivers judge their own children—or than kinship caregivers judge the children in their care (Shore et al., 2002). Children in CWS are facing greater challenges than nonmaltreated peers in their ability to function and get along with others successfully.

5.4 Emotional and Behavioral Well-Being

The link between maltreatment and consequent conduct problems begins early and is evident whether a child is maltreated in preschool, elementary school, or adolescence (Keiley et al., 2000; Salzinger et al., 2002; Toth et al., 2000). Although many of the children involved with CWS are too young to become engaged in delinquent behavior, the overlap between exposure to maltreatment and becoming delinquent has been well documented (Jonson-Reid & Barth, 2000; Widom, 1989). Maltreatment has also been associated with increased depression in children and adolescents (McLeer et al., 1998; Schraedley, Gotlib, & Hayward, 1999), subsequent involvement in substance abuse (Perez, 2001; Widom, Weiler, & Cotler, 1999), and becoming sexually active at an early age (Fiscella et al., 1998; Nordenberg et al., 1996; Perez, 2001).

At the same time, youths also become involved with CWS because they have prior mental health problems and delinquent behavior, sometimes without any prior child maltreatment (U.S. Government Accounting Office, 2003). Although the extent to which children become involved in CWS solely because of their mental health problems is not clear, there is also a group of children who become involved in CWS following altercations with their families who bruised or injured the child while attempting to grapple with the child's problem behavior (Friesen et al., 2003). Although we do not make estimates of the extent of these problems in this report, it is possible that the high levels of children's mental health problems in our sample derive from circumstances unrelated to child maltreatment (Barth, Wildfire, & Green, 2003).

This section presents bivariate and multivariate analyses of problem behaviors, depression, delinquency, sexual behavior, and substance abuse. Comparisons are made by age, gender, race/ethnicity, and service setting. Data from other national studies are also presented as a comparison to children involved in CWS.

5.4.1 Problem Behaviors: The Child Behavior Checklist, Youth Self-Report, and Teacher Report Form

Scores on the suite of behavior checklists developed by Achenbach and colleagues were used as indicators of children's mental health and behavioral and emotional functioning. Externalizing, Internalizing, and Total Problem Behaviors were measured using the Parent Report Form of the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the Youth Self-Report (YSR). The population of children whose families were investigated for maltreatment exhibits a much larger proportion of clinical and borderline scores than does the normative sample. Seventeen percent of the normative sample is categorized as clinical/borderline (Achenbach, 1991a, 1991b, 1991c). Whether the caregiver, teacher, or youth is the source of the behavioral rating, children whose families were investigated for maltreatment are approximately twice as likely as the normative sample to fall into the borderline/clinical range for problem behaviors. Depending on the source of the report, the proportion of children in the borderline/clinical range varies from 33% to 44% on Externalizing behaviors, 24% to 36% on Internalizing behaviors, and 36% to 44% on the Total Problems scale (Table 5-27). Whereas these findings show statistically significant agreement among caregiver, youth, and teacher reports of Total Problem Behaviors, Kappa coefficients comparing parents to teachers, teachers to youths, and youths to parents were low, ranging from .14 to .21, which suggests only slight improvements in agreement over chance. These low Kappas are not unusual across raters in different settings, but do indicate that there are multiple and unique perspectives on the performance of children.

Table 5-27. Children with Clinical/Borderline Problem Behaviors as Measured by the CBCL, TRF, and YSR
  Externalizing Internalizing Total Problems
Percent / (SE)
Parent report 4-15 years 43.4
(2.3)
31.6
(1.6)
44.6
(2.3)
Norms^_i 17 17 17
Teacher report 5-15 years 43.8
(2.4)
36.3
(2.1)
37.3
(3.2)
Norms^_ii 5 5 5
Youth report 11+ years 33.0
(3.0)
24.3
(2.5)
36.3
(2.6)
Norms 5 5 5
^ Norms are based on children up to 18 years old. (back: ^_i, ^_ii)

Using T scores rather than dichotomous scores is another way of viewing problem behavior scores. T scores are best used for comparisons of the degree of deviance indicated by children's scores on different scales and instruments (Achenbach, 1991a). A correlation matrix including group means and standard deviations is presented to provide information for readers interested in making comparisons to other studies that use correlations and T scores (Table 5-28). Because the YSR was only administered to children 11 years and older, the correlation matrix is presented for this age group only. T scores for children aged 5 to 15 years are presented at the bottom of the table, and correlations between CBCL and TRF scores for children aged 5 years to 15 years are presented in a table footnote.

Similarities to nationally representative samples exist (e.g., Achenbach, McConaughy, & Howell, 1987; Lambert, Lyubansky, & Achenbach, 1998). The lowest correlations between raters are for internalizing scores—higher correlations exist for externalizing and total problem behavior scores (Table 5-28). Additionally, the lowest correlations between pairs of raters are between youths and teachers, whereas the highest correlations are between youths and caregivers. Correlations between caregiver and teacher reports for 5- to 15-year-olds are lower than national norms for 4- to 18-year-olds for Externalizing, Internalizing, and Total Problem Behavior: .43, .31, and .44, respectively (Achenbach, 1991a). Some of this difference may be attributable to age differences in the two populations as well as differences in the types of caregivers (e.g., biological, foster, kinship, and group home caregivers) reporting behavior in a child welfare population. The many residential and educational transitions that foster children experience would also be likely to reduce more error into these ratings, thus lowering the correlations between them.

Table 5-28. Correlation Matrix and Mean T Scores: CBCL, TRF, and YSR (11 to 15 years)
Score Mean
(SD)
1
60.4
(11.7)
2
56.6
(12.7)
3
60.1
(12.7)
4
58.7
(9.1)
5
55.2
(9.8)
6
56.9
(9.1)
7
53.6
(13.0)
8
50.0
(12.6)
9
53.2
(13.5)
1. CBCL Ext. 1.00                
2. CBCL Int. .72 1.00              
3. CBCL Total .91 .90 1.00            
4. TRF Ext. .34 .21 .32 1.00          
5. TRF Int. .24 .27 .29 .50 1.00        
6. TRF Total .34 .28 .37 .87 .81 1.00      
7. YSR Ext. .47 .32 .44 .29 .17 .27 1.00    
8. YSR Int. .30 .34 .38 .15 .21 .20 .61 1.00  
9. YSR Total .43 .39 .48 .27 .24 .29 .87 .89 1.00
Mean
(SD)
5 –15 yrs
57.6
(12.0)
54.5
(11.8)
57.7
(12.5)
57.4
(9.2)
54.5
(10.5)
55.6
(9.7)
     
Note: CBCL-TRF correlations for 5- to 15-year-olds are r = .29 (Externalizing), r = .21 (Internalizing), and r = .31 (Total); All correlations are significant at p < .001.

Bold correlations indicate correlations between raters on same scale.

Differences from past studies are most notable in the level of problems reported by youth, caregivers and teachers (Table 5-28). Though past studies (e.g., Stanger & Lewis, 1993; Youngstrom, Loeber, & Stouthamer-Loeber, 2000) have found that youth tend to report higher levels of problems than either caregivers or teachers, youth involved with the child welfare system, on average, are reporting lower levels of externalizing, internalizing, and total problem behaviors than caregivers or teachers. There does appear to be a tendency for caregivers to report more problems than teachers-similar to past research on child welfare-involved children (Randazzo, Landsverk, & Ganger, 2003).

5.4.2 Child Behavior Checklist—Caregiver Reports

CBCL results for children aged 2 and 3 years were included earlier in this chapter. Among children aged 4 to 15 years, children in out-of-home care and older children are generally reported as having the most problem behaviors, based on the Total Problem Behavior Scale of the CBCL. Caregivers of children in out-of-home care reported significantly more problem behaviors than caregivers of children remaining at home. Group home caregivers reported a significantly greater proportion of problem behaviors for the children they cared for than either foster or kinship caregivers. The proportion of children in group care with behavior problems is almost twice as large as the proportion in kinship care, which is the placement with the lowest proportion of children with behavior problems (Table 5-29). Caregivers also reported that, overall, the oldest children have significantly more problem behaviors than both groups of younger children (aged 4 to 5 and aged 6 to 10). This difference is true for children remaining at home, as well, with the older children reported as having significantly more problem behaviors.

Table 5-29. Caregiver Report of Clinical/Borderline Total Problem Behaviors (Aged 4 to 15 Years) as Measured by the CBCL
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Mean/ (SE)
Age 4-5 36.9 d
(3.7)
37.2
(5.6)
37.9
(7.2)
37.4 e
(4.1)
54.7
(12.0)
9.9
(4.8)
0 27.8
(8.7)
6-10 40.4 f
(2.9)
35.0
(3.9)
49.4
(4.6)
38.4 g
(3.0)
66.3
(8.0)
48.1
(9.6)
95.9
(3.7)
58.2
(6.4)
11+ 55.4
(3.1)
55.6
(4.7)
54.8
(4.6)
55.3
(3.5)
47.4
(7.0)
42.2
(7.1)
79.6
(8.4)
56.1
(5.2)
Race/ Ethnicity Black 44.0
(3.7)
44.0
(5.4)
42.8
(6.3)
43.6
(3.8)
45.2
(8.0)
43.0
(9.3)
64.8
(14.9)
46.2
(6.9)
White 47.2
(2.8)
44.6
(3.7)
50.7
(3.7)
46.2
(3.2)
63.3
(5.3)
38.0
(9.1)
87.9
(7.8)
55.8
(5.0)
Hispanic 37.7
(3.7)
31.3
(5.0)
49.0
(5.4)
36.1
(3.6)
80.4
(8.7)
24.1
(8.6)
--- 64.6
(8.5)
Other 46.8
(7.0)
38.4
(9.6)
60.8
(7.5)
45.0
(7.4)
72.2
(8.0)
--- --- 65.1
(9.5)
TOTAL 44.6
(2.3)
41.6
(3.0)
48.9
(3.1)
43.5 a
(2.4)
58.8 b
(4.3)
40.6 c
(5.3)
82.5
(6.7)
54.2
(3.5)
^ Includes “other” out-of-home placement (back)

a Proportion of borderline/clinical scores for children in out-of-home placements is higher than for children remaining at home (X2 = 6.2, p ≤ .01) (back)

b Proportion of borderline/clinical scores for children in group care is higher than for children in foster care (X2 = 6.7, p ≤ .01) (back)

c Proportion of borderline/clinical scores for children in group care is higher than for children in kinship foster care (X2 = 8.7, p ≤ .01) (back)

d Proportion of borderline/clinical scores for children aged 11+ years is higher than for 4- to 5-year-olds (X2 = 19.8, p ≤ .001) (back)

e Proportion of borderline/clinical scores for children aged 11+ years remaining at home is higher than for 4- to 5-year-olds remaining at home (X2 = 15.0, p ≤ .001) (back)

f Proportion of borderline/clinical scores for children aged 11+ years is higher than for 6- to 10-year-olds (X2 = 14.9, p ≤ .001) (back)

g Proportion of borderline/clinical scores for aged 11+ years remaining at home is higher than for 6- to 10-year-olds remaining at home (X2 = 13.4, p ≤ .001) (back)

The bivariate findings presented in Table 5-29 are supported by logistic regression, which confirms that older children and those living in out-of-home care have significantly greater odds of being reported by caregivers as having problem behaviors. Children aged 11 and older have approximately twice the odds of 4- to 5-year-olds (OR = 2.07, p ≤ .001) and 6- to 10-year-olds (OR = 1.77, p≤ .001) of being reported as having borderline/clinical problem behaviors. Children in foster care have approximately twice the odds and children in group care almost five times the odds of in-home children who are not receiving services of being reported as having problem behaviors (Table 5-30).

Table 5-30. Logistic Regression Modeling Borderline/Clinical Problem Behaviors (Aged 4 to 15 Years) as Measured by the CBCL
Characteristic OR 95% CI
Age 11+ (reference group)
4-5 .48 *_i .34, .70
6-10 .56 *_ii .41, .77
Gender Female (reference group)
Male 1.25 .95, 1.63
Race/ Ethnicity White (reference group)
Black .88 .62, 1.24
Hispanic .70 .48, 1.00
Other .98 .56, 1.73
Child Setting/ Services^ In-home, no services (reference group)
In-home, services 1.31 .93, 1.85
Foster home 1.94 *_iii 1.33, 2.82
Kinship care .93 .57, 1.54
Group home care 4.85 *_iv 1.90, 12.42
Cox and Snell pseudo-R2 = .04

* p≤.001 (back: *_i, *_ii, *_iii, *_iv)

5.4.3 Youth Self-Report (YSR)

Youth reports of Total Problem Behavior (available for children aged 11 and older) do not differ significantly by service setting or race/ethnicity. The most important finding in these analyses is that, regardless of race/ethnicity and service setting, children aged 11 years and older who have become involved with CWS are twice as likely to score within the clinical range than the normative sample (Achenbach, 1991b), 36% versus 17% (Table 5-31). Controlling for gender, race/ethnicity, and setting, the logistic regression analysis confirmed the bivariate findings of no significant differences in self-report of problem behaviors.

Table 5-31. Youth Self-Report of Clinical/Borderline Total Problem Behaviors (Aged 11 to 15 Years)
TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Percent/ (SE)
Race/ Ethnicity Black 29.9
(5.6)
28.8
(8.9)
34.3
(9.0)
30.6
(6.3)
25.6
(12.1)
28.2
(10.1)
66.3
(15.1)
26.5
(8.2)
White 38.4
(4.2)
37.8
(6.3)
38.1
(6.7)
37.9
(4.7)
39.8
(10.6)
43.3
(9.6)
47.1
(18.4)
41.7
(7.9)
Hispanic 35.7
(4.0)
26.7
(6.7)
61.1
(12.5)
35.0
(4.3)
--- --- --- 44.6
(14.5)
Other 41.1
(8.5)
--- 47.1
(13.4)
36.2
(9.3)
--- --- --- 67.5
(12.3)
TOTAL 36.3
(2.6)
33.8
(3.9)
41.1
(4.1)
36.0
(2.7)
32.4
(8.2)
39.4
(7.4)
60.7
(11.3)
38.5
(4.9)
^ Includes “other” out-of-home placement. (back)

5.4.4 Teacher Report Form (TRF)

For teacher reports of Total Problem Behaviors, there are no significant differences by age, service setting, or race/ethnicity. Teachers report that 37% of 5- to 15-year-olds fall into the clinical/borderline problem behavior category (Table 5-32). Multivariate analysis controlling for age, gender, and race/ethnicity confirmed bivariate analyses, indicating no significant differences between groups on teacher-reported problem behaviors.

In summary, though behavior problems vary somewhat by setting, race/ethnicity, and age, children are generally quite similar in their high levels of problem behavior on entrance to CWS. This finding that alleged maltreating parents report their own children as being so troubled has not been as well documented in other research (which has focused on children in out-of-home care). Although problem behaviors are more prevalent for older children and children living in out-of-home care, the levels of problem behavior are substantial across all age groups and settings.

5.4.5 Depression: The Children's Depression Inventory

Children aged 7 years and older reported on their own depressive symptomatology using the Children's Depression Inventory (CDI). A total of 15% of children whose families were investigated for maltreatment score within the depressive range, compared with only 9% of the normative sample (Kovacs, 1992). While in most instances the level of depression reported is similar across age, race/ethnicity, and setting, Black children report depression at levels comparable to the normative sample and significantly less than White children, who are reporting depression at levels double the norm (Table 5-33).

Table 5-32. Teacher Report of Clinical/Borderline Problem Behaviors (Aged 5 to 15 Years) as Measured by the TRF
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home ^
Percent/ (SE)
Age 5 27.5
(7.6)
--- 32.5
(13.6)
29.3
(9.5)
0 --- --- ---
6–10 36.3
(3.8)
33.7
(4.1)
46.4
(5.2)
36.4
(3.6)
56.4
(20.2)
19.0
(7.3)
0 34.4
(13.6)
11+ 41.2
(4.6)
41.5
(5.8)
41.8
(6.5)
41.6
(4.8)
42.3
(14.0)
44.6
(13.5)
--- 42.3
(10.7)
Race/Ethnicity Black 41.6
(5.8)
37.4
(6.6)
48.1
(9.0)
40.4
(5.9)
68.4
(15.8)
47.3
(13.6)
--- 56.9
(11.9)
White 32.4
(3.5)
29.9
(4.3)
42.6
(5.5)
33.2
(3.7)
24.2
(8.4)
17.0
(7.6)
--- 24.1
(6.1)
Hispanic 46.2
(8.7)
46.9
(8.3)
44.2
(11.5)
46.2
(8.0)
--- --- 0 ---
Other 38.4
(7.9)
47.4
(10.6)
17.8
(7.2)
39.7
(8.4)
--- --- 0 ---
TOTAL 37.3
(3.2)
35.7
(3.5)
42.6
(3.7)
37.5
(3.1)
50.9
(15.8)
24.3
(7.0)
--- 34.8
(8.4)
^ Includes “other” out-of-home placement. (back)

Logistic regression controlling for age, gender, race/ethnicity, and setting found some significant differences in depression. Females have almost three times the odds of males of reporting depression (OR = 2.85, p ≤ .001). As with the bivariate analyses, White children are significantly more likely than Black children to report depression: Whites have twice the odds of Blacks of reporting depression. Children in group care have five times the odds of children remaining at home and not receiving services of reporting depression (Table 5-34).

To better understand the findings about depression, the YSR Depression subscale for children aged 11 and older was compared with CDI scores for children aged 11 and older. Comparisons were made on overall depression levels as well as by gender, race/ethnicity, and service setting. YSR and CDI findings are very similar. A total of 10% of YSR respondents scored in the depressive range. A significant association exists between YSR and CDI depression scores (X2 = 17.1, p ≤ .001), with 82% of children reporting as not depressed on both the YSR and CDI. The kappa between these ratings was .43, indicating moderate agreement above chance.

Unlike CDI, bivariate analyses indicate no race/ethnicity, gender, or service setting differences on the YSR Depression subscale. As with CDI, multivariate analysis for the YSR Depression subscale indicates that children in group care are at the greatest odds of reporting depression. On YSR, children in group care have over seven times the odds of children at home and not receiving child welfare services of reporting depression (OR = 7.31, p ≤ .001).

Table 5-33. Self-Report of Depression (Aged 7 to 15 Years) as Measured by CDI
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Percent/ (SE)
Age 7-12 14.4
(1.9)
13.4
(2.3)
13.9
(2.5)
13.5
(1.9)
21.6
(7.3)
13.6
(8.5)
--- 23.2
(6.6)
13+ 17.4
(3.4)
18.3
(4.7)
15.8
(7.1)
17.6
(3.9)
--- --- 26.0
(9.2)
16.8
(4.0)
Race/ Ethnicity Black 9.2 a
(1.9)
7.9
(2.9)
7.1
(2.2)
7.7 b
(2.2)
19.5
(13.4)
--- --- 19.1
(7.0)
White 18.0
(2.2)
18.9
(3.2)
13.5
(2.5)
17.2
(2.4)
19.2
(5.0)
--- --- 22.4
(6.1)
Hispanic 19.7
(5.0)
15.8
(6.8)
35.9
(12.8)
19.9
(5.2)
--- --- --- 16.4
(7.6)
Other 12.0
(4.8)
--- 14.0
(6.9)
11.8
(5.3)
--- --- --- 23.1
(9.5)
TOTAL 15.3
(1.5)
14.6
(2.2)
14.5
(2.6)
14.6
(1.6)
17.8
(5.8)
16.2
(6.3)
44.2
(12.5)
20.8
(4.1)
^ Includes “other” out-of-home placement (back)

a White children report significantly more depression than Black children (X2 = 9.3, p≤.01) (back)

b White children remaining at home report significantly more depression than Black children remaining at home (X2 = 9.1, p≤.01) (back)

In summary, children involved with CWS report more depression than normative samples whether depression is examined with CDI or the YSR Depression subscale. Children living in group homes are the most likely to report depression.

5.4.6 Delinquency

Delinquency in NSCAW was measured using the caregiver-reported Child Behavior Checklist Delinquency subscale (Achenbach, 1991a) and 72 items from the Self-Reported Delinquency (SRD) measure (Elliott & Ageton, 1980) that were used for Wave 7 (1987) of the National Longitudinal Survey of Youth (NLSY). See Chapter 2 for a detailed description of the SRD.

5.4.7 CBCL Delinquency Subscale

Approximately one-fourth of all 6- to 15-year-olds are classified by their caregivers as borderline or clinical on the Delinquency subscale of the CBCL, five times greater than the normed sample of youths in the general population (Achenbach, 1991a). Children in out-of-home care are the most likely to be categorized as delinquent (40%), eight times greater than the normative sample (Achenbach, 1991a). Of those in out-of-home care, children in group care are significantly more likely than children in foster care to be categorized as delinquent—70% of youths in group care are rated by caregivers as having borderline or clinical levels of delinquent behavior versus 27% of youths in foster care (Table 5-35). Among children living at home, those receiving child welfare services are significantly more likely to be delinquent than those who are not receiving child welfare services.

Table 5-34. Logistic Regression Modeling Depression (Aged 7 to 15 Years) as Measured by CDI
Characteristic OR 95% CI
Age 13+ (reference group)
7-12 .93 .50, 1.74
Gender Female (reference group)
Male .35* .20, .61
Race/ Ethnicity White (reference group)
Black .45**_i .27, .75
Hispanic 1.00 .50, 1.97
Other .61 .25, 1.53
Child Setting/ Services In-home, no services (reference group)
In-home, services 1.00 .54, 1.86
Foster home 1.35 .57, 3.17
Kinship care 1.14 .38, 3.39
Group home care 5.09**_ii 1.40, 18.42
Cox and Snell pseudo-R2 = .05

* p ≤ .001, (back)

** p ≤ .01 (back: **_i, **_ii)

Only one significant difference in delinquency by age exists. Caregivers of children living at home reported significantly more delinquency for 11- to 15 year-olds than for 6- to 10-year-olds. Elementary age children in out-of-home care have very high levels of delinquency-levels comparable to middle school children. No significant differences in delinquency were found by gender or race/ethnicity (Table 5-35).

Multivariate analyses controlling for age, race/ethnicity, gender, and service setting find significant differences among service settings only; other bivariate differences do not hold up. While children living at home and receiving child welfare services are almost twice as likely as children living at home and not receiving services to be classified as delinquent, children in out-of-home care are at even greater risk. Children in foster care have three times the odds (p < .001), and children in group care have nine times the odds (p ≤ .001) of children living at home and not receiving services of being classified as delinquent. Children remaining at home and not receiving child welfare services and children in kinship care have the greatest overlap with respect to delinquency classification by their caregivers (Table 5-36).

Table 5-35. Caregiver Report of Clinical/Borderline Delinquent Behaviors for 6- to 15-Year-Olds as Measured by CBCL
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home ^
Percent/ (SE)
Age 6-10 21.2
(2.2)
15.3
(2.6)
29.6
(5.0)
18.7 d
(2.2)
51.2
(10.0)
37.0
(9.6)
81.6
(12.6)
44.0
(7.8)
11+ 29.8
(2.8)
26.4
(3.6)
35.2
(3.8)
28.9
(3.1)
31.1
(7.2)
11.9
(4.0)
67.4
(11.1)
35.6
(5.5)
Gender Male 23.6
(2.1)
17.3
(2.7)
33.0
(4.6)
21.4
(2.2)
42.4
(6.9)
20.8
(5.5)
77.6
(9.4)
42.6
(6.1)
Female 25.6
(2.2)
21.2
(2.9)
31.4
(4.2)
23.9
(2.4)
44.7
(7.8)
31.1
(10.2)
61.1
(15.4)
38.2
(6.9)
Race/ Ethnicity Black 24.7
(3.0)
18.4
(4.2)
33.0
(7.5)
22.6
(3.3)
40.0
(7.5)
32.9
(10.8)
84.3
(11.1)
38.0
(7.2)
White 26.5
(2.4)
21.5
(3.0)
33.1
(4.3)
24.6
(2.6)
40.1
(8.1)
23.2
(10.2)
78.0
(10.0)
42.6
(7.3)
Hispanic 18.6
(2.8)
13.5
(4.5)
28.6
(7.6)
17.3
(2.6)
76.0
(14.2)
--- --- 39.5
(13.7)
Other 26.2
(5.2)
22.7
(6.6)
32.0
(10.3)
25.5
(5.5)
--- --- --- 33.8
(10.7)
TOTAL 24.6
(1.7)
19.3 b
(2.2)
32.2
(3.5)
22.7 a
(1.7)
43.6
(6.0)
27.2 c
(6.7)
70.1
(9.5)
40.2
(5.5)
^ Includes “other” out-of-home placement (back)

a Proportion of borderline/clinical scores are higher for children in out-of-home care than children remaining at home (X2 = 6.5, p≤.01) (back)

b Proportion of borderline/clinical scores are higher for children remaining at home and receiving child welfare services than children remaining at home and not receiving child welfare services (X2 = 6.9, p≤.01) (back)

c Proportion of borderline/clinical scores are higher for children in group care than children in kinship care (X2 = 8.3, p≤.01) (back)

d Proportion of borderline/clinical scores are higher for children aged 11 years of age or older remaining at home than 6- to 10-year-olds remaining at home (X2 = 6.4, p≤.01) (back)

5.4.8 Self-Reported Delinquency (SRD)

Items from the Self-Reported Delinquency (SRD) (Elliott & Ageton, 1980) were used to obtain information from 11- to 15-year-olds about the commitment of violent and nonviolent delinquent acts over the 6 months prior to their interview. These measurement tools, administered in the audio computer-assisted self-interviewing (ACASI) component of the interview, provide more specific and concrete indication of delinquent behavior than does the YSR. Behaviors range from such nonviolent acts as running away, property damage, and theft, to such violent acts as aggravated assault and attempted rape. One-fifth (20%) of youths aged 11 and older reported engaging in at least one violent act within the prior 6 months. 21 Youths living in group homes are often significantly more likely to report delinquency. For violent delinquency, bivariate analyses indicate no significant differences by service setting, gender, or race/ethnicity (Table 5-37).

Multivariate analyses controlling for age, race/ethnicity, gender, and service setting indicate one difference in violence by setting. Children in group homes have almost five times the odds of children living at home and not receiving services of having committed at least one violent act in the prior 6 months (Table 5-38).

5.4.9 Number and Frequency of Delinquent Acts

Items from the SRD measure were also used to obtain information about the total number and frequency of violent and nonviolent delinquent acts engaged in during the previous 6 months. Of the 36 possible activities, 28 are classified as nonviolent, 7 as violent, and one question asks about any arrests in the prior 6 months. Youths report an average of 2.5 different delinquent acts (SE = .4), with a range from zero delinquent acts up to 36. Youths consistently report commitment of more nonviolent acts (Mean = 1.9, SE = .3) than violent acts (Mean = .4, SE = .1). A total of 10% of youths report being arrested in the previous 6 months. No significant differences were found among youths by gender, race/ethnicity, or service setting for the commitment of any violent or nonviolent acts or recent arrests.

Table 5-37. Self-Report of Any Violent Act Committed During the Past 6 Months (11- to 15-Year-Olds)
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Percent/ (SE)
Gender Male 23.4
(5.1)
27.1
(7.5)
16.5
(4.2)
23.7
(5.3)
16.9
(7.1)
--- 57.0
(17.1)
21.8
(8.1)
Female 17.7
(2.6)
13.8
(3.0)
15.6
(3.6)
14.3
(2.5)
41.5
(14.0)
48.8
(11.4)
51.6
(16.3)
40.4
(8.3)
Race/ Ethnicity Black 20.6
(3.6)
17.0
(4.8)
21.2
(8.4)
18.4
(4.0)
--- 47.7
(13.0)
--- 21.9
(9.9)
White 20.0
(3.9)
19.7
(5.6)
15.0
(3.2)
18.3
(4.2)
33.1
(10.2)
--- 66.4
(14.7)
31.7
(9.6)
Hispanic 14.3
(4.9)
--- 14.6
(8.6)
14.5
(5.3)
--- --- --- ---
Other 34.0
(10.0)
--- --- 28.4
(11.8)
--- --- --- 61.8
(11.5)
TOTAL 20.1
(2.8)
19.2
(3.8)
16.0
(3.1)
18.2
(2.9)
30.5
(9.4)
34.0
(9.5)
54.1
(11.9)
32.6
(6.0)
^ Includes “other” out-of-home placement (back)

Table 5-38. Logistic Regression Modeling 11- to 15-Year-Olds Who Have Committed Any Violent Act in the Past 6 Months as Measured by SRD
Characteristic OR 95% CI
Gender Female (reference group)
Male 1.47 .80, 2.69
Race/ Ethnicity White (reference group)
Black 1.09 .58, 2.06
Hispanic .79 .33, 1.89
Other 2.18 .92, 5.16
Child Setting/ Services In-home, no services (reference group)
In-home, services .74 .40, 1.38
Foster home 1.44 .47, 4.41
Kinship care 2.03 .81, 5.11
Group home care 4.76* 1.80, 12.59
Cox and Snell pseudo-R2 is .02

* p≤.01 (back)

For each behavior engaged in, youths were also asked about the frequency of each delinquent act (1 = once to 5 = five or more times). A mean frequency score for violent and nonviolent behavior was computed for all youth by averaging the frequency items for 7 violent and 28 nonviolent behaviors, with scores ranging from 0 to 5. Youths report committing violent acts with greater frequency than nonviolent acts during the 6 months prior to the interview—two times for violent acts versus 0.6 time for nonviolent acts. Youths living in group homes report committing nonviolent acts significantly more frequently during the past 6 months (1.6 incidents) than children in any other service setting (approximately 0.5 incident). No significant differences in the violent or nonviolent mean frequency scores were found by gender or race/ethnicity.

The proportion of youths who reported committing these acts are presented in Table 5-39. Frequencies of individual violent and nonviolent acts are presented for the proportion of youths who reported engaging in the behavior. On average, youths indicate they have committed delinquent acts two to three times over the past 6 months. Acts committed by the greatest proportion of youths are skipping school and being unruly in public. Though fewer youths reported violent behaviors, 7% had been in a gang fight; 5% used a weapon, force, or intimidation to get something they wanted; and 5% attacked another person with the idea of seriously hurting or killing them.

A significant proportion of youths in CWS have committed delinquent acts, particularly those living in group care. Caregivers of youths receiving child welfare services report that 70% of youths living in group care exhibit delinquent behavior at the borderline or clinical level; this is a huge proportion, almost nine times greater than the normative sample from CBCL (Achenbach, 1991a). For self-reported delinquency, a sizeable proportion (20%) of youths 11 years and older report committing violent acts in the 6 months prior to interview, and over 50% of youths living in group care report committing a violent act. In view of the serious nature of many of these acts, the fact that 20% report violent behavior is of considerable concern, as is the large proportion of youths in group care reporting violent behavior. Aggression in adolescence is a strong predictor of continued violence into later adolescence and adulthood (Farrington, 1989).

5.4.10 Sexual Behavior

Information on sexual behavior from youths 11 years and older was collected using ACASI. These questions are a modification of items from LONGSCAN (Runyan et al., 1988) and ask about sexual activity, including age at first intercourse, use of birth control, and childbearing. Approximately one-quarter of youths aged 11 to 15 reported having had sexual intercourse. No significant differences were found by service setting or race/ethnicity.

We also compared the prevalence of engagement in sexual intercourse by most serious abuse type in order to better understand the correlates of sexual behavior among children investigated as victims of maltreatment. Over half of the children with sexual abuse as the most serious abuse type reported having had sexual intercourse. This is double the proportion of all 11- to 15-year-olds represented in our sample and significantly higher than youths with any other type as the most serious abuse (Table 5-40).

Table 5-39. Frequency and Proportion of Delinquent Behaviors in the 6 months Prior to Child Interview
Delinquent Behavior Frequency of Act Committed Act
Mean / (SE) Percent / (SE)
Violent Acts Attacked someone with a weapon or with the idea of seriously hurting or killing them 2.73
(.35)
5.1
(1.5)
Hit someone with the idea of hurting them 2.44
(.24)
14.1
(2.3)
Used a weapon, force, or strong-arm methods like threats to get money or things from people 1.64
(.30)
5.3
(1.9)
Threw objects such as rocks or bottles at people 2.19
(.28)
7.6
(1.9)
Involved in a gang fight 2.70
(.39)
7.4
(1.9)
Physically hurt/threatened to hurt someone to get them to have sex 1.93
(.46)
1.1
(0.4)
Had/tried to have sexual relations with someone against their will 2.03
(1.03)
1.4
(0.6)
Nonviolent Acts Ran away .24
(.06)
10.5
(1.7)
Skipped school 2.00
(.25)
19.4
(3.2)
Lied about age for movie 1.92
(.22)
12.3
(2.1)
Hitchhiked 2.30
(.46)
5.0
(1.6)
Carried hidden weapon 2.62
(.34)
7.5
(1.7)
Unruly in public 2.26
(.19)
19.2
(2.5)
Begged formoney/things 2.87
(.47)
6.8
(1.7)
Drunk in public 2.69
(.40)
7.5
(2.0)
Damaged property 2.29
(.30)
10.4
(2.0)
Set fire to a house, building, car, or other property 2.34
(.88)
2.2
(0.8)
Avoided paying for things (e.g., bus, subway rides, movies, food,clothing) 2.27
(.32)
9.8
(1.4)
Entered/tried to enter a building to steal 2.35
(.37)
6.6
(1.6)
Stole/tried to steal things worth ≤ $5 1.88
(.20)
8.3
(1.9)
Stole/tried to steal things worth between $5 and $50 3.01
(.42)
6.1
(1.9)
Stole/tried to steal things worth between $50 to $100 3.16
(.37)
4.5
(1.7)
Stole/tried to steal things worth >$100 2.90
(.34)
4.4
(1.5)
Took something from a store without paying for it 2.02
(.23)
11.8
(2.4)
Snatched someone's purse/wallet or picked someone's pocket 3.25
(.60)
2.6
(0.9)
Took something from a car 2.08
(.53)
5.5
(1.5)
Bought/sold stolen goods 2.50
(.34)
6.1
(1.9)
Took/drove vehicle without permission 2.42
(.12)
4.2
(1.2)
Stole vehicle 2.20
(.36)
2.2
(0.9)
Used false checks/money 2.78
(.64)
3.3
(1.1)
Used credit cards without permission 1.50
(.25)
3.0
(1.1)
Sold items above value 2.71
(.22)
5.2
(1.7)
Paid for having sex 1.48
(.31)
3.4
(1.0)
Sold marijuana/hashish 2.45
(.46)
5.9
(1.5)
Sold hard drugs 2.77
(.65)
2.2
(0.9)

Supporting the bivariate analyses, multivariate analyses controlling for gender, race/ethnicity, service setting, and most serious abuse type indicate differences by abuse type only. Children with sexual abuse as the most serious abuse type are at significantly greater odds (p < .001) of reporting ever having had sexual intercourse than children with any other most serious abuse type (Table 5-41).

To depict more clearly how much greater the odds are that children with a most serious abuse type of sexual abuse have had sexual intercourse than children with other most serious abuse types, additional logistic regressions (not presented) were run with each other type of abuse as the reference group. Children with sexual abuse as the most serious abuse type have over three times the odds of physically abused children (OR = 3.6, p < .001), over 10 times the odds of children whose caregiver failed to provide for them (OR = 10.4, p < .001), almost four times the odds of children who were not supervised (OR = 3.9, p < .001), and over 12 times the odds of children with other types of maltreatment as the most serious abuse type (OR = 12.5, p < .001) of ever having had sexual intercourse.

Table 5-40. Child Has Had Sexual Intercourse (11- to 15-Year-Olds)
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Percent/ (SE)
Race/ Ethnicity Black 30.2
(4.8)
29.3
(8.0)
23.0
(4.8)
27.2
(5.5)
--- 28.3
(10.4)
84.5
(8.8)
44.2
(10.1)
White 26.3
(4.5)
27.8
(6.5)
23.6
(7.5)
26.6
(5.0)
22.1
(5.3)
--- 46.5
(0.0)
24.5
(7.5)
Hispanic 20.8
(6.6)
--- 16.1
(8.3)
21.6
(7.1)
--- --- --- ---
Other 14.8
(4.4)
--- 19.6
(6.5)
11.1
(3.8)
--- --- --- 33.8
(14.3)
Most Serious Type of Abuse Physical Maltreatment 26.0 a
(4.7)
34.1
(6.8)
15.8
(3.8)
27.2
(5.3)
--- --- --- 15.3
(6.2)
Sexual Maltreatment 54.2 b e g
(9.0)
58.7
(12.1)
45.8
(17.0)
53.4 c f h
(10.2)
--- 39.3
(16.1)
--- 58.9 d
(12.7)
Failure to Provide 11.6
(3.4)
--- --- 11.7
(3.7)
--- --- --- 11.1
(5.4)
Failure to Supervise 25.5
(5.6)
26.7
(8.0)
15.6
(5.6)
24.0
(6.2)
--- --- 70.1
(14.8)
35.7
(7.6)
Other 9.5
(4.5)
--- --- --- --- --- --- ---
TOTAL 25.8
(3.2)
26.1
(4.6)
22.0
(4.2)
24.9
(3.6)
26.3
(5.5)
18.5
(5.3)
50.5
(12.4)
31.5
(6.0)
^ Includes “other” out-of-home placement (back)

a Sexually abused children report having ever had sex significantly more than physically abused children (X2 = 7.6, p < .01) (back)

b Sexually abused children report having ever had sex significantly more than children whose caregivers failed to provide for them (X2 = 14.6, p < .001) (back)

c Sexually abused children remaining at home report having ever had sex significantly more than children remaining at home whose caregivers failed to provide for them (X2 = 11.0, p≤.001) (back)

d Sexually abused children living in out-of-home care report having ever had sex significantly more than children living in out-of-home care whose caregivers failed to provide for them (X2 = 6.5, p≤.01) (back)

e Sexually abused children report having ever had sex significantly more than children whose caregivers failed to supervise them (X2 = 8.9, p < .01) (back)

f Sexually abused children remaining at home report having ever had sex significantly more than children remaining at home whose caregivers failed to supervise them (X2 = 7.6, p≤.01) (back)

g Sexually abused children report having ever had sex significantly more than children who were maltreated in other ways (X2 = 12.8, p < .001) (back)

h Sexually abused children remaining at home report having ever had sex significantly more than children remaining at home who were maltreated in other ways (X2 = 9.8, p < .01) (back)

Table 5-41. Logistic Regression Modeling 11- to 15-Year-Olds Who Have Ever Had Sexual Intercourse
Characteristic OR 95% CI
Gender Female (reference group)
Male 1.17 .57, 2.42
Race/Ethnicity White (reference group)
Black 1.34 .74, 2.44
Hispanic .62 .25, 1.53
Other .49 .21, 1.14
Child Setting/ Services In-home, no services (reference group)
In-home, services .72 .37, 1.41
Foster home 1.24 .60, 2.56
Kinship care .52 .21, 1.30
Group home care 1.97 .66, 5.83
Most Serious Type of Abuse Sexual Maltreatment (reference group)
Physical Maltreatment .28 *_i .14, .55
Failure to Provide .10 *_ii .04, .25
Failure to Supervise .25 *_iii .13, .51
Other .08 *_iv .02, .28
Cox and Snell pseudo-R2 is .11

* p < .001 (back: *_i, *_ii, *_iii, *_iv)

Because these large differences could be due to a nonconsensual first sexual intercourse experience, bivariate analyses examined most serious abuse type by consensual versus nonconsensual first sexual intercourse experience. No significant differences were found. Children with all abuse types are similar in their likelihood of having had a nonconsensual first sexual intercourse experience—73% of sexually abused youths report that their first sexual intercourse experience was consensual compared with 87% of nonsexually abused youths. One likely explanation for this counterintuitive finding is that a substantial proportion of children who were reported with sexual abuse as their most serious maltreatment type did not experience genital penetration during their sexual victimization.

The majority of children who have ever had sexual intercourse—which is only 26% of all children in the population of 11- to 15-year-olds—report having sexual intercourse for the first time between the ages of 12 and 15. Over half of the children who have had intercourse report always using protection. One-fourth report having been pregnant or gotten someone pregnant, and nearly one-fifth report that they have a child (Table 5-42). Slightly less than one-fifth of youths report that sex was nonconsensual the first time.

Table 5-42. Sexual Behavior of 11- to 15-Year-Olds Who Have Ever Had Sexual Intercourse
Measure Percent(SE)
Age of child first time had sex <8 3.8
(1.2)
8–9 6.8
(3.0)
10–11 13.6
(3.6)
12–13 56.7
(7.1)
14–15 17.7
(4.8)
Was this first time forced or consensual? Forced 16.7
(4.7)
Consensual 83.4
(4.7)
Frequency child used protection, such as a condom or other methods Never or rarely 25.7
(6.4)
Sometimes 7.5
(2.7)
Often 12.9
(4.9)
Always 54.0
(7.3)
Child has been or gotten someone pregnant 25.6
(6.5)
Child has children   15.9
(5.3)
Average number of children 1.0
(.01)

Comparisons between these findings and the 1999 results of the Youth Risk Behavior Survey (YRBS) (CDC, 1999) provide evidence about how children involved with CWS compare to high school students nationally. Because YRBS contains children in older age ranges (9th through 12th graders), exact comparisons by age cannot be made. Youths involved with CWS tend to have had sexual intercourse at rates comparable to those of high-school students nationally. When only 9th graders from YRBS are examined, approximately 39% (CI: 32.4%–44.8%) report having had sexual intercourse. This is a slightly greater proportion than all 11- to 15-year-olds involved with CWS (25.8%; CI: 19.9%–32.6%) but less than 14-year-olds (54.1%, CI: 39.3%–68.1%) or 15-year-olds (59.1%, CI: 50.8%–67.0%).

Youths involved with CWS are, however, much more likely to have been pregnant or gotten someone pregnant than high school students nationally. Children aged 11 to 15 years whose families have been investigated for child maltreatment report they have been pregnant or gotten someone pregnant with almost four times the frequency of 9th to 12th graders nationally: 25.6% (CI: 14.9%–40.3%) versus 6.3% (CI: 4.8%–7.8%).

In summary, youths involved with CWS are having sex at rates comparable to slightly older national samples. CWS-involved youths are also at greater risk for pregnancy than national samples. Youths with sexual abuse as the most serious type of maltreatment are significantly more likely to report they have had sexual intercourse than youths with other types of maltreatment. A nonconsensual first sexual intercourse experience does not explain this difference (i.e., maltreatment types are similar in the likelihood of having had a nonconsensual first sexual intercourse experience).

5.4.11 Substance Abuse

Information on substance use by youths 11 years of age and older was collected using ACASI. These questions are derived from items in the Monitoring the Future (University of Michigan, 2001) and Youth Risk Behavior (CDC, 1999) surveys and ask about lifetime substance use as well as use within the past 30 days. About 13% of youths aged 11 years and older whose families were investigated for maltreatment report using at least one illegal substance in their lifetime. Illegal substances include marijuana or hashish, inhalants, cocaine, crack, heroin, and illicit use of prescription medications (e.g., painkillers, tranquilizers, stimulants, or sedatives). Children living in out-of-home care are significantly more likely to report having ever used an illegal substance. This difference is primarily attributable to children living in group care. Almost three-quarters of children living in group care report illegal substance use at some time in their lives (Table 5-43).

Multivariate analyses controlling for race/ethnicity, service setting, and gender support bivariate analyses, specifically that children in group care have the greatest odds of reporting use of illegal substances. Children in group care have over nine times the odds of children remaining at home and not receiving child welfare services of reporting illegal substance use (Table 5-44).

Youths were asked about lifetime use of several different substances, including alcohol and tobacco. Almost 40% of youths report using alcohol or cigarettes at some time during their life, 7% report use of chewing tobacco or snuff, 17% report marijuana/hashish use, 13% report illicit use of prescription medication, 10% have used inhalants, and 6% have used hard drugs (cocaine, crack, or heroin). Lifetime substance use does not differ for children served in-home versus out-of-home (Table 5-44).

Youths who reported ever using a substance were next asked a follow-up question about use of that substance in the past 30 days (Table 5-45). Of the 38% who have ever used alcohol, 42% have used it in the past 30 days; over half of the youth who have ever smoked cigarettes have also smoked during the past 30 days; and of the 17% of youths reporting use of marijuana/ hashish in their lifetime, 50% have used marijuana/hashish in the past 30 days. Over half of youths who reported ever using prescription medication illicitly or using cocaine, crack, or heroin also reported use during the past 30 days. Use in the past 30 days did not differ significantly by in-home versus out-of-home placement for any substance (Table 5-45).

The number of illegal substances used in the past 30 days was calculated for all youth (Table 5-45). On average, youths reported using .2 illegal substances during the past 30 days. Most youths (87%) reported no use of illegal substances during the past 30 days, 8% used one substance, 1% used two substances, 2% used three substances, and 2% used all four illegal substances. No differences exist by service setting.

Table 5-43. Use of Any Illegal Substance^ in Lifetime (Aged 11 to 15 Years)
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^^
Percent/ (SE)
Gender Male 22.2
(4.3)
22.6
(6.3)
16.4
(4.5)
20.6
(4.8)
13.7
(4.2)
--- 82.0
(8.6)
31.8
(6.4)
Female 26.6
(4.4)
25.9
(5.1)
24.4
(6.9)
25.5
(5.0)
28.0
(9.5)
30.0
(10.0)
67.1
(12.6)
34.4
(6.9)
Race/ Ethnicity Black 20.7
(4.4)
23.9
(7.5)
12.6
(3.4)
20.1
(5.4)
--- --- --- 23.3
(6.5)
White 26.5
(4.1)
23.8
(5.4)
27.1
(7.4)
24.8
(4.3)
23.1
(5.3)
--- --- 38.1
(8.5)
Hispanic 22.2
(6.3)
24.1
(7.2)
16.8
(8.5)
22.3
(6.7)
--- --- --- 20.5
(9.7)
Other 25.6
(6.9)
--- 20.4
(9.3)
17.6
(6.4)
--- --- --- 65.4
(12.2)
TOTAL 24.8
(3.2)
24.6
(3.8)
20.8
(4.7)
23.5
(3.5)
20.9 a
(5.0)
30.6 b
(7.5)
74.0
(8.1)
33.3
(4.4)
^ Includes marijuana/hashish, inhalants, cocaine, crack, heroin, and illicit use of prescription medications (painkillers, tranquilizers, stimulants, or sedatives) (back)

^^ Includes “other” out-of-home placement (back)

a Children living in group care are more likely than children living in kinship care to report illegal substance use (X2 = 8.7, p < .01) (back)

bChildren living in group care are more likely than children living in foster care to report illegal substance use (X2 = 7.9, p < .01) (back)

The average number of days of illegal substance use was also calculated for all youths (Table 5-45). Because such a small proportion of youths reported illegal substance use, the number of days of use was also small (.5 days). No differences were found in the number of days of illegal substance use by in-home versus out-of-home setting. Differences do exist among out-of-home placement type—youths living in group homes reported significantly more days of illegal substance use than youths living in foster care (0.8 day versus 0.1 day).

Findings from the National Longitudinal Study of Adolescent Health (AddHealth, Carolina Population Center, 2002) and the 2001 National Household Survey on Drug Abuse (NHSDA) were examined to learn how the substance use of 11- to 15-year-olds involved with CWS compares with youths in other national studies. The AddHealth comparison data came from the 11- to 15-year-olds in the Wave 1 public use sample, collected from September 1994 to December 1995. NHSDA (since 2002 renamed the National Survey on Drug Use and Health [NSDUH]) is a yearly, nationally representative study of the use of illegal drugs by the U.S. population aged 12 years and older. Comparative NHSDA data are from the 2001 survey for youths aged 12 to 17 years (for detailed information about NHSDA and NSDUH, see http://www.oas.samhsa.gov/nhsda.htm). Standard errors are not available for AddHealth or NHSDA data, making statistical inference too chancy. Standard errors from NSCAW give some indication if proportions for NSCAW youths and other national studies may overlap, but without standard errors from AddHealth or NHSDA, conclusions about the similarity between children involved in CWS and youths in the general population cannot be drawn.

Table 5-44. Logistic Regression Modeling 11- to 15-Year-Olds Who Have Ever Used an Illegal Substance
Characteristic OR 95% CI
Gender Female (reference group)
Male .82 .43, 1.58
Race/ Ethnicity White (reference group)
Black .77 .37, 1.58
Hispanic .80 .39, 1.63
Other .89 .41, 1.94
Child Setting/ Services In-home, no services (reference group)
In-home, services .86 .48, 1.56
Foster home .89 .43, 1.84
Kinship care 1.46 .64, 3.33
Group home care 9.11* 3.77, 21.98
Cox and Snell pseudo-R2 is .04

* p≤.001 (back)

NSCAW and AddHealth youths generally report similar levels of lifetime substance use. Half of AddHealth 11- to 15-year-olds report cigarette use, 45% have used alcohol, and 19% have used marijuana. Cigarette and marijuana use during the past 30 days is also available from the AddHealth public use data. A total of 72% of AddHealth youths who have ever smoked cigarettes report smoking during the past 30 days, a proportion that appears greater than the 53% of youths involved with CWS. Of AddHealth youths who have used marijuana in the past, approximately 52% report marijuana use during the past 30 days, similar to the recent marijuana use of youths in CWS (50%).

As shown in Table 5-46, various forms of substance use during the past 30 days can be compared for youths involved with CWS and youths in the general population using the 2001 NHSDA data. NHSDA asked all respondents about use during the past 30 days, whereas NSCAW limited recent use questions to only those substances for which a youth indicated past use. Utilizing the paired NSCAW questions of lifetime and current use for each substance, use in the past 30 days was calculated for all 11- to 15-year-olds in CWS, regardless of prior use history. Substance use over the past 30 days for youths in CWS appears slightly higher than for youths in the general population. Youths involved with CWS appear to be reporting slightly more use of cigarettes, marijuana, and inhalants than did youths in the 2001 NHSDA. NHSDA standard errors are needed to verify this difference.

Table 5-45. Substance Use History (Aged 11 to 15 Years)
Characteristic TOTAL Setting
In-Home Out-of-Home
No Services Services TOTAL In-Home Foster Care Kinship Foster Care Group Care TOTAL Out-of-Home^
Percent/ (SE)
Substances Ever Used Alcohol 38.3
(3.0)
39.3
(4.1)
36.4
(3.9)
38.4
(3.2)
35.1
(8.7)
26.8
(7.8)
78.1
(7.5)
37.5
(6.3)
Cigarettes 38.6
(2.9)
37.1
(4.0)
37.2
(3.9)
37.1
(3.2)
44.0
(7.1)
28.4
(7.9)
62.0
(12.6)
48.0
(6.6)
Chewing tobacco or snuff 9.8
(2.2)
11.4
(3.1)
5.9
(1.8)
9.8
(2.4)
4.7
(2.1)
--- 37.2
(13.8)
10.4
(3.8)
Illegal Substances Ever Used Marijuana or hashish 17.3
(2.9)
16.3
(3.2)
16.1
(4.3)
16.2
(3.2)
18.7
(4.6)
20.3
(7.3)
53.3
(12.9)
24.8
(4.7)
Inhalants 10.1
(2.1)
9.8
(3.1)
7.9
(2.1)
9.3
(2.4)
8.1
(2.6)
16.4
(6.2)
32.5
(12.7)
15.7
(3.8)
Cocaine, crack, or heroin 5.7
(1.3)
4.5
(1.7)
2.7
(1.0)
4.0
(1.2)
--- --- 48.0
(12.3)
17.3
(4.7)
Nonprescribed meds 12.6
(2.5)
13.9
(3.6)
7.6
(1.6)
12.0
(2.7)
5.9
(2.1)
11.7
(5.5)
46.4
(12.6)
17.5
(4.6)
Substance Use in Past 30 days^^_i Alcohol 42.3
(4.5)
44.2
(6.3)
41.3
(10.0)
43.4
(4.9)
18.3
(8.2)
--- 40.7
(16.1)
34.8
(7.4)
Cigarettes 53.3
(5.0)
60.1
(7.5)
47.8
(9.0)
56.4
(6.1)
31.1
(11.3)
61.0
(14.1)
54.2
(13.9)
37.4
(7.6)
Chewing tobacco or snuff 74.0
(10.4)
73.2
(13.5)
95.3
(3.1)
76.0
(11.7)
--- --- --- 57.3
(12.3)
Illegal Substances Used in Past 30 days^^_ii Marijuana or hashish 49.6
(6.5)
55.1
(8.4)
47.6
(13.9)
52.9
(7.5)
33.1
(12.6)
--- 20.9
(10.3)
35.7
(8.4)
Inhalants 47.0
(7.5)
45.1
(12.3)
40.0
(9.9)
43.8
(9.4)
--- --- --- 61.1
(13.4)
Cocaine, crack, or heroin 56.6
(13.5)
--- 78.6
(12.5)
69.7
(16.1)
--- --- --- 36.9
(17.1)
Nonprescribed meds 61.8
(9.6)
62.7
(13.2)
71.9
(9.2)
64.5
(11.0)
--- --- 50.7
(23.9)
49.1
(16.4)
No. of substances used .2
(.1)
.3
(.1)
.2
(.1)
.2
(.1)
.1
(.04)
.3
(.2)
.8
(.4)
.3
(.1)
Days of Use .5
(.2)
.6
(.3)
.3
(.1)
.5
(.2)
.1 a
(.04)
.8
(.5)
.8
(.3)
.5
(.2)
^ Includes “other” out-of-home placement (back)

^^ Use in past 30 days for each substance was only asked of youths if they indicated they had ever used the substance (back: ^^_i, ^^_ii)

a Children living in group care report significantly more days of use than children living in nonkinship foster care (t = 2.5, p = .01) (back)

Table 5-46. Report of Substance Use During Past 30 Days: CWS and 2001 NHSDA Youths
Substance NSCAW Youth (11- to 15-Year-Olds) 2001 NHSDA (12- to 17-Year-Olds)
Percent / (SE) Percent
Cigarettes 20.5
(2.5)
13.0
Chewing tobacco or snuff 5.3
(1.4)
2.1
Alcohol 16.1
(2.1)
17.3
Marijuana 8.6
(1.5)
4.6 ^_i
Inhalants 4.6
(1.2)
1.1 ^_ii
Any illegal drug 13.0
(2.4)
10.8
^ Data are for 12- to 13-year-olds and 14- to 15-year-olds with proportions averaged for the two age categories (back: ^_i, ^_ii)

To summarize, 11- to 15-year-olds involved with CWS and living at home generally report a significantly greater proportion of substances used in the previous 30 days than children placed out of the home; this may be because children in out-of-home care are under high surveillance. Comparison to other national studies is incomplete because standard errors from AddHealth and NHSDA are unavailable. The slightly higher rates of recent use by youths involved with CWS than NHSDA youths cannot be verified. A significant difference might suggest that substance involvement may also be a risk for maltreated youths receiving services, though a more confident interpretation of the significance of substance abuse as a risk for children in CWS, and how that involvement might affect substance abuse rates, is dependent on later analyses when comparisons can be made across time.

5.4.12 Discussion of Emotional and Behavioral Well-Being

Children with a report of maltreatment have consistently poorer emotional and behavioral well-being than children in the general population. All respondents (caregivers, teachers, and youths) reported more behavior problems than in normative samples. Depression is much higher and delinquency is more prevalent. Children involved with CWS are also at greater risk of teen pregnancy than the other national samples of slightly older youths. Substance abuse also appears to be more prevalent among youths in CWS. As evidenced from current findings and previous research, problem behaviors may escalate into violence (Herrenkohl et al., 2000), substance abuse can lead to risky sexual behavior (Tapert et al., 2001) and substance abuse is also associated with depression (Costello et al., 1999). As the number of problems a youth experiences increase, so do negative outcomes (Pollard, Hawkins, & Arthur, 1999). Children living in group care have the poorest emotional and behavioral well-being. Though some measure of problems experienced by youths in group care may result from problems that are associated with the experience of placement into that setting (Dishion, McCord, & Poulin, 1999), from these data it appears not to be a major contributor to problem behavior because of the relatively short stays in group care prior to assessment. The markedly higher levels of problem behavior appear to be largely the result of the selection of children with the most problems into group home care.

5.5 Summary of Findings and Conclusions

5.5.1 Well-Being of Young Children

  • Less than half of young children are within the normal weight range—many are overweight, underweight, or at risk of either condition. These proportions are much greater than would be expected in the general population.

  • The cognitive development of young children is of substantial concern, with large numbers in this group scoring below average on standardized measures.

  • For children birth to 5 years, higher language skills are associated with being under 1 year, White, and a girl.

  • Caregivers report serious problem behaviors for 2- to 3-years olds—over 50% more than for children in the general population. These elevated rates exist for children regardless of their service setting.

5.5.2 Cognitive Functioning

  • Composite intelligence scores are generally within the normal range, though on the low end, with an overall average of 94.

  • Verbal and nonverbal intelligence subscores are higher for White children.

  • Lower verbal and nonverbal composite scores for Hispanic children are at least partially attributable to their lower verbal scores. (There is no Spanish-language version of the K-BIT.)

  • A greater proportion of children in CWS have low intelligence and achievement scores (more than two standard deviations below the mean) than the normative samples.

  • Math achievement scores are significantly higher for 6- to 10-year-olds than for children 11 years and older and significantly lower for Black than White children.

5.5.3 Adaptive and Social Functioning

  • Children involved with CWS are much more likely to have lower daily living and social skills than normative samples.

  • Children living in nonkinship foster care are significantly more likely to be rated by caregivers as having low daily living and social skills than children remaining at home.

5.5.4 Behavioral Well-being

  • Children in CWS have many more problem behaviors than normative samples, regardless of the source of the report and regardless of the child's setting.

  • Caregiver reports of problem behavior indicate that children 11 years and older have greater odds than younger children of exhibiting conduct problems. Yet children aged 6 to 10 have quite elevated rates of problem behaviors.

  • Children living in nonkinship and group care are reported as exhibiting the most problem behaviors.

  • Depression is more common for children in CWS than for children in the general population.

  • Although behavioral and emotional problems are of concern for children across settings, children in group care are even more likely to exhibit serious behavior problems and depression compared with children in other settings.

  • Caregiver reports of delinquency are much greater than in the CBCL normative sample.

  • Youths in the entire sample also report high rates of delinquency.

  • Ten percent of youths 11 years and older were arrested sometime during the 6 months prior to interview.

  • Twenty percent of youths 11 years and older reported committing at least one violent delinquent act during the 6 months prior to interview and had usually committed the act an average of twice.

  • Youths with a most serious abuse type of sexual abuse are significantly more likely than youths with other types of abuse to have had sexual intercourse—a difference that is not limited to those with a nonconsensual first sexual intercourse experience.

  • Youths involved with CWS are almost four times more likely than slightly older youths in the general population to have been pregnant or gotten someone pregnant.

  • Youths in group care have the greatest likelihood of reporting ever using illegal substances and of being reported to exhibit delinquent behavior.

In summary, children whose families have been investigated for maltreatment are entering CWS with substantially lower cognitive and academic abilities, fewer skills, more problem behaviors, and even poorer physical health than their counterparts in the general population. Whereas any single risk factor, such as low social skills, does not determine a child's functioning, when factors are compounded the possibility of problems increases (Herrenkohl et al., 2000; Pollard et al., 1999). The accumulation of risks increases the likelihood of various, more serious, and life-impairing problems including substance use, school problems, delinquency, and violence (Deater-Deckard et al., 1998; Pollard et al., 1999; Saner & Ellickson, 1996). The confluence of measured developmental risks, compounded by the high rates of exposure to poverty and violence described in earlier chapters, explains why the population of maltreated children has such a high lifetime risk of health, mental health, and legal problems (Felitti et al., 1998). In these data, we see the early accumulation of such adverse experiences already beginning to have a major impact on children's functioning.

Examining the areas in which these children are particularly deficient and identifying the subgroups of children who are more prone to difficulties may help in the development of strategies to assist these children before and after they come to the attention of CWS. In later chapters, we examine the services that children have received before and since becoming involved with CWS to better understand their correspondence with the children's needs. This will clarify the extent to which CWS, which holds safety and permanency to be superordinate goals, is also able to address the well-being of children from the outset of their experiences with CWS.

5.5.5 Conclusions

In general, children involved with CWS are below the average for the general population of children the same age on physical, cognitive, behavioral, and social skill–based domains. Although many of these differences are not statistically significant, the uniformity of the underperformance is striking. This tendency to have lower scores is confirmed by the distribution of the scores. Particularly telling is the proportion of children in the study population who scored so far below average that they were in the clinical range or lower than two standard deviations below the test norms. Whether due to maltreatment experiences or the social circumstances from which these children come, children reported as the victims of child maltreatment are facing substantial developmental challenges compared to children in the general population.

The safety and well-being of children builds on their physical well-being. The proportion of young children involved with CWS who may be considered “failure to thrive” (i.e., their weight-for-age ranks lower than the 5th percentile) is twice that of the general population; the proportions considered overweight or underweight based on their Body Mass Index are three times what would be expected. 22

These analyses raise substantial concerns about the development of children involved with CWS. The proportions of children who score in the clinical or high-risk group (or in the group with the lowest skill level) are at least twice that of the general population on almost every standardized measure—with the difference between the two populations much higher than on many of the measures (Table 5-47). Only 30% of children do not have any measures in the clinical or high-risk range.

Table 5-48 summarizes the significant differences in development, functioning, and behavior by the child characteristics of age, gender, race/ethnicity, and setting for children involved with CWS. Although there are some differences among the children by age and gender, the majority of the significant differences are associated with a child's race/ethnicity and setting. Among the measures that exhibited differences by race/ethnicity, Black children most often scored lower on standardized measures than White, non-Hispanic children. Young Black children involved with CWS appear to be at the highest risk for developmental delay or neurological impairment. They have poorer language skills than their counterparts who are White. Older Black children do not score as well as White children of the same age in tests of verbal and nonverbal ability and mathematics. Some of these differences may be attributable to tests that are not culturally syntonic with the previous experiences of Black children, but true differences are also a very strong possibility.

Differences in child setting very often reveal children in group care and nonkinship foster care as faring the worst. Children in group care exhibit more behavioral problems than children in other settings. This was shown consistently through both caregiver-reported and youth self-reported measures of problem behaviors, depression, delinquency, and substance abuse. In comparison to children remaining at home, children in nonkinship foster care appear to have poorer social and daily living skills and more behavioral issues. Children in kinship care very often have scores more similar to those of the children remaining at home than the scores of children in other types of out-of-home placements. It may be that decisions about which children will enter which type of placement reflect consideration for their functioning—especially their level of problem behaviors.

Table 5-47. Proportion of Children Involved with CWS at "Clinical" Levels on Standardized Measures as Compared with the General Population
Standardized Measure Proportion “Clinical” a Comparable Norm
Percent
BDI (cognitive development) 31 b_i 2.5
BINS (risk of developmental delay or neurological impairment) 53 c 14
PLS-3 (language skills) 14 b_ii 2.5
CBCL (problem behaviors), 2 to 3 years 27 d_i 5
CBCL (problem behaviors), 4 to 15 years 44 d_ii 17
YSR (problem behaviors) 36 d_iii 17
TRF (problem behaviors) 37 d_iv 17
CDI (depression) 15 e 9
K-BIT (verbal and nonverbal ability) 5 b_iii 2.5
SSRS (social skills) 38 f 16
Vineland Screener (daily living skills) 10 g 2
MBA (reading and mathematics skills) 5 (reading) b_iv
12 (mathematics) b_v
2.5
a As defined by measure, unless otherwise indicated (back)

b More than 2 standard deviations below mean (back: b_i, b_ii, b_iii, b_iv, b_v)

c High risk (back)

d Clinical/borderline (back: d_i, d_ii, d_iii, d_iv)

e Depressive (back)

f Fewer social skills (back)

g Low daily living skills (back)

Table 5-48. Differences in Development, Functioning, and Behavior by Child Characteristics

This table contains several footnotes, with several data cells referencing the same footnote. When finished reading a footnote, use the browser <Back> button to return to the last data cell you were reading.
Measure Groups at a Disadvantage Within Child Characteristics
Age Gender Race/Ethnicity Setting
Physical Attributes Height 1 year of age (vs. less than 1, and 2 to 3)      
Weight       Group care (vs. all other settings)
Body Mass Index     Black (vs. Hispanic—out-of-home only) ^ Kinship care (vs. in-home, no services and foster care)
Head Circumference       Foster care (vs. in-home, with services and kinship care)
Standardized Measures BDI (cognitive development) N/A      
BINS (risk of developmental delay or neurological impairment) N/A   Black (vs. White) ^^
Other (vs. White)
 
PLS-3 (language skills) 1 to 2, and 3 to 5(vs. less than 1) Males Black and Other races (vs. White)  
CBCL (problem behaviors),2 to 3 years N/A      
CBCL (problem behaviors),
4 to 15 years
11 and older
(vs. 4 to 5, and 6 to 10)
    Out-of-home (vs. in-home) ^
Foster care (vs. in-home, no services)
Group care (vs. all other settings)
YSR (problem behaviors) N/A Female   Group care (vs. in-home, no services)
TRF (problem behaviors)        
CDI (depression)   Female White (vs. Black) Group care (vs. kinship care ^^ and in-home, no services)
Modified NLSY Temperament Scale (emotional regulation) N/A N/A N/A In-home (vs. out-of-home, negative hedonic tone, children less than 1)
Kinship care (vs. foster care, compliance and insecure attachment, 2 year olds)
K-BIT (verbal and nonverbal ability)     Black (vs. White)
Hispanic (vs. White)
 
SSRS (social skills)       Foster care (vs. in-home, no services and In-home, services)
Vineland Screener (daily living skills) 3 to 5
(vs. 0 to 2, and 6 to 10)
  White (vs. Black—out-of-home only) ^ Foster care (vs. in-home, no services and in-home, services)
MBA (reading and mathematics skills) 11 and older (vs. 6 to 10—reading) ^^
11 and older (vs. 6 to 10—mathematics)
  Black (vs. White—mathematics)  
Additional Measures of Risk CBCL Delinquency Subscale 11 and older
(vs. 6 to 10—in-home only) ^
    Out-of-home (vs. in-home) ^
In-home, services (vs. in-home, no services)
Foster care (vs. in-home, no services)
Group care (vs. kinship care ^and in-home, noservices)
Self-Reported Delinquency (violent acts past 6 months) N/A     Group care (vs. in-home, no services)
Number and Frequency of Delinquent Acts N/A      
Sexual Behavior N/A      
Illegal Substance Use (ever used) N/A     Group care (vs. foster care and kinship care) ^^
Group care (vs. in-home, no services)
Illegal Substance Use (days of use)       Group care (vs. foster care) ^^
^ Results from bivariate analyses only, because differences within in-home and out-of-home subpopulations not tested in regressions

^^ Results from bivariate analyses only—not confirmed in regressions




16 These results were based on the categorical BINS score (i.e., low risk, moderate risk, high risk). When the analysis was run on the continuous BINS score, White children received significantly lower scores from Hispanic interviewers than from either White interviewers or Black interviewers. There was also a trend toward Black children' receiving significantly lower scores from White interviewers than from Black interviewers (p=.03). (back)

17 Differences that arose on the subtest scores include Black children receiving lower scores on Reasoning and Academic Skills from White interviewers than from Black interviewers (p < .001) and Hispanic children receiving lower scores on Conceptual Development from Black interviewers than from White interviewers (p < .001). (back)

18 Although temperament may provide useful background for understanding parent and child behavior over time, the scores are difficult to interpret in their own right. For this reason, we have not made the usual multivariate comparisons in temperament scores by race/ethnicity, age, and service setting. (back)

19 There is no Spanish-language version of the K-BIT available. (back)

20 Although the SSRS was also administered to teachers as part of NSCAW, these data were not available in time for inclusion in this report. SSRS teacher-rated scores are available in the general release data, however, and will be analyzed and presented in future NSCAW reports. (back)

21 Violent acts include attacking “someone with a weapon or with the idea of seriously hurting or killing them;” “hit[ting] someone with the idea of hurting them;” “us[ing] a weapon, force, or strong-arm methods like threats to get money or things from people;” “throw[ing] objects such as rocks or bottles at people;” “involve[ment] in a gang fight;” “physically hurt[ing] or threaten[ing] to hurt someone to get them to have sex;” and “ha[ving] or tr[ying] to have sexual relations with someone against their will.” (back)

22 Indicators of children's health and injuries appear in Chapter 9 and provide a more complete information on their physical well-being. (back)

 

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