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Maltreated Infants and Toddlers: Predictors of Developmental Delay

Scarborough, Anita A. PhD*; Lloyd, E Christopher PhD; Barth, Richard P. PhD

Journal of Developmental & Behavioral Pediatrics: December 2009 - Volume 30 - Issue 6 - p 489-498
doi: 10.1097/DBP.0b013e3181c35df6
Original Article

Objective: The aim of this study was to examine the relationship of child, caregiver, and maltreatment characteristics at the time of the investigation with low scores on developmental measures obtained 18 and 36 months after substantiation in a nationally representative sample of maltreated infants and toddlers.

Method: A proxy for developmental delay was constructed based on a criterion of 2 or more scores ≥1 SD below the mean in the domains of adaptive behavior, cognition or communication at each assessment time point. Twenty-three percent of children were classified as having developmental delay, 26% with inconsistent low scores, and 51% with no low scores. An ordered logistic regression was conducted to determine factors associated with low scores.

Results: Case worker report of special needs at the time of the investigation, living in continuous poverty, and with caregiver characteristics of cognitive impairment and not having a high school education were associated with low scores. Failure to provide and “other” types of maltreatment, which included sexual abuse and abandonment, were more highly associated with low scores 18- and 36-month postinvestigation. A notable finding was that 15% of children were <6% height/weight. Parameter estimates from an ordered logistic regression are presented to explain the increased likelihood of low scores.

Conclusion: Characteristics associated with low scores and the developmental delay proxy are identifiable at the time of investigation of maltreatment of infants and toddlers, emphasizing the urgency of providing early intervention developmental services to avoid developmental delay and to maximize outcomes in this highly vulnerable population.


From the *Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC; †School of Social Work, College of Professional Studies, University of Arkansas at Little Rock, Little Rock, AR; and ‡School of Social Work, University of Maryland, Baltimore, MD.

Received March 23, 2009; accepted September 22, 2009.

This document includes data from the National Survey on Child and Adolescent Well-being, which was developed under contract with the ACYF/DHHS. The data have been provided by the National Data Archive on Child Abuse and Neglect.

The information and opinions expressed herein reflect solely the position of the authors. Nothing herein should be construed to indicate the support or endorsement of its content by ACYF/DHHS.

Supplemental Digital Content: Table summarizing developmental measures used in the study.

Address for reprints: Anita A. Scarborough, Frank Porter Graham Child Development Institute, CB 8185, University of North Carolina, Chapel Hill, North Carolina 27599-8185; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.