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Prevalence and Severity of Child Impairment in a US Sample of Child Maltreatment Investigations

Helton, Jesse J., PhD*; Lightfoot, Elizabeth, PhD; Fu, Q. John, MD, PhD*; Bruhn, Christina M., PhD

Journal of Developmental & Behavioral Pediatrics: May 2019 - Volume 40 - Issue 4 - p 285–292
doi: 10.1097/DBP.0000000000000655
Original Article

Objectives: Although there is agreement that childhood disability is both a risk and result of maltreatment, the extent of disability in the child welfare system remains unclear. Our objective is to determine the prevalence and severity of child impairment in a national sample of child abuse and neglect investigations in the United States.

Methods: We used data from the National Survey of Child and Adolescent Well-Being II, a study of 2644 children older than 3 years who were subjects of child abuse and neglect investigations. Groups of children were identified by latent profile analysis using continuous standardized measures of intelligence, emotional or behavioral impairments, adaptive behaviors, and social skills.

Results: Whether the child remained in home or was removed to foster care after an investigation, 3 classes of children were identified: (1) slightly over one-tenth were in an intellectual disability subgroup characterized by marked intellectual impairments alongside delays in daily living functioning, (2) over one-third were in an emotional or behavioral impairment subgroup characterized by both frequent and severe internalizing and externalizing behaviors, and (3) slightly over half were in a typically developing subgroup.

Conclusion: When using standardized measures of disability, nearly half of the children investigated by child protection in the United States are not typically developing. These findings suggest that those working for the child welfare system need to be attentive to the complex needs of children with intellectual disabilities and emotional or behavioral impairments and their families, many of whom are under significant stress.

*College of Public Health and Social Justice, St. Louis University, St. Louis, MO;

School of Social Work, University of Minnesota, St. Paul, MN;

School of Social Work, Aurora University, Aurora, IL.

Address for reprints: Jesse J. Helton, PhD, School of Social Work, St. Louis University, Tegeler Hall 303, 3550 Lindell Boulevard, St. Louis, MO 63103; e-mail:

The authors declare no conflict of interest.

Received October 23, 2018

Accepted January 03, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.