Journal of Child & Adolescent Trauma, 6:11–24, 2013

Copyright © Taylor & Francis Group, LLC

ISSN: 1936-1521 print / 1936-153X online
DOI: 10.1080/19361521.2013.732202

Behavioral and Emotional Profiles of Neglected

Children

MARIE-EVE NADEAU,1 PIERRE NOLIN,2 AND CARINE

CHARTRAND1
1
Rivière-des-Prairies Hospital
2
University of Quebec

This study explored the emotional and behavioral profiles of 41 neglected children,
ages 6 to 12 years, who were compared with a control group of 41 children. The
Achenbach System was used in order to describe emotional and behavioral profiles
based on the Diagnostic Criteria of the DSM-IV [Diagnostic and Statistical Manual of
Mental Disorders, 4th ed.]). Neglected children had more symptoms on DSM-IV Scales
related to conduct or attention/hyperactivity problems. Based on the perceptions of
teachers, children exposed to neglect showed more externalized and internalized prob-
lems as well as symptoms on DSM-IV Scales. Results supported the relevance of using
the Diagnostic Criteria of the DSM-IV and the importance of getting the different per-
ceptions of respondents to better understand the emotional and behavioral portrait of
neglected children.

Keywords child neglected, internalization problems, externalization problems,

ADHD, oppositional defiant problems, posttraumatic stress problems

The relationship between abuse (all types) and the emergence of psychological, emotional,
and behavioral difficulties has been well documented. Indeed, various studies have shown
that abused children presented more psychopathologies (Cook et al., 2005, Ford, 2005)
including posttraumatic stress disorders (Saigh, Yasik, Sack, & Koplowicz, 1999), self-
mutilation behaviors, depression and anxiety problems (Kendall-Tackett, 2002), sexualized
behaviors (Hall, Mathews, & Pearce, 2002), oppositional problems and conduct problems
(Jaffee, Caspi, Moffitt, & Taylor, 2004), attachment problems (Schore, 2001), and eating
disorders (Johnson, Cohen, Kasen, & Brook, 2002). However, certain studies have pro-
posed that affective, social, and behavioral components were not affected in the same way,
depending on the type of maltreatment experienced by the child (Cicchetti, & Toth, 2000;
Trocmé et al., 2003).
The Canadian Incidence Study of Reported Child Abuse and Neglect carried out by
Trocmé et al. (2003) draws attention to four categories of abuse: (a) physical abuse, (b) sex-
ual abuse, (c) emotional abuse, and (d) neglect. Although neglect is the most frequent type
of maltreatment, this category of abuse is least studied (De Bellis, 2005). When neglected,
the child’s security and development are jeopardized by lack of attention or protection by

Submitted June 16, 2010; revised October 30, 2010; revised February 17, 2011; revised May 15,
2011; accepted May 17, 2011.
Address correspondence to Marie-Eve Nadeau, Clinique d’intervention des troubles anxieux,
Hôpital Rivière-des-Prairies, 7070, boulevard Perras, Montréal, Quebec, Canada H1E 1A4. E-mail:
marie-eve.nadeau@uqtr.ca

11
12 M.-E. Nadeau et al.

the caregiver (Trocmé et al., 2003). Parents show inability to provide the necessary care or
answer basic needs linked to health, hygiene, protection, education, and affective environ-
ment (Éthier, Lacharité, & Gagnier, 1994). Neglect not only affects the daily functioning of
the child, but also its entire development. In children particularly, this exposure may result
in delays or impairments in motor, language, cognitive, emotional, or behavioral develop-
ment and acquisition of social skills (De Bellis, Hooper, Spratt, & Woolley, 2009; Hildyard,
& Wolfe, 2002; Nolin & Ethier, 2007).
The theory of attachment and neurobiological development proposed by Schore (2001)
is certainly one of the explanatory models that can help to understand the affective and
behavioral manifestations of neglected children. This model allows viewing neglect as a
traumatizing situation, but also as a source for altering psychological or biological devel-
opment, as well as the abilities of interpersonal regulation, which can contribute to the
emergence of psychopathologies. Indeed, severe alterations in the attachment relationship
(e.g., parent’s responses are not adjusted to the child’s emotional needs, thus, the child
cannot use proper self-regulation abilities) increase sensitivity to stress (e.g., problems
focusing attention and modulating awareness level), and compromise socioemotional learn-
ing or self-regulation of emotions and behaviors (e.g., inability to regulate emotions without
external support, the sensation of being invaded by many intense emotions, excessive search
for help, social dependency or isolation, disengagement). In this connection, Schore (2001)
pointed out the importance of a stable attachment link in the psychological and neurode-
velopment of the child. Thus, it seems that trauma at a young age alters the development
of the brain regions associated with modulating emotions and stress responses (Cook et al.,
2005).
When faced with traumatizing events in relationships, neglected children find it dif-
ficult to adjust to situations that produce stress or assimilate new emotional experiences.
Thus, under these conditions, their analytical capacities tend to disintegrate; hence, the
emergence of their cognitive, emotional, and behavioral disorganization and their prone-
ness to react with extreme helplessness, confusion, withdrawal, or rage (Teicher, Anderson,
Polcari, Anderson, & Navalta, 2002).

Emotional Problems Associated with Neglect

Attachment failures and neurobiological integrity may also lead to severe problems regard-
ing self-regulation of affect (Cook et al., 2005; Perry, Pollard, Blakely, Baker, & Vigilante,
1995; Schore, 2001). First of all, self-regulation of affect starts with the precise identifica-
tion of internal emotional experiences. The child must be able to express his emotion while
feeling safe, modulate it, or regulate it based on his internal experiences. Neglected chil-
dren show more pathological expressions including dissociation, cyclothymia, or avoidance
of emotionally charged situations, and have poor adapting strategies (Cook et al., 2005;
Schore, 2001). Also, these children often present with emotional liability, a quick escalat-
ing of responses when faced with anxiogenic situations deemed to be minor (Cook et al.,
2005) and they develop more emotional problems associated with anxiety or depression
(Lacharité, 1999).
Indeed, they are easily upset and have more trouble discriminating between emo-
tions in comparison to those who have not been exposed to this specific type of abuse
(Pollack, Cicchetti, Hornung, & Reed, 2000). Moreover, these children obtain lower scores
on scales measuring self-esteem and have negative moods and a poor sense of humor
(Erickson, Egeland, & Pianta, 1989). Also, they tend to be more negative and more
 Behaviors, Emotions, and Neglect 13

dependent toward others (Egeland, Sroufe, & Erickson, 1983). Internalized symptoms have
been the main focus of studies for neglected children. However, researchers and practi-
tioners do not necessarily associate internalized symptoms with potential developmental
psychopathologies.

Behavioral Problems Associated with Neglect

When it comes to behavioral problems, studies suggest that aggressive and delinquent
behaviors are more associated with physical abuse than neglect (Lacharité, 1999; Prino
& Peyrot, 1994; Shonk & Cicchetti, 2001). However, when we consider that neglected
children tend to be passive and avoidant in their interactions (Crittenden, 1992), their
behaviors are less disturbing but are still consider an oppositional response. Furthermore,
certain studies have shown that neglected children have more aggressive behaviors (Bousha,
& Twentyman, 1984; Erickson et al., 1989) and are less cooperative and conformist
(Crittenden, 1992; Haskett & Kistner, 1991; Hoffman-Plotkin & Twentyman, 1984) than
children who were not exposed to any form of abuse. Thus, neglected children also showed
a certain level of aggressiveness, had disturbing behaviors, were not very cooperative,
and were at higher risk of social and emotional problems (Hildyard & Wolfe, 2002).
Externalized symptoms can also evolve into developmental psychopathologies even if these
links have not been shown yet.

Social Problems Associated with Neglect

Neglected children were also characterized as being withdrawn from others (Prino &
Peyrot, 1994), were involved in a limited number of social interactions (Erickson &
Egeland, 1996; Erickson, Egeland & Pianta, 1989; Hildyard, & Wolfe, 2002), predom-
inantly adopted an avoidance behavior in their interactions with others (Camras, &
Rappaport, 1993; Erickson et al., 1989; Hoffman-Plotkin, & Twentyman, 1984), were not
very popular with other young people (Erickson, & Egeland, 1996; Erickson et al., 1989),
and had fewer friends in class than other children (Bolger, Patterson, & Kupersmidt, 1998).
However, the child may function differently in the various settings it is in (e.g., fam-
ily and school). Moreover, the relationship between the child and his parent may lead to
a different analysis of his behavior than its teacher’s perception. For examples, certain
authors consider the teacher’s perceptions as more objective than the parent’s points of
view, because (a) the perception of the mother who herself grew up in a maltreating family
is tainted with subjectivity and negativity (Lacharité, 1999) or is insensitive and unrespon-
sive to her children’s feelings (Lyons-Ruth, Connell, & Zoll, 1989); (b) some parents have
overly high expectations when it comes to their children’s behavior or harbor negative
perceptions of their children (Feldman et al., 1995); (b) that maltreating parents have unre-
alistic expectations as to the capabilities and needs of their children and biased perceptions
of their children’s behaviors (Jourdan-Ionescu & Palacio-Quintin, 1997); and (d) the par-
ents’ perceptions can be biased by multiple factors, including stress, conflicts, and lack of
parenting skills (Reid, Kavanagh, & Baldwin, 1987). These findings emphasize the impor-
tance of calling upon more than one type of respondent in order to get a more complete
profile of the child’s affect and behavior.
The review of the literature clearly shows that neglect is associated with social, emo-
tional, and behavioral problems, which are largely internalized. However, those findings are
based on the assessment of only one respondent which do not represent the child’s global
14 M.-E. Nadeau et al.

functioning. In consequence, this does not totally exclude the possibility of observing exter-
nalized symptoms in these children. Another possibility to explain this divergence consists
in the child’s own protection factors (e.g., his context of evolution, his temperament, and
his personality).
Therefore, the purpose of this study was to explore the role of the respondents
when they assess emotional and behavioral problems and investigate those internalized
symptoms and externalized symptoms of neglected children based on traditional scales
(Syndrome Scales) and clinical scales (DSM-IV [Diagnostic and Statistical Manual of
Mental Disorders, 4th ed.] Oriented Scales; American Psychiatric Association, 1994)
from the Achenbach System of Empirically Based Assessment: School-Age Forms and
Profiles (ASEBA) in comparison to a control group. The DSM-IV Oriented Scales were
used to document the possible developmental psychopathologies based on diagnostic cat-
egories that could be associated with neglected children. To proceed, two versions of the
same questionnaire were used: one completed by the biological parent (Child Behavior
Checklist for Ages 6–18 [CBCL]) and one by the teacher (Teacher’s Report form [TRF]) of
the child.
Therefore, it has been suggested that: (a) neglected children will present more inter-
nalized symptoms (anxious/depressed, withdrawn/depressed, thought problems), but also
present more externalized symptoms (rule-breaking behavior and aggressive behavior) in
comparison to the control group; (b) neglected children will also present more symptoms on
clinical scales (DSM-IV Oriented Scales) than the control group; and (c) different profiles
of children will be obtained depending on the two types of respondents.

Method

Participants
This study involved a total of 82 children ages 6 to 12, divided into two groups.
Demographic data relevant to both groups are presented in Table 1. Group 1 (neglected chil-
dren) included 41 children including 22 boys and 19 girls with an average age of 10.13 years
old. Neglected children were recruited by the Child Protection Services of Mauricie and
Centre-du-Québec (CJMCQ, Québec, Canada). This institution has the legal mandate to
identify cases of maltreatment (neglect or abuse). CJMCQ standard procedures require that

Table 1
Clinical characteristics for neglected children and nonmaltreated children

Variables Neglect Controls t Pearson χ 2

N 41 41
Chronological age, mean 10.13 (1.99) 9.39 (1.58) 1.87
(SD)
% Male 46% 46% 0.80
Child IQ, mean (SD) 94.12 (12.41) 102.05 (14.00) 2.71∗∗
Hollingshead SES Score, 66.09 (11.28) 63.22 (6.16) 45.32∗∗∗
mean (SD)
∗∗
p < .01. ∗∗∗ p < .001.
 Behaviors, Emotions, and Neglect 15

the type of maltreatment be determined by a detailed study conducted by agency practition-

ers. Procedures concerning protection of the child involve therefore, a succinct number of
steps to confirm neglect.
First, accusations of neglect are investigated, and a social worker evaluates the fam-
ily by visiting the home. This social worker is equipped with a decisional tree in order
to examine certain aspects in detail according to each case presented. As quickly as pos-
sible, within a maximum of 24 to 48 hours following a report of child neglect, the social
worker must decide whether there are sufficient indications to refer the case to a second step
for evaluation. In this case, a more in-depth evaluation is carried out. The social worker
has a maximum of 12 days (ideally fewer) to clearly document the case, and the type
of maltreatment (neglect, physical abuse, sexual abuse, etc.) and the degree of urgency.
Meetings are set up with the child, parents and any other persons deemed important. At this
point, parents are questioned about the allegations of maltreatment and told the possible
legal consequences of the investigation. A decision is made based on: (a) objectified facts,
(b) the vulnerability of the child where its development is compromised, and (c) the quality
of parental skills. If the hypothesis of neglect is retained, the child’s protection becomes
the responsibility of the Direction of Youth Protection.
Voluntary measures may also be proposed to the parents (e.g., starting a 6-month inter-
vention program for family members), or legal actions can be taken (e.g., placing the child
with a foster family without approval of the biological family). Children in this study were
identified by the CJMCQ from families in which neglect was confirmed, with the consent of
parents. As described earlier, the Direction of Youth Protection uses a standardized method
to evaluate child’s abuse. However, one must always keep in mind that the information
given during the evaluation has been obtained following the voluntary testimony of parents
and that it is not possible to guarantee with certainty that the type of maltreatment identified
with the children of the current study is the only one at issue.
Group 2 (control group) includes 41 children including 26 boys and 15 girls with an
average age of 9.39 years old. They were recruited in five elementary schools of the Chemin
du Roy School Board in La Mauricie (Quebec, Canada), with the School Board’s coopera-
tion. These control children were paired with the neglected ones according to gender, age,
and IQ (Table 1). Children with intellectual disability were excluded based on their IQ
results. Sexually abused children, mental retardation, brain injury, neurological disorder,
autism or pervasive developmental disorder were excluded. Socioeconomic status was cal-
culated using the Hollingshead Index of Socioeconomic Status (SES) in order to control
the poverty’s effect on the child cognitive development. Given the significant differences
between the groups regarding these two variables (IQ and SES), they will be placed as
covariables in the comparison analyses of the groups.

Tests
Control test: Intelligence. IQ was estimated using four subtests of the Canadian
Wechsler Intelligence Scale for Children, 3rd edition with the method developed by
Kaufman, Kaufman, Balgopal, and McLean (1996) and whose psychometric value has
been demonstrated. This shortened version is made up of two verbal subtests (Similarities
and Vocabulary) and two nonverbal subtests (Picture completion and Block design). The
average IQ is 100 with a standard deviation of 15 (Wechsler, 1991).
Instruments measuring behavioral and emotional problems. The ASEBA (CBCL and
TRF; Achenbach, & Rescorla, 1991) is a questionnaire frequently used in both research
and clinical settings for investigating internalized and externalized behavioral problems
16 M.-E. Nadeau et al.

in children. The ASEBA evaluates behavioral and emotional problems found in children
based on the Syndrome Scales: Anxious/depressed, withdrawn/depressed, somatic com-
plaints, social problems, thought problems, attention problems, rule-breaking behavior,
and aggressive behavior. In addition to providing the scores of each of these tradi-
tional scales (Syndrome Scales), it allows the documentation of certain problems listed
based on the DSM-IV Oriented Scales: Affective problems, anxiety problems, somatic
problems, attention/hyperactivity problems, oppositional defiant problems, conduct prob-
lems, sluggish cognitive tempo, obsessive-compulsive problems, and posttraumatic stress
problems.
The DSM oriented scales were constructed by experts from many cultures who identi-
fied ASEBA items that they judged to be very consistent with particular DSM-IV diagnostic
categories.The questionnaire contains 113 items, and there is a version for the child’s par-
ent and his teacher. For each item that describes specific behavioral or emotional problems,
the parent or teacher must weigh the different expressions proposed based on a 3-point
Likert scale (0 [none]; 1 [sometimes]; 2 [often]). The correction program used in this study
was the ADM (Assistant Data Manager) system (Achenbach, 2007). The raw results were
converted into a T-score. A t-score between 65 and 70 is considered borderline versus a
T-score greater than 70 meaning a possible behavioral or emotional problem (Achenbach
& Rescorla, 2006). This instrument has good methodological properties (Achenbach &
Rescorla, 2006).

Procedures
The research project was approved by the Ethics Committee of the University of Québec in
Trois-Rivières. Parents signed an informed consent form before the children were assigned
to the research professional. After the consent is obtained, a research professional met with
biological parents in the family and with teachers in the school setting of the children in
order to evaluate behavioral and emotional problems using ASEBA. The children have been
assigned to the research professional by the researchers without knowing which group they
belonged to (blind to condition).

Statistical Analysis
Statistical analyzes were performed on each of the demographic variables and IQ, using chi-
square or ANOVA, as was a continuous variable (e.g., IQ) or dichotomous variable (e.g.,
gender). These analyzes were intended to ensure the homogeneity of the two groups on
these variables before comparing them on emotional and behavioral scales. Subsequently,
two multivariate analyses with covariance (MANCOVAs) were first carried out using all the
Syndrome Scales (anxious/depressed, withdrawn/depressed, somatic complaints, social
problems, thought problems, attention problems, rule-breaking behavior and aggressive
behavior) based on the scores from the parents’ questionnaires, and then on the scores
of the teachers’ questionnaires, taking into account IQ and Hollingshead Index of SES
as covariables. Next, two MANCOVAs were carried out using the DSM-IV Oriented
Scales (affective problems, anxiety problems, somatic problems, attention/hyperactivity
problems, oppositional defiant problems, conduct problems, sluggish cognitive tempo,
obsessive-compulsive problems, and posttraumatic stress problems), taking into account
the Hollingshead Index of SES as a covariable, one with the scores of the questionnaires
completed by the parents and the other with the questionnaires completed by the teachers.
 Behaviors, Emotions, and Neglect 17

Partial Eta Square (ηp 2 ) was reported to describe effect sizes for significant differences
(Small < 0.06; Medium = 0.12; Large > 0.16).

Results

Syndrome Scales (Parent’s Report Form)

The MANCOVA showed no effect of the IQ (F(8,71) = 0.49, ns) or SES (F(8,71) = 0.63,
ns) covariables and no group effect (F(8,78) = 1.31, ns) on all Syndrome Scales
(anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought
problems, attention problems, rule-breaking behavior, and aggressive behavior) as reported
by the parents. The averages and standard deviations obtained by each of the two groups
on all of the scales are in Table 2.

Syndrome Scales (Teacher’s Report Form)

The MANCOVA showed no effect of the IQ (F(8,71) = 0.87, ns) and SES
(F(8,71) = 1.17, ns) covariables, but revealed a significant difference between the
two groups (F(8,71) = 2.78, p < 0.01) for all Syndrome Scales (anxious/depressed,
withdrawn/depressed, somatic complaints, social problems, thought problems, attention
problems, rule-breaking behavior, and aggressive behavior) from the perspective of the
teachers. The averages and standard deviations obtained by each of the two groups on
all of the scales are in Table 3. Follow-up univariate analyses showed the groups differed
on withdrawn/depressed (medium effect sizes), social problems (medium effect sizes),
thought problems (medium effect sizes), attention problems (medium effect sizes), rule-
breaking behavior (medium effect sizes) and aggressive behavior (medium effect sizes),
suggesting that neglected children have more problems associated with internalized and
externalized signs than children in the control group, according to their teachers.

Table 2
Parent syndrome scale scores for neglected children and nonmaltreated children

Traditional scales
Version completed by Neglect Controls Partial
the parent mean (SD) mean (SD) Statistic Eta2
IQ F(8, 71) = 0.49 .05
SES F(8, 71) = 0.63 .07
Group effect F(8, 71) = 1.31 .13
Anxious/Depressed 57.24 (9.05) 55.73 (5.73) F(1, 78) = 0.71 .01
Withdrawn/Depressed 59.44 (7.23) 57.95 (6.70) F(1, 78) = 0.68 .01
Somatic complaints 54.76 (6.09) 57.10 (6.34) F(1, 78) = 3.41 .04
Social problems 60.46 (8.10) 58.12 (5.89) F(1, 78) = 1.50 .02
Thought problems 56.76 (6.63) 57.24 (7.40) F(1, 78) = 0.03 .00
Attention problems 56.78 (6.68) 54.22 (3.48) F(1, 78) = 2.83 .04
Rule-breaking 60.07 (7.97) 57.07 (6.88) F(1, 78) = 2.46 .03
behavior
Aggressive behavior 62.73 (9.94) 59.44 (7.27) F(1, 78) = 2.85 .04
18 M.-E. Nadeau et al.

Table 3
Teacher syndrome scale scores for neglected children and nonmaltreated children

Traditional scales
Version completed by Neglect mean Controls Partial
the teacher (SD) mean (SD) Statistic Eta2
IQ F(8,71) = 0.87 .09
SES F(8,71) = 1.17 .12
Group effect F(8,71) = 2.78∗∗ .24
Anxious/Depressed 56.98 (7.29) 55.41 (6.21) F(1,78) = 2.35 .03
Withdrawn/Depressed 61.00 (8.73) 55.12 (5.68) F(1,78) = 13.61∗∗∗ .15
Somatic complaints 53.93 (5.87) 52.22 (4.89) F(1,78) = 1.67 .02
Social problems 61.63 (7.92) 57.32 (6.50) F(1,78) = 7.90∗∗ .09
Thought problems 57.15 (8.70) 52.73 (4.88) F(1,78) = 10.65∗∗ .12
Attention problems 60.44 (9.06) 54.05 (4.77) F(1,78) = 13.21∗∗∗ .15
Rule-breaking behavior 60.49 (9.13) 54.73 (5.88) F(1,78) = 9.05∗∗ .10
Aggressive behavior 63.71 (12.14) 56.34 (7.21) F(1,78) = 9.50∗∗ .11
∗∗
p < .01. ∗∗∗ p < .001.

DSM-IV Oriented Scales (Parent’s Report Form)

The MANCOVA showed no effect of the IQ (F(9,70) = 0.36, ns) and SES (F(9,70) = 1.28,
ns) covariables and no group effect (F(9,70) = 1.71, ns) for all DSM-IV Oriented
Scales (affective problems, anxiety problems, somatic problems, attention/hyperactivity
problems, oppositional defiant problems, conduct problems, sluggish cognitive tempo,
obsessive-compulsive problems, and posttraumatic stress problems), based on the parent’s
perspective. The averages and standard deviations obtained by each of the two groups
on all of the scales are in Table 4. Univariate analyses showed the groups differ on
attention/hyperactivity (small effect sizes) and conduct problems (small effect sizes), sug-
gesting that the neglected children had more symptoms associated with these symptoms of
psychopathologies than children in the control group.

DSM-IV Oriented Scales (Teacher’s Report Form)

The MANCOVA showed no effect of the IQ (F(9,70) = 0.83, ns) and SES (F(9,70) = 0.85,
ns) covariables, but revealed a significant difference between the two groups
(F(9,70) = 2.17, p < 0.05), for all DSM-IV Oriented Scales (affective problems, anx-
iety problems, somatic problems, attention/hyperactivity problems, oppositional defiant
problems, conduct problems, sluggish cognitive tempo, obsessive-compulsive problems,
and posttraumatic stress problems) based on the teachers. The averages and standard
deviations obtained by each of the two groups on all of the scales are in Table 5. Follow-
up univariate analyses showed the groups differ on affective problems (medium effect
sizes), attention/hyperactivity problems (medium effect sizes), oppositional defiant prob-
lems (medium effect sizes), conduct problems (medium effect sizes), sluggish cognitive
tempo (medium effect sizes), obsessive-compulsive problems (medium effect sizes), and
posttraumatic stress problems (medium effect sizes). Thus, the neglected children showed
more clinical signs associated with these problems than children in the control group.
 Behaviors, Emotions, and Neglect 19

Table 4
Parent DSM oriented scales scores for neglected children and nonmaltreated children

DSM-IV scales Version Neglect mean Controls Partial

completed by the parent (SD) mean (SD) Statistic Eta2
IQ F(9,70) = 0.36 .04
SES F(9,70) = 1.28 .14
Group effect F(9,70) = 1.71 .18
Affective problems 56.02 (7.27) 57.51 (6.25) F(1,78) = 0.81 .01
Anxiety problems 57.32 (8.34) 56.44 (6.26) F(1,78) = 0.07 .00
Somatic problems 54.71 (6.20) 56.95 (6.57) F(1,78) = 3.35 .04
Attention deficit/ 55.41 (6.05) 52.76 (3.57) F(1,78) = 4.80∗ .06
hyperactivity problems
Oppositional defiant 60.61 (8.50) 58.63 (7.41) F(1,78) = 1.88 .02
problems
Conduct problems 61.20 (8.70) 57.15 (6.94) F(1,78) = 4.10∗ .05
Sluggish cognitive tempo 55.88 (7.20) 54.71 (6.48) F(1,78) = 0.20 .00
Obsessive-compulsive 55.44 (8.54) 54.78 (5.57) F(1,78) = 0.01 .00
problems
Posttraumatic stress 59.17 (9.49) 58.56 (6.76) F(1,78) = 0.09 .00
problems
∗
p < 0.05.

Discussion
The main goal of this study was to document emotional problems (internalized symptoms)
and behavioral problems (externalized symptoms) of neglected children on the Syndrome
Scales and DSM-IV Oriented Scales (ASEBA) based on the points of view of the two
respondents (biological parents and teacher), in comparison to a control group. The results
confirmed that neglected children had more internalized problems than children in the
control group, which is in line with the results of previous studies that have clearly demon-
strated this fact. Moreover, the results of this study support the suggestion that neglect is
also associated with externalized behaviors, a feature which seems to be less documented in
the literature (Bousha & Twentyman, 1984; Crittenden, 1992; Erickson et al., 1989; Haskett
& Kistner, 1991; Hildyard & Wolfe, 2002; Hoffman-Plotkin & Twentyman, 1984; Shields,
& Cicchetti, 1998). Furthermore, externalized behaviors are better observed in a school
setting than by family members.
As a matter of fact, the children had different emotional and behavioral profiles depend-
ing on the points of view of the respondents. Parents did not identify any problems in the
Syndrome Scales, whereas they pointed out externalized symptoms associated with con-
duct or attention/hyperactivity problems (DSM-IV Oriented Scales), in comparison with
children in the control group. In this way, parents tend to see their children as relatively nor-
mal in comparison to the perception of teachers, beside behaviors that needs more parental
management and are more disturbing for them.
On the other hand, based on the point of view of teachers, neglected chil-
dren had more symptoms on the Syndrome Scales, in particular internalized prob-
lems (withdrawn/depressed, social and thought problems), externalized problems
20 M.-E. Nadeau et al.

Table 5
Teacher DSM oriented scales scores for neglected children and nonmaltreated children

DSM-IV scales Version

completed by the Neglect (1) Controls (2) Partial
teacher mean (SD) mean (SD) Statistic Eta2
IQ F(9,70) = 0.83 .10
SES F(9,70) = 0.85 .10
Group effect F(9,70) = 2.17∗ .22
Affective problems 58.63 (6.23) 54.71 (5.78) F(1,78) = 7.59∗∗ .09
Anxiety problems 57.44 (7.87) 55.12 (6.19) F(1,78) = 3.19 .04
Somatic problems 53.20 (5.65) 52.00 (4.65) F(1,78) = 0.54 .01
Attention 60.90 (10.41) 54.46 (4.59) F(1,78) = 10.36∗∗ .12
deficit/hyperactivity
problems
Oppositional defiant 60.46 (9.22) 55.00 (6.03) F(1,78) = 8.60∗∗ .10
problems
Conduct problems 61.46 (10.41) 55.10 (7.11) F(1,78) = 8.82∗∗ .10
Sluggish cognitive 58.34 (7.03) 53.68 (4.93) F(1,78) = 11.21∗∗ .13
tempo
Obsessive-compulsive 57.54 (8.89) 56.02 (6.80) F(1,78) = 2.31 .03
problems
Posttraumatic stress 61.41 (9.21) 56.00 (6.64) F(1,78) = 9.82∗∗ .11
problems
∗
p < 0.05. ∗∗ p < 0.01.

(rule-breaking behavior, aggressiveness) and symptoms linked to affective problems,

attention/hyperactivity problems, oppositional defiant problems, conduct problems, slug-
gish cognitive tempo, obsessive-compulsive problems, and posttraumatic stress problems,
than the control group. Consistent with the effects of attachment dysregulation, emotional,
behavioral, and social problems of neglected children are confirmed by results. The the-
ory of attachment, as presented in the introduction, is certainly one of the explanatory
models that can clinically help to understand the affective and behavioral manifestations
of the current study’s neglected children by keeping in mind that neglect is considered as
relational trauma. This enables the drawing of connections between internalized symp-
toms (withdrawn/depressed, social problems, obsessive-compulsive, and posttraumatic
stress problems) and externalized symptoms (rule-breaking behaviors, aggressiveness,
oppositional defiant, and conduct problems) that could be associated to the difficulty of
neglected children to modulate their affects and behaviors. In addition, this theory could
explain the attentional difficulties observed in the cohort of neglected children (e.g., hyper-
activity of hypothalamic-pituitary-adrenal axis, which leads to attention/hyperactivity
problems and sluggish cognitive tempo symptoms).
Also, using two kinds of respondents allows describing the affect and behavior of the
child in different living environments (family and school). In fact, in this study, neglectful
parents saw their children differently than teachers did, an element which also contributes
to explaining certain contradictory facts seen in the scientific literature on neglect with
regard to internalized and externalized behaviors. It must be emphasized that few studies
have shown interest in describing the impact of the neglect by using more than one type
 Behaviors, Emotions, and Neglect 21

of respondent. However, few authors listed have noted a difference between the answers
provided by the parents and teachers (Culp, Howell, McDonald Culp, Blankemeyer, 2001).
Other authors have emphasized that maltreating parent’s may have biased perceptions of
their children’s behaviors (Jourdan-Ionescu & Palacio-Quintin, 1997) as their perceptions
could be tainted by subjectivity and be biased by multiple factors, including stress, conflicts,
and lack of parenting skills (Reid et al., 1987). Moreover, maltreating parents are more
insensitive and unresponsive to their children’s feelings (Lyons-Ruth et al., 1989). For these
reasons, certain authors proposed that the teacher’s perception is more objective (Lacharité,
1999). These findings underscore the importance of using the widest range of measure in
order to arrive at a more complete profile of the child’s affect and behavior. Clinically,
perceptions of different raters are essential to a successful treatment plan because different
raters may be observing different behaviors.
Overall, results of this study confirm the importance of using a wide variety of scales,
in particular the DSM Oriented Scales, to get a complete profile of the neglected chil-
dren. Until very recently, the questionnaires used in previous studies did not allow a
diagnostic clinical analysis based on the psychiatric model of the DSM-IV, but it is now
possible with the ADM (Achenbach, 2007) of the ASEBA (CBCL and TRF; Achenbach
& Rescorla, 1991). It seems to be an interesting route because it would provide healthcare
practitioners with profiles based on the diagnostic criteria of DSM-IV, thus contributing to
set-up treatments adapted to the child’s psychological situation and prevent development
of psychopathologies.
Finally, the results of this study support the idea put forth by Cicchetti (2004) who
stipulated that neglect has negative effects on the child’s development beyond the simple
fact of living in a poor socioeconomic environment. Indeed, covariance analysis showed
that neglected children were different from those in the control group with regard to emo-
tional and behavioral problems, even after having controlled the socioeconomic level. This
supports the fact that these internalized and externalized behaviors were associated with
neglect and not poverty.

Limitations and Future Research

Cautions in interpreting the data need to be taken into account in this study, in particular
the purity of the neglected group versus other types of maltreatment. The cooperation of
caseworkers and the administrative and legal structure that governs the identification of
types of maltreatment have definitely been a great help in targeting neglected children in
this case. However, it is impossible to be 100% certain that neglected children have never
been exposed to other types of abuse or violence. It is important to consider that not every
child has been exposed to the same context of neglect (e.g., severity, chronicity) and that
each child has its own temperament or personality (e.g., ego resilience or ego control);
those can explain the divergences of responses among neglected children.
Future researches should obtain precisions about the chronicity or severity of neglect
in order to specify the behavioral and emotional profiles of neglected children to consider
the persistence of those symptoms in time. Furthermore, other factors, especially social
desirability in parents, could have influenced the results without the specific reasons being
known. The perceptions of the child himself, growing in those context, should give us
a better comprehension of the impacts of neglect, specially for internalized problems
that could have been underestimate. The use of self-reported questionnaires (e.g., Beck
Youth Inventories, California Child Q-Set) or of a semistructured interview (e.g., Anxiety
Disorders Interview Schedule for Children, Child Attachment Interview) with children
22 M.-E. Nadeau et al.

themselves would perhaps enable a more objective documentation of the psychological

(attachment-personality) and behavioral functioning of the latter and the elimination of a
bias, notably in the cases in which a parent or teacher could have underestimated a child’s
distress. The current study examined the emotional and behavioral profiles of neglected
children. It is important to intervene early in the development of the child in view of the fact
that the neglected children demonstrate many internalized and externalized problems and
are at high risk for psychopathologies (e.g., anxiety, depression, ADHD, SCT, oppositional,
and conduct problems).

Acknowledgments
Funding for this study was provided by the Canadian Institutes of Health Research. The authors
would like to thank the Mauricie-Centre-du-Quebec Child Protection Services (Mauricie, Québec,
Canada) particularly Daniel Gagnon and Martin Dionne, who facilitated the recruitment of subjects.
The authors would also like to thank the personnel at the schools of the Commission Scolaire Chemin-
du-Roy (Mauricie, Québec, Canada). They would also like to thank Véronique Parent, Andrée-Anne
Durocher, Mylène Henry, Isabelle Frigon, Marie-France Gobeil, and Louise Bourassa who made an
invaluable contribution to this study.

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