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00 09 –4 02 1/ 20 09 /0 20 91 37 -1 61 Child Welfare League of America 137
Effects of Early Maltreatment on
Development: A Descriptive
Study Using the Vineland
Adaptive Behavior Scales-II
Arthur Becker-Weidman
Children with histories of chronic early maltreatment
within a caregiving relationship may develop complex
trauma or developmental trauma and suffer from a
variety of deficits in many domains. This study explored
the effects of complex trauma on the development of
57 children, as measured by the Vineland Adaptive
Behavior Scales-II. This is the first descriptive study to
report on the significant discrepancies between chrono-
logical and developmental ages in adopted and foster
children. This study found that adopted and foster
children with a psychiatric diagnosis of reactive attach-
ment disorder show developmental delay in the domains
of communication, daily living skills, and socialization.
The average adaptive behavior composite score for the
children in this study yielded a developmental age (age
equivalency) of 4.4 years, while the average chronological
age was 9.9 years.
Arthur Becker-Weidman PhD is Director, Center for Family Development, Williamsville,
New York.
138 CHILD WELFARE • VOL. 88, #2
The purpose of this article is to describe the effects of com-
plex trauma (also called developmental trauma), which is
defined as chronic early maltreatment within a caregiving
relationship, on several domains of development, as measured by
the Vineland Adaptive Behavior Scales-II (the Vineland; Sparrow,
Cicchetti, & Balla, 2005).
The term complex trauma describes the dual problem of children’s
exposure to traumatic events and the impact of this exposure on
immediate and long-term outcomes. Complex traumatic exposure is
a child’s experience of multiple traumatic events that occur within
the caregiving system—the social environment that is supposed to
be the source of safety and stability in a child’s life. Typically, com-
plex trauma exposure refers to simultaneous or sequential occur-
rences of child maltreatment—including emotional abuse, neglect,
sexual abuse, physical abuse, and witnessing domestic violence—
that are chronic and begin in early childhood. Moreover, the initial
traumatic experiences (e.g., parental neglect and emotional abuse)
and the resulting emotional dysregulation, loss of a safe base, loss
of direction, and inability to detect or respond to danger cues, of-
ten lead to subsequent trauma exposure (e.g., physical and sexual
abuse or community violence; Cook, Blaustein, Spinazzola, & Van
der Kolk, 2003, p. 5).
The clinical formulation of complex trauma or developmen-
tal trauma (Cook, Spinazzola, Ford, Lanktree, Blaustein, Cloitre,
DeRosa, Hubbard, Kagan, Liautaud, Mallah, Olafson, & Van der
Kolk, 2005; Van der Kolk, 2005) describes seven domains of im-
pairment affected by chronic early relational maltreatment: (1) at-
tachment, (2) biology, (3) affect regulation, (4) dissociation, (5) be-
havioral control, (6) cognition, and (7) self-concept. The Vineland
provides one measure of some of these impairments by measuring
Address reprint requests to Arthur Becker-Weidman, Center for Family Development,
5820 Main Street, Suite 406, Williamsville, NY 14221. Phone: 716-810-0790. E-mail:
Aweidman@Concentric.net.
Becker-Weidman 139
adaptive functioning in the following domains: communication,
daily living skills, socialization, and motor skills (motor skills are
measured only in children up to age 6), as well as an overall meas-
ure of adaptive functioning, and a maladaptive behavior index
rating. The Vineland-II has been the norm for people from birth
through age 90. Within each domain are several subdomains. Adap-
tive behavior is defined as “the performance of daily activities re-
quired for personal and social sufficiency . . . as age related . . . by
the expectations or standards of others . . . is modifiable . . . by typ-
ical performance, not ability” (Sparrow et al., 2005, p. 6).
There is a large body of literature describing the effects of early
maltreatment on later child development, behavior, and function-
ing. Children reared in orphanages show a significant cognitive
delay of eight IQ points when compared with similar children who
are placed in foster care or raised with their biological parents.
“These results point to the negative sequelae of early institutional-
ization” (Nelson, Zeanah, Fox, Marshall, Smyke, & Guthrie, 2007,
p. 1937). Children with histories of maltreatment, such as physical
and psychological neglect, or physical and sexual abuse, are at risk
of developing severe psychiatric problems (Gauthier, Stollak, Messe,
& Arnoff, 1996; Malinosky-Rummell & Hansen, 1993). These chil-
dren are likely to develop reactive attachment disorder (Green-
berg, 1999; Lyons-Ruth & Jacobvitz, 1999) and may be described as
experiencing complex trauma. When the trauma experienced is
caused by the abuse or neglect inflicted by a primary caregiver, the
normal development of secure attachment is disrupted. Such chil-
dren are at risk of developing a disorganized pattern of attachment
(Lyons-Ruth & Jacobvitz, 1999; Main & Hesse, 1990; Solomon &
George, 1999). Disorganized attachment is associated with a num-
ber of developmental problems including dissociative symptoms
Note: The author was a Coordinator and Examiner in the revision of the Vineland-II
(Sparrow, Cicchetti, & Balla, 2005, p. 176) and the Center for Family Development was
a participating facility (p. 178).
140 CHILD WELFARE • VOL. 88, #2
(Carlson, Cicchetti, Barnett, & Braunwald, 1995), depression, anxiety,
and acting-out symptoms (Lyons-Ruth, 1996; Lyons-Ruth, Alpern,
& Repacholi, 1993).
Children who have experienced chronic early maltreatment
and resulting complex trauma are at significant risk for a variety of
other behavioral, neuropsychological, cognitive, emotional, inter-
personal, and psychobiological disorders (Cook et al., 2005; Van
der Kolk, 2005). Many children with histories of maltreatment are
violent (Robins, 1978) and aggressive (Prino & Peyrot, 1994) and,
as adults, are at risk of developing a variety of psychological prob-
lems (Schreiber & Lyddon, 1998) and personality disorders, including
antisocial personality disorder (Finzi, Cohen, Sapir, & Weizman,
2000), narcissistic personality disorder, borderline personality dis-
order, and psychopathic personality disorder (Dozier, Stovall, & Al-
bus, 1999). Neglected children are at increased risk of social with-
drawal and rejection, and have pervasive feelings of incompetence
(Finzi et al., 2000). Children who have histories of abuse and neglect
are at significantly higher risk of developing posttraumatic stress
disorder as adults (Allan, 2001; Andrews, Varewin, Rose, & Kirk,
2000). Sexually abused children are at significant risk of develop-
ing anxiety disorders (2 times the average), major depressive dis-
orders (3.4 times the average), alcohol abuse (2.5 times the average),
drug abuse (3.8 times the average), and antisocial behavior (4.3 times
the average; MacMillian, 2001). Adverse childhood experiences have
profound effects on later development, physical health, psycho-
logical development, and on a variety of other domains (Edwards,
Holden, Felitti, &Anda, 2003). Providing for the effective treatment
of such children is a public health concern (Felitti, 2002; Walker,
Goodwin, & Warren, 1992).
Early interpersonal experiences have a profound impact on
the brain because the brain pathways responsible for social per-
ception are the same pathways that integrate such functions as the
creation of meaning, the regulation of body states, the regulation of
emotion, the organization of memory, and the capacity for interper-
sonal communication and empathy (Siegel, 2002). Stressful experi-
ences that are overtly traumatizing may cause chronic elevated
Becker-Weidman 141
levels of neuroendocrine hormones such as cortisol (Siegel, 2002).
High levels of these hormones can cause permanent damage to
the hippocampus, which is critical for memory (McEwen, 1999).
Maltreatment during early childhood can cause vital regions of
the brain to develop improperly, leading to a variety of physical,
emotional, cognitive, and mental health problems (U.S. Depart-
ment of Health and Human Services [DHHS], 2001). In 2005, out
of 74 million children in the United States, there were over
900,000 substantiated and indicted cases of child maltreatment
(DHHS, 2007). It is primarily children younger than 4 years of
age that are at greatest risk, accounting for 79% of child maltreat-
ment-related fatalities (DHHS, 2007). Of 16 million U.S. children
under 4 years old, 267,479 were victims of maltreatment in 2005
alone (DHHS, 2007).
The previously mentioned implications become profound when
it is considered that over 900,000 children in the United States were
confirmed by child protective service agencies to be maltreated,
and this figure is considered an underestimate (DHHS, 2005). Nearly
three-quarters of these children had no reported history of prior
victimization (DHHS 2005, 2007). It is essential that we understand
the pervasive effects of child maltreatment so that appropriate in-
terventions, based on the child’s strengths and weaknesses, can be
implemented. This article is an attempt to shed some light on the
effects of child maltreatment on certain aspects of child develop-
ment and the delays that result.
Method
This study is a descriptive study. The data were collected from the
Center for Family Development’s data center and identifying infor-
mation regarding the children and families was removed to ensure
confidentiality in the analysis and reporting. All identifying infor-
mation was kept in a locked cabinet separate from research data.
All families that come to the Center for Family Development
have as one component of their comprehensive assessment the ad-
ministration of the Vineland-II prior to beginning treatment.
142 CHILD WELFARE • VOL. 88, #2
Subjects
To be included in this study, the child had to meet the following
criteria:
• The child had to complete a Vineland-II in 2007.
• The child had to meet the DSM-IV-R (American Psychiatric
Association, 1994) criteria for reactive attachment disorder.
• The child had to meet the clinical criteria for complex
trauma as described by Cook et al. (2005). Briefly, this clin-
ical construct refers to the observed sequelae of chronic
early maltreatment within a caregiving relationship. These
children are described has having impairment in the seven
domains: (1) attachment, (2) biology, (3) affect regulation,
(4) dissociation, (5) behavioral control, (6) cognition, and
(7) self-concept (p. 392).
• The child had to be either adopted or in foster care within
the child welfare system.
Of the subjects, 57 met these criteria and were included in the
study. No potential subjects met the second, third, and fourth cri-
teria who did not also meet the first criterion. No potential subjects
who met all the criteria were excluded from this study.
The diagnosis of reactive attachment disorder and adherence
to the clinical criteria of complex trauma were assigned by expe-
rienced mental health professionals at the center on the basis of
information obtained during a comprehensive, multidisciplinary
assessment. All children in the study had been referred with a pro-
visional diagnosis of reactive attachment disorder by other mental
health providers, child welfare staff, or pediatricians who prac-
ticed in other locations not affiliated with the clinic.
The data was collected from 57 Vineland-IIs. The subjects con-
sisted of 27 boys and 30 girls; 19 were in foster care, and 38 were in
adoptive families. The subjects consisted of 1 Asian, 4 Hispanics,
15 African Americans, and 37 Caucasians. Their ages ranged from
2 to 18 years with a mean of 9.9 years and a standard deviation of
4.8 years. Subject characteristics are presented in Table 1.
Becker-Weidman 143
Measure
The Vineland-II is a reliable and valid instrument for assessing
adaptive behavior for people from birth to 90 years of age in the
following domains: communication (receptive, expressive, and writ-
ten subdomains), daily living skills (personal, domestic, and com-
munity subdomains), socialization (interpersonal relationships,
play and leisure time, and coping skills), and motor skills (fine
and gross motor skills for children up to 6 years of age), addition-
ally it provides a maladaptive behavior index score that includes
TABLE 1
Characteristics of Participating Youth
a
The age range was 2.3–18 years. M⫽9.9 and SD ⫽4.5.
CHARACTERISTIC (N)%
Age
a
2–6 (16) 28.1
6.1–10 (10) 17.5
10.1–14 (17) 29.8
14.1–18 (14) 24.6
Gender
Male (27) 47.4
Female (30) 52.6
Race
Asian (1) 1.8
Hispanic (4) 7.0
African American (15) 26.3
Caucasian (37) 64.9
Placement
Adoptive home (38) 66.7
Foster home (19) 33.3
144 CHILD WELFARE • VOL. 88, #2
externalizing, internalizing, and other scales. The maladaptive be-
havior index is “a composite of internalizing, externalizing, and
other types of undesirable behavior that may interfere with the in-
dividual’s adaptive functioning” (Sparrow et al., 2005, p. 3). It is
scored as average (less than 18), elevated (18 to 20), or clinically
significant (21 to 24). A level of average indicates that the person
displays about the same number of maladaptive behaviors as most
others. An elevated level indicates that the person exhibits more
maladaptive behaviors than 84% of those the same age in the stan-
dardization sample. A clinically significant level indicates that the
person exhibits more maladaptive behaviors than 98% of those the
same age in the standardization sample. The data for this study
came from the Vineland-II survey forms (the survey interview and
the parent/caregiver rating form). The two forms differ only in the
method of administration (Sparrow et al., 2005).
The survey interview form was administered by the author
during the first of three evaluation interviews and prior to mak-
ing a clinical diagnosis. The parent/caregiver rating form was
given to the parent during the first interview and returned by the
parent before the second interview. The returned form was re-
viewed with the parent to clarify any questions or uncertainties.
The survey form was used for 11 subjects and the parent/care-
giver rating from was used for 46 subjects. The decision to use the
survey form or the parent/caregiver rating form was based on the
parent’s reading level and preference (i.e., would the parent pre-
fer to take the instrument home or have it completed in the of-
fice?). In each instance the author read the instructions and fur-
ther clarified by completing the first section of the Vineland in the
office with the parent.
Extensive details regarding the reliability and validity of the
Vineland-II instrument are found in the manual (Sparrow et al.,
2005). Internal consistency as measured by split-half method yields
coefficients in upper 0.80s to low 0.90s. Test-retest reliability falls in
the good-to-excellent range. Inter-interviewer reliability is also very
good. Interrater reliability is judged excellent.
Becker-Weidman 145
Results
The results of this study may be found in Table 2, which presents
average raw scores, standard scores, percentile rank, adaptive level,
and age equivalent levels. All children from this study are pre-
sented here. The use of standard scores allows comparison across
a wide range of ages.
As can be seen, while the average age of the children in this
study was 9.9 years, the average age-equivalent level is moder-
ately low to low, with an overall age-equivalent level of 4.4 years.
TABLE 2
Score Summary Data (n⫽57, average age ⫽9.9)
RAW STANDARD PERCENTILE ADAPTIVE AGE
SUBDOMAIN/DOMAIN SCORE SCORE RANK LEVEL EQUIVALENT
a
Receptive 28 Mod. Low 2:11
Expressive 22 Low 1:3
Written 27 Mod. Low 7
Communication 64 1 Low 3:9
Personal 57 Low 4:6
Domestic 17 Mod. Low 6:5
Community 38 Mod. Low 6:6
Daily Living Skills 73 4 Mod Low 5:10
Interpersonal Relations 44 Low 3:2
Play and Leisure Time 32 Low 3:6
Coping Skills 23 Mod. Low 3:11
Socialization 69 2 Low 3:6
Adaptive Behavior Composite 68 2 Low 4:4
Internalizing 8 Elevated
Externalizing 12 Clinically Significant
Maladaptive Behavior Index 28 Clinically Significant
a
Age equivalent scores are presented in the years:months format.
146 CHILD WELFARE • VOL. 88, #2
The average maladaptive behavior index is clinically significant as
is the externalizing scale, while the internalizing scale is elevated.
Tables 3 and 4 present the data divided into the upper and
lower halves based on age. As can be seen, the older children (mean
age 14) have a mean adaptive composite standard score of 67.7,
while the children in the younger group (mean age 5.75) have a
mean adaptive composite score of 78.8. A t-test (two-tailed) results
in t⫽3.667, pⱕ0.0007, showing that the older children are statis-
tically significantly more disturbed than the younger group. If we
compare the maladaptive behavior indices for each group, we ob-
serve similar findings (t⫽⫺2.03, pⱕ0.05).
TABLE 3
Score Summary Data—Younger Half (n⫽28, average age ⫽5.75)
RAW STANDARD AGE
SUBDOMAIN/DOMAIN SCORE SCORE SD EQUIVALENT SD
Receptive 25.18 7.7 3.3 3.3
Expressive 72.7 26.1 4.6 3.9
Written 14.4 14.0 4.8 2.9
Communication 81.6 16.7 4.25 3.4
Personal 46.3 19.1 4.3 4.0
Domestic 10.4 8.7 3.6 2.8
Community 22.3 18.6 4.5 3.0
Daily Living Skills 81.8 15.7 4.1 3.3
Interpersonal Relations 39.4 13.3 3.0 1.9
Play and Leisure Time 25.4 11.4 2.8 1.5
Coping Skills 17.4 12.4 3.3 2.5
Socialization 76.9 12.3 3.0 2.0
Adaptive Behavior Composite 78.8 14.5 3.8 2.9
Internalizing 7 4.5 Elevated
Externalizing 11.4 4.8 Clinically Significant
Maladaptive Behavior Index 25.4 11.0 Clinically Significant
Becker-Weidman 147
When comparing the standard scores for the older and younger
groups, we find the data shown in Table 5.
The data indicate that the older group has statistically signifi-
cantly more difficulties (greater delay/lower standard score rela-
tive to age) than the younger group in the area of socialization,
and overall adaptive behavioral functioning. In addition, the older
group’s maladaptive behavior index score is statistically signifi-
cantly higher than that of the younger group. The difference in the
communications skills domain is not statistically significant and
the difference in daily living skills approaches statistical signifi-
cance. With a larger sample, more differences may emerge. While
TABLE 4
Score Summary Data—Older Half (n⫽29, average age ⫽14)
RAW STANDARD AGE
SUBDOMAIN/DOMAIN SCORE SCORE SD EQUIVALENT SD
Receptive 31.3 5.2 5.4 3.6
Expressive 96.6 7.2 7.4 3.5
Written 37.7 8.3 10.4 3.5
Communication 73.5 9.5 7.7 3.5
Personal 67.0 7.3 8.3 3.5
Domestic 24.1 10.6 8.2 3.4
Community 53.0 13.6 9.5 3.2
Daily Living Skills 71.7 11.6 8.7 3.4
Interpersonal Relations 47.6 11.4 4.5 2.8
Play and Leisure Time 38.7 8.8 5.1 2.4
Coping Skills 28.8 11.1 5.7 3.0
Socialization 63.2 7.9 5.1 2.7
Adaptive Behavior Composite 67.7 7.5 7.2 3.2
Internalizing 9.1 4.3 Clinically Significant
Externalizing 13.3 4.6 Clinically Significant
Maladaptive Behavior Index 32.5 8.5 Clinically Significant
148 CHILD WELFARE • VOL. 88, #2
there were no differences between the two groups in mental health
services history or severity of maltreatment, other mediating vari-
ables, such as a longer length of stay in foster care for the older
group, may also be factors influencing the observed differences
between the two groups.
The data presented in Table 6 indicate that there are no statisti-
cally significant differences between Caucasian children and eth-
nic minority children (African American, Hispanic, and Asian) on
their domain standard scores or maladaptive behavior index score.
TABLE 5
Comparison of Older and Younger Group Domain Standard Scores
VARIABLE DOMAIN T-VALUE P-VALUE
Communications Skills 1.41 .17
Daily Living Skills 1.83 .07
Socialization 3.29 .002
Adaptive Behavior Composite 2.37 .02
Maladaptive Behavior Index ⫺2.4 .02
TABLE 6
Comparison of Ethnic Minority and Caucasian Children Domain Standard Scores
and Maladaptive Behavior Index Scores
VARIABLE DOMAIN T-VALUE P-VALUE
Communications Skills ⫺0.1 .94
Daily Living Skills ⫺1.0 .60
Socialization 0.18 .85
Adaptive Behavior Composite 0.0 1.0
Maladaptive Behavior Index 0.4 .70
Becker-Weidman 149
By comparing the raw and standard scores for each subdomain
and each domain, we see no statistically significant difference be-
tween the males and females in this study; t-test p-values ranged
from 0.99 to 0.32.
Figure 1 shows the score profile plotted on a normal curve
distribution.
The children in this study show significant impairment in all
domains and subdomains. By way of comparison, this group of
children is notably more impaired than the group of children de-
scribed in the Vineland-II manual as the “emotional/behavioral
disturbance sample.” These data are reproduced in Table 7.
Discussion
Understanding how a child’s previous history of maltreatment
affects the child’s everyday functioning is very important for treat-
ment planning, parenting, and school placement and services. This
is the first study to report on the discrepancies between chronolog-
ical and developmental ages in adopted and foster children and
while this is a preliminary descriptive study, these data have sev-
eral important implications.
Limitations
Some limitations to this study bear mentioning:
• While the data show marked discrepancies between chrono-
logical and developmental ages in adopted and foster chil-
dren, the data were collected from only one clinic. It would
be useful to replicate this study at other clinics.
• The Vineland data is collected from parent reports. Since
there is a teacher version of the Vineland-II, it would also
be informative to collect data from both teachers and par-
ents on these children. The ratings of children’s behavior by
parents and teachers using the two versions of the Vineland
show only a modest relationship (Sparrow, Cicchetti, & Balla,
2006, p. 122). This should not be surprising since parents and
teachers experience different facets of the child’s functioning
150 CHILD WELFARE • VOL. 88, #2
FIGURE 1
Score Profile for Study Sample (n⫽57)
Becker-Weidman 151
in two different environments. The use of both parent and
teacher instruments may provide a more robust picture of
the adaptive behavior functioning of adopted and foster
children.
• Another limitation is the sample size of 57. However, even
with this relatively small sample size, some findings were
striking. More subjects would allow for an analysis of dif-
ferent age groups, which would expand the information
gained and would be a valuable extension of this study.
TABLE 7
Comparison of Study Group Scores with Vineland’s Emotional/Behavioral
Disturbance Sample
VINELAND SAMPLE
1
STUDY SAMPLE
DIFFERENCE
2
DIFFERENCE
FROM NONCLINICAL FROM VINELAND
SUBDOMAIN/DOMAIN MEAN SD REFERENCE GROUP MEAN SD CLINICAL GROUP
Receptive 12.1 2.7 ⫺2.7* 10.0 2.7 ⫺2.1*
Expressive 13.4 2.6 ⫺2.0* 11.3 2.7 ⫺2.1*
Written 12.8 2.9 ⫺2.2* 11.9 3.4 ⫺0.9
Communication 87.2 12.3 ⫺14.5* 77.5 14 ⫺9.7*
Personal 14.3 2.7 ⫺9.0* 10.8 2.9 ⫺3.5*
Domestic 13.7 3.3 ⫺1.4* 10.9 3.2 ⫺2.8*
Community 13.1 2.8 ⫺2.2* 11.3 3.2 ⫺1.8*
Daily Living Skills 92.3 14.1 ⫺9.0* 76.7 14.5 ⫺15.6*
Interpersonal Relations 11.7 2.5 ⫺3.4* 9.2 2.7 ⫺2.5*
Play and Leisure Time 11.9 3.8 ⫺3.2* 8.8 2.5 ⫺3.1*
Coping Skills 12.0 2.6 ⫺3.3* 10.5 2.9 ⫺1.5*
Socialization 82.4 13.1 ⫺19.0* 69.9 12.3 ⫺12.5*
Adaptive Behavior 85.7 11.7 ⫺15.4* 73.1 12.7 ⫺12.6*
Composite
1
(Sparrow et al., 2005, p. 153) n ⫽34.
2
Controlling for sex, race/ethnicity, and education level, and matched by age range with clinical group.
152 CHILD WELFARE • VOL. 88, #2
Implications for Treatment and Parenting
It is obvious from these data that these children have significant
delays of over five years in adaptive behavior in all domains and
most subdomains. This level of impairment is even more substan-
tial than that of the Vineland normative group identified as the
emotional/behavioral disturbance sample (see Table 7). This find-
ing suggests that the effects of complex trauma are quite pervasive
and serious. For most people, chronological age and developmen-
tal age are largely in sync, so treatment and parenting decisions
based on chronological age largely match the developmental capa-
bilities of the child. However, with the children in this study, that
is not the case, and there are important implications for treatment
and parenting. The children in this study had histories of chronic
early maltreatment within a caregiving relationship, resulting in
complex trauma or developmental trauma, and met the diagnostic
criteria for reactive attachment disorder. They showed substantial
delays in adaptive functioning. Treatment and parenting decisions
must be made in light of those delays.
It is not surprising that the older children (mean age 14 years)
are more disturbed than the younger children (mean age 5.75 years).
The older group has a lower mean adaptive behavior composite
standard score and lower mean communication, daily living skills,
and socialization domain standard scores, as well as a higher mean
maladaptive behavior index and higher mean internalizing and
externalizing scores. We know that multiple foster placements in-
crease the risk of placement disruption (Fisher, Burraston, & Pears,
2005), and foster placement instability is associated with poor child
outcomes (Rubin, O’Reilly, Luan, & Localio, 2007). The older chil-
dren in this study had been in care longer and had more place-
ments than the younger children. One implication for treatment is
that it is vital to begin treatment as early as possible and with ap-
proaches that show some evidence of effectiveness, such as dyadic
developmental psychotherapy, which is an evidence-based and ef-
fective treatment for such disorders (Becker-Weidman, 2006a, 2006b;
Becker-Weidman 153
Becker-Weidman & Hughes, 2008; Hughes, 2007). As described else-
where (Becker-Weidman & Hughes, 2008; Becker-Weidman & Shell,
2005), this evidence-based and effective treatment is grounded in
attachment theory and addresses the various domains of impair-
ment found in complex trauma. Dyadic developmental psycho-
therapy relies on a variety of well-founded elements of treatment
such as affect arousal and regulation, gradual exposure to trauma,
parent education, and consultation, explaining how the past may
be continuing to affect present behavior, forming, and maintaining
a therapeutic relationship through therapist acceptance, affirma-
tion, empathy, and various other dimensions (Lambert, 2004).
The language delays in the receptive and expressive domains
suggest that parents, teachers, and providers must be particularly
careful to find out whether the child actually understands what is
being discussed. In addition, since expressive language delays are
especially large, asking the child to further elaborate on a situation,
experience, or feeling may lead to frustration for the child and par-
ent since the child may not be able to articulate as clearly as the
parent would expect based on the child’s chronological age.
The delays in daily living skills suggest that parenting the child
based on the developmental age may be most helpful. It may re-
duce the parents’ and child’s frustration. When a parent asks a child
to “act your age,”—meaning their chronological age—this may not
be possible for a child showing this level of delay. Parenting the
child at the child’s adaptive behavioral level may allow the child
and parent to develop a relationship with less stress and conflict,
enabling the normal developmental processes to become engaged
and allowing the child to progress and “catch up.”
Many of these children have poor hygiene; note the low aver-
age personal subdomain age equivalent score of 4.6 years for the
nearly 10-year-old average child in this study). Expecting such a
child to be able to properly wash or brush teeth often leads to fre-
quent battles between parent and child. The parents often feel frus-
trated with the child’s perceived lack of compliance and the child may
feel frustrated by being asked to do something which is beyond his
154 CHILD WELFARE • VOL. 88, #2
or her ability at that moment in time. Having the parent engage in
the task with the child, making it an enjoyable, mutually shared ex-
perience, can be therapeutic by reducing conflict and stress and by
improving the quality of the parent-child relationship. The shift
from “compliance” to “teaching/helping” can have a very positive
effect on the relationship and the child’s functioning.
The adaptive behavior delays in the socialization domain are
especially significant (an age equivalent score of 3.6 years). For the
child in school, a regular socialization group in which the school
social worker, counselor, or psychologist can observe and coach
may be particularly helpful. Merely telling the child how to act or
play may be ineffective for several reasons. First, the age equiva-
lent score is so low that such a cognitive intervention may not be
effective. Instead, focusing on practicing pro-social behaviors in
vivo may be much more effective in making the skill an implicit
memory-based and muscle-based skill. Second, the language de-
lays may make talk-based interventions ineffective. Close supervi-
sion in social situations allows the parent, teacher, or counselor to
intervene before a negative behavior has escalated too far. In addi-
tion, the “teaching” that can occur in vivo in the moment may be
more effective for longer term learning. Many of these children did
not receive such in vivo age-appropriate supervision and teaching
at earlier ages, and cannot make use of cognitively based sugges-
tions until they have incorporated skills that are learned in emo-
tional and interpersonal contexts.
Because reactive attachment disorder and complex trauma are
relationship difficulties, it is not surprising that the area in which
the greatest difference between chronological and developmental
age is found is in the socialization domain. The older children
had been without effective treatment for a longer period than the
younger children and so their delays and difficulties may have
worsened over time. One clinical implication of this may be that
relationship-based treatments, such as family therapy, and those
grounded in attachment therapy may be more effective in remedi-
ating these deficits than individual therapies.
Becker-Weidman 155
Early intervention with effective treatment is very important.
One treatment outcome study followed children receiving dyadic
developmental psychotherapy for four years after treatment ended
and compared that group to a control group that did not receive
dyadic developmental psychotherapy (Becker-Weidman, 2006b).
The two groups were matched on a variety of demographic vari-
ables and the two groups’ pretest scores had no statistically signif-
icant differences. That study found that the children who received
dyadic developmental psychotherapy had statistically and clini-
cally significantly lower scores on the child behavior checklist af-
ter treatment, while children in the control group had scores that
remained in the clinical range and actually became worse to a sta-
tistically significant degree on four scales (anxious/depressed, at-
tention problems, rule-breaking behavior, and aggressive behavior).
The findings of this study suggest that without effective treatment,
children with reactive attachment disorder and complex trauma
become more symptomatic.
The previously mentioned are just a few of the possible impli-
cations for parenting and therapy given the adaptive behavioral
delays exhibited by these children. The general principle suggested
is to treat the child at his or her developmental level or age equiv-
alent level and, as the child’s functioning improves, adjust accord-
ingly. Broadly speaking, this is what parents do when their child’s
chronological and developmental age match; increasing responsi-
bilities and expectations as the child’s performance and behavior
progresses. However, with these children, cognitive and adaptive
functioning may be extremely discrepant, compromising a parent’s
intuitive judgment of the child’s abilities, and causing frustration
for both parent and child.
Implications for Schools and Child Welfare
Educators may benefit from understanding that many of the prob-
lem behaviors they see at school with children such as those in this
study are the result of complex trauma and the delays in adaptive
behavior that may result from it. Recognizing the student’s actual
156 CHILD WELFARE • VOL. 88, #2
level of adaptive functioning, instead of merely the child’s chrono-
logical age, can help the teacher adapt the lesson plan, level of ma-
terial, and how this material is communicated (based on the child’s
receptive language level and cognitive development). For exam-
ple, it is interesting to note that for older children (see Table 4), the
mean receptive subdomain score is two years below their expressive
subdomain score. Since we usually communicate with people at the
“level” they communicate with us, it may be that at times the child’s
“oppositional and defiant” behaviors may actually be indicate a lack
of understanding. If the teacher, or parent, is speaking to the child
at the child’s higher expressive level, but the child’s understanding
(receptive subdomain) is much lower, then the child may appear
defiant, but simply may not understand the request. It would then
be useful to ask the child what he or she understood the request to
be, rather than assume that non-compliance is a sign of defiance.
Children who have reactive attachment disorder or complex
trauma often require special education services. Under the Indi-
viduals with Disabilities Education Improvement Act of 2004, (a
reauthorization of Public Law 94-142), states are required to pro-
vide a free and appropriate public education for all children re-
gardless of disability. The guidelines for assessing children with
disabilities include measuring adaptive behavior. The present study
provides data indicating the extent of delay and impairment such
children experience. Children in the child welfare system may re-
quire special education services to address these delays. Child wel-
fare workers and school personnel should be aware of these factors
and consider adaptive delays when making placement decisions
for such children. Smaller class size, longer time to complete work,
and recognizing the child’s developmental age and ensuring that
expectations match the developmental age are other recommenda-
tions for educators.
Foster parents require adequate training to understand the na-
ture, extent, and implications of their child’s adaptive behavior
impairments. Too often, foster and adoptive parents report not be-
ing adequately trained or not being made aware of the adaptive
Becker-Weidman 157
functioning of their children and how this may affect the child’s
functioning in their home, with peers, and in school. Adding a unit
on adaptive functioning, and how it is negatively affected by chronic
early maltreatment in a caregiving relationship, to model approach
to partnerships in parenting (MAPP) and group preparation and
selection (GPS) training for foster and adoptive parents, would be
helpful. Such training might help parents better understand and
help their children, and could lead to fewer placement disruptions.
Implications for Further Research
This descriptive study suggests a number of intriguing findings. Is
developmental functioning affected by treatment? Administering
the Vineland before and after treatment could point toward an an-
swer. Since adaptive functioning appears to be related to behavior
and functioning in a variety of domains, such as school perform-
ance, peer relationships, and overall functioning, it would be im-
portant to determine if and how treatment might impact adaptive
functioning as measured by the Vineland. Anecdotal data from
families in this study indicate that children’s adaptive functioning
improves after treatment. For example, we find that many of these
children had no friends in school, but that after treatment, peer re-
lationships improved, as reported by the child and the child’s par-
ents. It would be useful to measure this to determine to what extent
this finding is statistically significant.
The literature indicates that chronic early maltreatment within
a caregiving relationship, complex trauma, has pervasive negative
effects on developmental functioning and developmental age. The
findings of this study indicate that these negative effects worsen
over time; older children have a large gap between chronological
and developmental age. Further research to explore the mechanism
by which this occurs and to evaluate moderating variables such as
IQ, length of time in a stable setting, and other variables would add
to our understanding of this complex phenomenon.
The children in this study were all adopted or in foster care
and had significant symptomatic behaviors that brought them to
158 CHILD WELFARE • VOL. 88, #2
the attention of a mental health facility. How does this group of
adopted and foster children compare with a matched group who
do not have significant behavioral, emotional, or psychological prob-
lems? It would be helpful to administer the Vineland to a group
of adopted and foster children who are not presenting with signif-
icant behavioral, emotional, and psychological problems. Such a
study might allow us better understand the factors that are con-
tributing to the significant adaptive behavioral delays observed in
this group of children. Is it a function of the severity of their early
maltreatment, a function of being in the child welfare system, or a
function of other factors?
A larger sample size would provide additional power to these
findings. A larger sample size might help determine whether some
of the findings of this study that were nearly statistically signifi-
cant, such as the difference in the daily living skills standard scores
between the older and younger groups, become significant.
In conclusion, this descriptive study is the first of its kind to
demonstrate the notable discrepancies between chronological and
developmental ages in adopted and foster children. These delays
have a number of very important implications for treatment, fur-
ther research, effective parenting, parent training, and the educa-
tion and child welfare systems. Understanding these implications
could have a profoundly positive effect on adopted children and
children in the child welfare system. Better treatment, increased
understanding of the child by parents and others, and better edu-
cational placements may all yield improving functioning and re-
duced placement and adoptive disruptions.
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