Behavior problems in school-aged physically abused and neglected children in Spain

Pergamon Child Abuse & Neglect, Vol. 19, No. 4, pp. 409-418, 1995

Copyright © 1995 Elsevier Science Ltd Printed in the USA. All rights reserved

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BEHAVIOR PROBLEMS IN SCHOOL-AGED PHYSICALLY ABUSED AND NEGLECTED

CHILDREN IN SPAIN

J O A Q U [ N D E PAI~IL A N D M . I G N A C I A A R R U A B A R R E N A

Facultad de Psicolog[a, San Sebastifin. Spain

Abs t rac t - -The present study investigated behavior problems in school-aged physically abused, neglected, and comparison children in the Basque Country (Spain). Data from the Teacher's Report Form of the Child Behavior Checklist was obtained on 66 children consisting of three groups (17 physically abused children, 24 physically neglected children, and 25 low-risk comparison children). The three groups were matched on seven sociodemographic variables. Overall, the abused and neglected children were higher than the comparison group on Total Behavior Problems scores. However, only neglected children obtained higher scores than the comparison group on the total score of the External- ized Scale, and only abused children scored higher than the comparison group on the total score of the Internalized Scale. Follow-up analysis indicated that both abused and neglected children had higher scores on the Social Problems, Delinquent Behavior, and Attention Problems subscales. Moreover, neglected children had higher scores on the Aggressive Behavior subscale than the comparison children, and abused children had higher scores on the Withdrawn subscale than the comparison children. The abused and neglected children also showed a lower school adjustment than the comparison group. Possible explanations of these findings are discussed and their implications for research and treatment are considered.

Key Words--Behavior problems, School-aged physically abused children, School-aged neglected children, Children in Spain.

INTRODUCTION

FROM A THEORETICAL perspective, it has been suggested that physical child abuse and neglect can significantly affect a variety of developmental events. It is also reasonable to expect that significant deficits (e.g., cognitive, affective, social) might be present, and that physically abused and neglected children might be at high risk to develop behavior problems and psychopathological disturbances (Cicchetti & Olsen, 1990).

However, the results of the research aimed at identifying the consequences of physical child abuse and neglect are often limited. Whereas studies agree in their reports of deficits in intellectual functioning of physically abused and neglected children, research on abused and neglected children's affective and behavioral characteristics is less clear (Crouch & Milner, 1993; Milner & Crouch, 1993; Salzinger, Feldman, Hammer, & Rosario, 1991). The differences in the study results may be partially explained by the lack of specification of the different types of child maltreatment (e.g., Barahal, Waterman, & Martin, 1981; Camras & Rappaport, 1993; Engfer & Schneewind, 1982; Gaensbauer & Sands, 1979; Martin & Beezley, 1977), methodological limitations (Newberger, Newberger, & Hampton, 1983), and the lack of a developmental perspective (Cicchetti & Olsen, 1990; Milner & Crouch, 1993). In addition, certain maltreatment types, as in the case of child neglect, have received limited attention

Received for publication November 29, 1993; final revision received March 7, 1994; accepted March 8, 1994.

Requests for reprints should be addressed to Joaqu[n de Patil, Facultad de Psicologfa, P.O. Box 1249, 20080 San Sebastifin, Spain.

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410 J. de Patll and M. I. Arruabarrena

from researchers (Crouch & Milner, 1993), and studies on school-aged children are scarce (Salzinger et al., 1991).

The studies in which child physical abuse and neglect have been differentiated present interesting results. Hoffman-Plotkin and Twentyman (1984) did not find differences in the cognitive development (i.e., intelligence and language ability) of physically abused and physically neglected preschoolers, although both groups had significantly lower scores on cognitive development than a comparison group. They also found that, relative to comparison preschoolers, neglected preschoolers presented less general interaction and physically abused preschoolers presented higher rates of aggressive interaction. Neglected and comparison preschoolers did not differ in their aggressive interactions. Erickson, Egeland, and Pianta (1989) reported that physically abused and physically neglected kindergarten children were rated by their teachers as more aggressive than comparison children, although no differences between abused and neglected children were found. Also, children of both groups were rated as more unpopular than a comparison group, but only neglected children showed more socially withdrawn problems. George and Main (1979) found that physically abused toddlers showed more aggressive behaviors toward their peers than a comparison group. However, George and Main also found that physically abused toddlers presented a lower rate of approach toward adults, and a higher frequency of avoidant behaviors toward adults and peers than nonabused toddlers. In contrast, while Jacobson and Straker (1982) found that physically abused children, relative to a comparison group, presented lower rates of social interaction behaviors, they did not find differences between the two groups in the frequency of aggressive behaviors.

The studies cited above support the view that physically abused and physically neglected children have problems in social interaction. However, it is unclear whether different behavioral profiles of abused and neglected children can be identified. An attempt to delineate the consequences of child maltreatment by focusing on a more complete description of behavioral problems was performed by Wolfe and Mosk (1983) and Kravic (1987), who used the parent version of the Child Behavior Checklist (CBCL, Achenbach & Edelbrock, 1983). In these studies, the physically abused children are described by their parents as having more behavior problems and less social competence than nonabused children described by their parents. But the only significant difference between the physically abused and comparison children in the Kravic's study (1987) was in the factor that measured aggressive problems. In the Wolfe and Mosk' study (1983), no behavioral dimension significantly differentiated the physically abused children from a group of children from distressed families. These results support the statement made by Friedrich and Eindenber (1983) that no typical behavioral or personality profile has been found for maltreated children.

A limitation of some of the studies that have focused on the social interaction patterns of physically abused and neglected children is that the information used to describe children's behavior problems comes from the children's own parents. These parents' psychosocial problems as well as the negative perception they may have of their child, and their possible attempt to justify their behavior, puts into question the validity of this source of information (Mash, Johnston, & Kovitz, 1983; Reid, Kavanagh, & Baldwin, 1987). Thus, it would be interesting to know to what extent the behavior problems of the child are present in other contexts (e.g., school), and also it is very important to use evaluators of the child's behavior that are blind to the status of maltreatment.

Most of the existing research about consequences of child physical abuse and physical neglect focuses on variables related to social interaction patterns with peers. Nevertheless, hypotheses that predict associations between aggression and child physical abuse and between isolation or inadequate social interaction and physical neglect do not appear to be clearly supported (Kaufman & Cicchetti, 1989; Milner & Crouch, 1993). Research aimed at testing these hypotheses should assess the effects of child physical abuse and physical neglect as different from other forms of maltreatment, and should also consider, as Crouch and Milner

Behavior problems in physically abused and neglected children 41 I

(1993) have suggested, gender differences. The results obtained by Maylone (1985), who reported more problems of aggressivity in abused boys and more problems of passivity in abused girls, support the importance of control for gender in the study of the effects of maltreatment on child's social interaction patterns.

The present study was designed to compare physically abused and physically neglected school-aged children's behavioral and social functioning with similar behavior in nonmaltreated children. It was expected that the physically abused and the physically neglected school-aged children, when compared to nonmaltreated children, would present more problems in their patterns of social interaction with peers. Further, it was hypothesized that physically abused school-aged children would present more externalizing problems (delinquent behavior and aggressive behavior) and the physically neglected school-aged children would present more internalizing problems (withdrawn, somatic complaints and anxiety/depression). It was also expected that both physically abused and neglected school-aged children would present more attention problems and more difficulties in their school adjustment than nonmaltreated counter- parts. Finally, the study explored the possibility of gender differences in social interaction patterns in physically abused, neglected, and nonmaltreated children. The study of Spanish school-aged physically abused and neglected children also provides data for cross-cultural comparisons.

METHOD

Subjects

The sample consisted of 66 children divided into three groups: physically abused children (n = 17), physically neglected children (n = 24), and low-risk comparison children who had not been reported for either physical abuse or physical neglect (n = 25). The physically abused and neglected children came from a larger sample which had been randomly selected from child physical abuse and neglect cases substantiated for different Child Protection Agencies of the Basque Country (Spain). The two groups were selected from the random sample by choosing physically abused and neglected children aged between 5 and 11 where only one type of child maltreatment was indicated.

The definitions that guided the selection of subjects were the ones used by the Child Protection Agencies. Physical abuse was defined as any nonaccidental behavior carried out by the parents or caretakers, which resulted in physical damage or illness for a child under 15 years old. Physical neglect was defined as any situation in which physical necessities (food, clothes, safety, health care, protection, and supervision in dangerous situations) were not met in a child temporarily, or chronically, by any member of the family. Although child physical abuse and neglect often occur in combination, in no case of physical abuse had any physical neglect been identified, and in no case of physical neglect had any physical abuse been identified.

The comparison children were selected from a large subject pool of children (from 834 families), who represented a stratified random sample of the general population of the Basque Country (Spain). Twenty-five children, who demographically matched the physically abused and physically neglected children, were selected from this subject pool to comprise the comparison group. All of the comparison children came from families in which no child maltreatment had been detected. Moreover, to reduce the possibility of undetected child maltreatment, it was required that all the mothers of the children in the comparison group scored under the 25th percentile on the Spanish version of the Child Abuse Potential (CAP) Inventory (Arruabar- rena & de Patil, 1992; de Pal1, Arruabarrena, & Milner, 1991; Milner & Wimberley, 1979,

412 J. de Pafil and M. I. Arruaba~ena

1980), which had been previously applied to the representative sample of 834 parents from the Basque Country.

The three groups (physical abuse, physical neglect, and comparison) were matched on socioeconomic status, marital status, mother 's educational level, gender of the child, age of the mother, age of the child, and number of children in the family. Chi-square tests indicated that the three groups were not significantly different in socioeconomic status, X 2 (4, N = 64) = 3.4, p > .05, marital status, X 2 (6, N = 66) = 11.7, p > .05, mother' educational level, X 2 (8, N = 60) = 13.3, p > .05, and gender of the child, X 2 (2, N = 66) = .5, p > .05. Analysis of variance indicated no significant group differences (p > .05) in age of the mother, age of the child, and number of children.

Instruments

Child Abuse Potential Inventory (CAP). The CAP Inventory (Milner & Wimberley, 1979, 1980) is a self-report questionnaire designed to evaluate the risk for child physical abuse. The CAP Inventory contains 160 items that are answered in a forced-choice, agree-disagree format. The questionnaire contains different scales: Abuse Scale, Lie Scale, Random Response Scale, and Inconsistency Scale (Milner, 1986). In the present research, a Spanish version of the CAP Inventory was used. The results of different studies with this version support its reliability, construct validity, and discriminant validity for the Spanish population (Arruabarrena & de Patil, 1992; Arruabarrena, de Patil, Mufioz, & Torres, 1991; de Patil, Arruabarrena, & Milner, 1991; de Patil & Rivero, 1992).

The Teacher's Report Form of the Child Behavior Profile (TRF). The TRF (Achenbach, 1991; Achenbach & Edelbrock, 1986) is designed to obtain teachers' descriptions of children's academic performance, adaptive functioning at school, and behavioral/emotional problems in a standardized format. The 1991 version of the instrument, used in the present study, is applicable for children 5 to 18 years of age. The combination of the scores obtained on the items evaluating the child's academic performance and school adjustment were used in the subscales of Academic Performance and Adaptive Functioning. The TRF also includes 118 items assessing behavior problems. The principal components analyses performed with clinical samples across sex/age groups (ages 5 to 11 and 12 to 18 years) suggests that the TRF contains eight syndrome subscales: Withdrawn, Somatic Complaints, Anxious/Depressed, Social Prob- lems, Thought Problems, Attention Problems, Delinquent Behavior, and Aggressive Behavior. Second-order factor analyses performed with these subscales across sex/age groups resulted in the formulation of two broader scales, Internalizing and Externalizing (Achenbach, 1991). The TRF Total Problem score was computed by summing all of the problem items. The TRF provides raw scores and T scores for the syndrome subscales, Externalizing, Internalizing, and Total Problem score, based on normative samples of each sex in each age range. In the present study, a translated version of the TRF was used. Although the 1986 and 1991 TRF versions had been applied in some research in Spain, no data are available on their reliability and validity.

Procedure

Teachers were asked to fill out the TRF for a specified child to obtain information about the child's behavioral characteristics at school. Teachers were not blind to the fact that the families of the physical abuse and neglect groups were receiving services from Social Services, but the teachers were not told about the type of services the families were receiving. Permission to evaluate the child was obtained from the parents.

Behavior problems in physically abused and neglected children

RESUL T S

413

Social and Behavior Problems

The Total Behavior Problems score was analyzed using analysis of variance (ANOVA) . This one-way A N O V A indicated a significant difference, F(2, 63) = 7.37, p = .001, between the three groups ' scores. A Newman-Keu l s ' test (p < .05) indicated that scores of Total Behavior Problems of the abuse and neglect groups were s ignif icant ly higher than those of the compar ison group (M = 52.92, SD = 9.98). However , no significant differences were observed between abused (M = 62.71, SD = 7.13) and neglected (M = 62.17, SD = 10.95) children, suggest ing that both groups had a s imilar level of behavior problems from a quantita- t ive global analysis.

These results indicated that the phys ica l ly abused and neglected children in this Spanish sample d i sp layed more behavioral p rob lems than the compar ison children. Nevertheless, the results did not reveal the exis tence of different behavior p roblems as a function of the type o f abuse. For this reason, group differences on the scales and subscales that the T R F assesses were analyzed.

The same statistical procedures were used to analyze the differences on the External iz ing and Internal izing scales. The one-way A N O V A s indicated significant group differences for both External izing, F(2, 63) = 4.03, p = .02, and Internal izing scales, F(2, 63) --- 3.30, p = .04. Differences on both scales between the three groups ' means were evaluated using the Newman-Keu l s ' test (p < .05). On the External iz ing Scale, the mean score of the neglect group (M = 59.75, SD = 11.71) was significantly higher than the score of the compar ison group (M = 51.40, SD = 9.43). The mean score o f the abuse group (M = 57.88, SD = 11.01 ) was not significantly different from the score of the neglect or the compar ison group. On the Internal izing Scale, the mean score of the abuse group (M = 63.00, SD = 7.17) was signif icantly higher than the score of the compar ison group (M = 55.72, SD = I !.20). The mean score of the neglect group (M = 60.25, SD = 8.47) was not significantly different from the score of the abuse or the compar i son groups.

The seven subscales o f the T R F used in the present study were analyzed using a M A N O V A to examine group differences. The mult ivar ia te test was significant, Wi lks ' l ambda = .62, F(14, 114) = 2.15, p = .01, therefore fo l low-up univariate analysis o f variance were conducted. The compar isons between the three groups, when A N O V A s were significant, were performed using the Newman-Keu l s ' test (p < .05).

On the Social Problems subscale, the one-way A N O V A indicated significant differences between groups, F(2, 63) = 5.25, p = .008. Further, the Newman-Keu l s ' test indicated that the mean scores of the abuse (M = 60.77, SD = 8.15) and neglect (M = 60.92, SD = 8.13) groups were signif icantly higher (p < .05) than the mean score of the compar ison group (M = 54.20, SD = 8.03). The difference between the abuse and neglect groups was not significant

(p > .05). The one-way A N O V A s also showed significant differences on the two subscales that com-

prise the External iz ing scale (i.e., Del inquent Behavior and Aggress ive Behavior) . On the Del inquent Behavior subscale the one-way A N O V A indicated a significant difference between the three groups, F(2, 63) = 7.43, p = .001. Whi le the N e w ma n-K e u l s ' test indicated that the mean scores of the abuse and the neglect groups were signif icantly higher than the mean score of the compar ison group (M = 53.16, SD = 5.42), the scores of abuse (M = 60.00, SD = 7.88) and neglect (M = 59.92, SD = 7.62) groups were not s ignif icantly different from each other. On the Aggress ive Behavior subscale the one-way A N O V A indicated a significant difference between the three groups, F(2, 63) = 3.32, p = .04. The N e w ma n-K e u l s ' test indicated that the mean score of the neglect group (M = 60.71, SD = 10.53) was significantly higher than the compar ison group (M = 54.04, SD = 8.52). The mean score of the abuse

414 J. de Patii and M. I. Arruabarrena

group (M = 59.29, SD = 9.16) was not statistically different from the mean scores of the neglect and the comparison groups.

Next, the three subscales that comprise the Internalizing scale (i.e., Withdrawn, Somatic Complaints, Anxious/Depressed) were analyzed. On the Withdrawn subscale the one-way ANOVA indicated a significant difference, F(2, 63) = 3.82, p = .03, between the three groups. The Newman-Keuls ' test indicated that the mean score of the abuse group (M = 65.35, SD = 9.71) was significantly higher than the mean score of the comparison group (M = 57.28, SD = 8.82). The mean score of the neglect group (M = 62.25, SD = 10.27) was not significantly different from the mean scores of the abuse and the comparison groups. On the Somatic Complaints and the Anxious/Depressed subscales, there were no significant differences (p > .05) between the groups.

On the Attention Problems subscale, the ANOVA indicated significant differences between groups, F(2, 63) = 5.25, p = .008. The Newman-Keuls ' test indicated that the mean scores of the groups of abuse (M = 62.94, SD = 9.01) and neglect (M = 67.33, SD = 13.80) were significantly higher than the mean score of the comparison group (M = 54.04, SD = 5.86). The difference between the abuse and the neglect groups was not significant (p > .05).

Finally, in an exploratory analysis, the relationship between the child's gender and social and behavioral problems was assessed using a t-test with Total Behavior Problem scores, independent of group status. The analysis revealed a significantly higher mean score for girls (M = 62.17, SD = 10.21 vs. M = 54.77, SD = 9.85, t = -2 .99, p < .01). Additional t-tests performed using the Externalizing and Internalizing scales showed only significant differences between groups on the Externalizing scores, with girls obtaining a higher mean score (M = 60.53, SD = 10.63 vs. M = 50.80, SD = 9.56, t = -3 .91, p < .001). Bonferonni adjustments were used in the t-tests. An overall MANOVA conducted to examine gender differences using the seven TRF subscales was not significant (p > .05). As an additional exploration of gender differences, Group (abuse, neglect, comparison) x Sex analyses were conducted on the scores of Total Behavior Problems, Internalizing scale, Externalizing scale, and the seven subscales. No significant interactions were found (p > .05).

Academic and Adaptive Functioning

The study also analyzed the school adjustment of the abuse, neglect, and comparison groups. For this analysis, the TRF provides the following measures related to the child's functioning at school: repeated grade, special class attendance, academic performance and adaptive functioning. Chi-square tests were performed for the two categorical variables: repeated grade and special class attendance. The chi-square tests showed significant differences for the repeated grade variable between the neglect and the abuse groups, X 2 (1, N = 36) = 4.96, p = .02, and between the neglect and the comparison groups, X 2 (1, N = 45) = 12.44, p < .0005. Thus, there was a significantly higher percentage of children who repeated a grade in the neglect group (57.1%, 12/21, three cases missing) than in the groups of abuse (20%, 3/15, two cases missing) and comparison (8.3%, 2/24, one case missing). For the special class attendance variable, the chi-square tests indicated significant differences between the abuse and the comparison groups, X 2 (1, N = 40) = 12.72, p < .0005, and between the neglect and the comparison groups, X 2 (1, N = 46) = 7.52, p < .01, indicating a significantly higher percentage of children in the groups of abuse (43.7%, 7/16, one case missing) and neglect (27.3%, 6/22, two cases missing) attended a special class compared to the comparison group (0%, 0/24, one case missing). The difference between the abuse and neglect groups was no significant on the special class attendance variable.

On the Academic Performance subscale of the TRF, the ANOVA indicated significant differences between groups, F(2, 63) = 12.41, p < .0001. The Newman-Keuls ' test (p < .05) indicated that the mean scores of the abuse (M = 38.65, SD = 6.70) and neglect (M = 39.12,

Behavior problems in physically abused and neglected children 415

SD = 6.73) groups were significantly lower than the mean score of the comparison group (M = 48.32, SD = 8.48). The difference between the abuse and neglect groups was not significant. On the Adaptive Functioning subscale, the ANOVA indicated significant differences between groups, F(2, 63) = 19.32, p < .0001. The Newman-Keuls' test (p < .05) indicated that the groups of abuse (M = 38.76, SD = 4.44) and neglect (M = 38.04, SD = 5.42) had a significantly lower score than the comparison group (M = 47.88, SD -- 7.42). The mean scores of the abuse and neglect groups were not statistically different.

DISCUSSION

Overall, the results of the present study support previous research (e.g., Erickson, Egeland, & Pianta, 1989; Jacobson & Straker, 1982; Kurtz, Gaudin, Wodarski, & Howing, 1993), which reported that physically abused and neglected children present a significantly greater number of social and behavioral problems and less school adjustment than nonmaltreated children. Specifically, in this sample of Spanish school-aged children, physically abused children were rated by their teachers as having more internalizing behavior problems than physically neglected and nonmaltreated children, whereas physically neglected children were reported as having more externalizing behavior problems than physically abused and nonmaltreated children. Both physically abused and neglected children presented a lower level of academic performance and a lower adaptive functioning at school than nonmaltreated children, with the neglected children showing the greatest academic delay.

Exploring the existence of specific behavioral patterns, the present study found that the physically abused and neglected children, when compared to nonmaltreated children, showed more problems in establishing and maintaining relationships with their peers. However, such deficits in social interaction seemed to be associated with different behavioral patterns. While physically abused children showed more social withdrawal, physically neglected children showed more aggressive behaviors.

The findings obtained in the present study are supported by some research carried out with school-aged physically abused and neglected children. For example, the present results are similar to those observed by Jacobson and Straker (1982), who reported that school-aged physically abused children showed more avoidance but no more aggressive behaviors in the interaction with peers in the school context than nonmaltreated children. However, the present findings are not similar to some studies of abused and neglected toddlers and preschoolers (e.g., Erickson, Egeland, & Pianta, 1989; George & Main, 1979; Hoffman-Plotkin & Twen- tyman, 1984), and did not support the general hypotheses of associations between aggression problems and physical abuse and between isolation or inadequate social interaction and physical neglect.

Methodological differences may explain the different results obtained about the socioemotional and behavioral consequences of physical abuse and neglect in children. However, it is also important to consider the possibility that developmental differences may contribute to variations in study results. From a developmental perspective, some authors (e.g., Crittenden, 1992) have suggested that maltreated children's coping strategies may vary not only as a function of the nature of the treatment experienced (e.g., physical abuse or physical neglect), but also as a function of the child's development, with coping strategies changing with the children's increasing physical and cognitive skills. Studies carried out by Crittenden (1988, 1992) provide data that are congruent with this perspective. Crittenden found a significant inhibition of angry behavior in physically abused toddlers in their interaction with their mothers, with the consequent substitution of compliant and/or cooperative behavior. On the other hand, she found that some neglected toddlers, although initially passive in the interaction with their parents, developed extremely active behavior.


The behavioral inhibition in relationships with significant adults in physically abused children and the development of externalizing behaviors in physically neglected children, could be considered as coping strategies which allow the child to adapt and survive in a hostile family environment. When the child enters the school context these behavioral patterns may be well- established, with a tendency to be maintained in relationships with other adults and peers. Moreover, it may be erroneous to expect that all physically abused and physically neglected children show one single coping strategy. As Kaufman and Cicchetti (1989) noted, some physically abused children show a greater tendency to use withdrawal, whereas others show aggression, and others demonstrate both behavioral tendencies. It is likely that physically neglected children also display different coping strategies. This view is supported by the studies who reported that both physically abused and physically neglected children show both externalizing and internalizing problems (Bousha & Twentyman, 1984; Erickson, Egeland, & Pianta, 1989; Jacobson & Straker, 1982; Jaffe, Wolfe, Wilson, & Zak, 1986; Kaufman & Cicchetti, 1989, Wolfe & Mosk, 1983).

Numerous studies have found an association between early abuse and neglect and later antisocial behavior (Crouch & Milner, 1993, Salzinger et al., 1991; Widom, 1989). The results of the present study showed a higher incidence of delinquent behaviors in physically abused and neglected children than in nonmaltreated children and indicated that such an association can be found in preadolescent ages.

Also, the present study found that physically abused and neglected children, compared to nonmaltreated children, presented more attention disorders, which could be directly linked to the deficits in school performance and adjustment found in this sample of abused and neglected children. It is interesting to note that the neglected children were those showing greatest problems in school performance. As Claussen and Crittenden (1991) found, physical neglect was correlated with cognitive and social/emotional neglect, and it is possible that deficits in the level of stimulation and interaction characteristics of the neglectful families, more than the physical neglect itself, was the main cause of the intellectual and cognitive delay shown by these children (Crouch & Milner, 1993, Kurtz, Gaudin, Wodarski, & Howing, 1993).

It is important to note the result related to the gender differences obtained on child behavior problems. Similar to the findings of Kaufman and Cicchetti (1989), the present study did not find a significant interaction effect between gender and maltreatment status. However, contrary to the Kaufman and Cicchetti (1989) and other studies (e.g., Maylone, 1985), which showed a greater tendency in boys to have more problems of aggressiveness, in the present research the girls presented more externalizing problems.

In summary, the present study reports the existence of different consequences on child's social and behavioral development depending on the type of maltreatment, suggesting the need to establish different treatment strategies for physically abused and neglected children. It is also important to note that the problems of school-aged abused and neglected children in their patterns of social interaction with peers, in their school performance and adjustment, and in the presence of delinquent behaviors, indicate that these children show a high risk towards later deficits in their social adjustment. The rehabilitative intervention with school-aged abused and neglected children ought to, according to these results, include not only parental and family treatment, but also specific interventions based on the individual assessment of each child in order to correct the deficits in the patterns of social interaction and cognitive development shown by these children.

The findings of this study can help clarify the specific consequences of physical abuse and neglect on Spanish children. However, these results need to be confirmed with studies that use simultaneously multiple measures (e.g., direct observation, interviews, questionnaires) in different contexts (e.g., family, school) to assess more fully the behavior patterns associated with child abuse and neglect. It might rather be, as the results of Howes and Espinosa (1985) suggested, that the behavioral patterns of maltreated children change, not only depend on the context in which the child is, but also depend on the specific situations of the same context.

Behavior problems in physically abused and neglected children 417

Acknowledgement--The authors gratefully acknowledge Joel S. Milner for his comments on an earlier draft of this paper.

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REsumE--Cette Etude menEe darts la region basque espagnole a porte sur ies probl~mes de comportement d'enfants d'fige scolaire abuses et nEgligEs, les comparant avec des enfants appareillEs selon certaines variables dEmographiques. Les donnEes ont Et6 obtenues ah partir des dossiers scolaires de 66 enfants rEpartis en trois groupes: 17 enfants abuses physiquement, 24 enfants nEgligEs et 25 enfants d'un groupe de comparaison considErE ~t risque non 61evE. Dans l'ensemble, les enfants maltraitEs et les enfants nEgligEs ont eu des scores plus 61evEs au niveau des troubles de comportement que le groupe de comparaison. Mais d'apr~s une Echelle pour mesurer l'extEriorisation, les enfants nEgligEs ont obtenu des scores plus ElevEs que le groupe de comparaison, tandis que i'Echelle d'intEriorisation a dEmontr6 que c'Etait les enfants maltraitEs qui ont eu des scores plus 61evEs. L'analyse a dEmontr6 que les enfants abuses et les enfants nEgligEs avaient des scores plus 61evEs d'apr~s ies instruments mesurant les probl~mes sociaux, les comportements dElinquants et les problbmes de concentration. De plus, les enfants nEgligEs s'avEraient plus agressifs que les enfants du groupe de comparaison tandis que les enfants abuses Etaient plus renfermEs sur eux- mEmes que les enfants du groupe de comparaison. Les enfants abuses et les enfants n6gligEs ont aussi dEmontrE un ajustement scolaire infErieur au groupe de comparaison. On discute des explications possibles, des recherches et des modalitEs de traitement qui pourraient s'appliquer.

Resumen--Este estudio investig6 los problemas de conducta en nifios/as de edad escolar objeto de maltrato fisico, de abandono ffsico, y un grupo de comparaci6n en el Pals Vasco (Espafia). Se obtuvieron datos de la versi6n para maestros dei Child Behavior Checklist de 66 nifios/as pertenecientes a tres grupos (17 objeto de maltrato ffsico, 24 objeto de abandono flsico, y 25 nifios/as comparaci6n bajo-riesgo). Los tres grupos fueron equiparados en siete variables sociodemogrificas. Globalmente, los nifios/as objeto de maltrato y abandono ffsico obtuvieron puntuaciones mis altas que el grupo comparaci6n en el Total de Problemas de Conducta. Sin embargo, s61o los nifios/as objeto de abandono ffsico obtuvieron puntuaciones m~is altas que el grupo comparaci6n en la puntuaci6n total de la Escala Externalizada, y s61o los nifios/as objeto de maltrato ffsico puntuaron mis alto que el grupo comparaci6n en la puntuaci6n total de la Escala Internalizada. Anilisis subsiguientes indicaron que tanto los nifios/as objeto de maltrato como los nifios/as objeto de abandono obtuvieron puntuaciones mls altas en las subescalas de Problemas Sociales, Conducta Delictiva, y Problemas de AtenciEn. Ademis, los nifios/as objeto de abandono ffsico obtuvieron puntuaciones mils altas que los nifios/as del grupo comparaci6n en la subescala de Conducta Agresiva, y los nifios/as objeto de maltrato ffsico tuvieron puntuaciones mis altas que los nifios/as del grupo comparaci6n en la subescala de Rechazo. Los nifios/as objeto de maltrato y abandono mostraron tambiEn un menor ajuste escolar que el grupo comparaci6n. Se comentan las posibles explicaciones de estos hallazgos y sus implicaciones para la investigaci6n y el tratamiento.

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Behavior problems in school-aged physically abused and neglected children in Spain