Child Neglect and Maltreatment and Childhood-to-Adulthood Cognition and Mental Health in a Prospective Birth Cohort

3.8.2016 12:06:00

Childhood maltreatment (abuse and neglect) has been associated with health consequences, often lasting into adulthood. For mental health, the association with maltreatment is well established and seen for several disorders across the life-course, including childhood behavioral disorders, adult mood/anxiety disorders, and suicidality. The influence of maltreatment on mental health has been observed for all types of abuse and neglect and is not confined to particular disorders.  In parallel with mental health, there are reports of maltreated individuals having impaired cognition and academic achievement in childhood/adolescence. Compelling findings for effects on child/adolescent cognition come from studies of severely neglected children raised in orphanages before adoption by well-off families. Such findings raise concerns that maltreatment could compromise educational attainment and adult cognition, as suggested by findings for mental health. However, understanding of long-term effects of maltreatment on cognition and educational qualifications is rudimentary because few studies measure cognition in adulthood. Findings to date are heterogeneous: some suggest that child maltreatment predicts cognitive deficits and poorer education by adulthood, study found no relationship with educational qualifications by age  and another showed no detrimental association of childhood abuse with late-life cognition.


Most research examining maltreatment and cognition/education over the long-term is based on small selected samples, often limited to sexual and/or physical abuse and usually disregards the potential influence of maltreatment on mental health, which is associated with cognition. To our knowledge, no previous study examines childhood maltreatment associations with adult cognition in a general population. Furthermore, it is unclear whether all or specific maltreatments are associated with cognition and related educational qualifications, as there is some suggestion that neglect is especially detrimental. Education level is of interest as a potential outcome partly because it may be influenced via development of cognitive abilities but also via mental health or by other factors, such as interest in school or motivation to study. Our main aim was to establish whether associations of maltreatment with cognition/educational qualifications are evident in childhood/adolescence and then persist to midlife, and whether associations are independent of mental health. To establish whether associations vary for different forms of maltreatment, we examined neglect and abuse separately. The main focus of our study is on child-toadulthood associations with cognition and educational qualifications, but to gain greater insight into long-term sequelae and the specificity of associations, we also examined mental health outcomes.


Data are from the 1958 British Birth Cohort all born during 1 week of 1958 in England, Scotland, and Wales (n ¼ 17,638) and immigrants with the same birth week recruited to age 16 (n ¼ 920). The cohort is primarily of white ethnicity (98%) but covers the full range of social class in Britain. Information was collected throughout childhood (birth and ages 7, 11, and 16 years) and adulthood (ages 23, 33, 42, 45, and 50 years). At age 45 years, a total of 9,377 persons (78%) participated from a target of 11,971 invited, and 9,315 participants completed a childhood maltreatment questionnaire. Ethical approval was given  and informed consent was obtained from all participants.


The main findings from our large population cohort include, first, the strong association of child neglect with cognitive deficits throughout life. To illustrate, for 6% of the population with a neglect score 4 (versus 0), cognition was 0.60 SD lower at 16 years and 0.28 SD lower at 50 years after allowance for confounding factors and mental health. Child neglect was associated also with an elevated risk of poor qualifications, interestingly even after allowing for 16-year cognition and mental health. Second, abuse was mostly unrelated to cognitive function childhood-to-adulthood. Sexual abuse was an exception, with lower cognitive abilities (7-16 years) and qualifications, although associations were not independent of mental health. Third, in comparison to the specific associations of childhood neglect and sexual abuse with cognitive abilities, all child maltreatments were associated with increased mental health symptoms, from childhood to adulthood.  Our finding of child neglect associations with cognition in childhood and decades later in adulthood has implications for policy, practice, and future research. Primary prevention of child neglect is paramount to avoid a lifelong cognitive burden and poorer educational qualifications. Likewise, prevention of all maltreatments is important for child-toadult mental health. Both cognition/education and mental health are closely connected to social and lifestyle factors that affect physical health. Our study adds to the evidence base on long-term outcomes of maltreatment. Understanding the breadth of long-term outcomes provides clues to possible opportunities for remedial action; for example, our finding that sexual abuse associations with cognition/ education were not independent of mental health suggests the need for future research on whether alleviation of mental health consequences could improve cognitive functioning.




Reference: Geoffroy, M. C., Pereira, P. S., Li, L. & Power, C. (2016). Child neglect and maltreatment and childhood-to-adulthood cognition and mental health in a prospective birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry, 55 (1), 33-40


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