To the Editor: In an important article in the October 2009 issue, Smith and colleagues (1) reported that physical, emotional, and sexual abuse each increased the likelihood of receipt of psychiatric services by African-American children. The authors contrasted this finding with results from a previous study of mine (2) that used data from the Capella Project, a site of the LONGSCAN study (LONGitudinal Studies on Child Abuse and Neglect). The study found that maltreatment had no effect on the likelihood of receipt of mental health services in a young, predominantly African-American sample. Smith and colleagues suggested that this discrepancy was attributable to differences between our samples; the children in the Capella Project sample were younger and more racially heterogeneous and most had been recruited from families reported to child protective services. They noted that the age of the Capella Project sample was particularly likely to explain this difference: that study examined services for children aged two to seven. There is likely some truth to this explanation. Analyses of data from the sample at an older age found a stronger effect of maltreatment on receipt of mental health services (3).
I would like to suggest an additional explanation for the discrepancy in our findings. Although it was not noted in our original reports (2,3), the maltreatment experienced by children in the Capella Project, at least as reported to child protective services, was overwhelmingly likely to be neglect (4) rather than physical or sexual abuse. Child neglect is a serious public health problem and is associated with child outcomes that are generally as negative as those associated with physical and sexual abuse (5). Despite its broad and profound impact on child behavioral and emotional development, neglect remains relatively understudied, particularly in mental health services research (5). The majority of children who have been neglected do not receive adequate mental health care.
The contrast between the results of my research and of Smith and colleagues' study points to a need for increased attention to the particular mental health needs of neglected children, which are often profound and are rarely addressed adequately in the real world.
Dr. Thompson is director of research, Juvenile Protective Association, Chicago.
Smith CO, Thompson MP, Johnson K, et al: Service utilization patterns of maltreated and nonmaltreated children from low-income, African-American families. Psychiatric Services 60:1386–1389, 2009
Thompson R: The course and correlates of mental health care received by young children: descriptive data from a longitudinal urban high-risk sample. Children and Youth Services Review 27:39–50, 2005
Thompson R, May MA: Caregivers' perceptions of child mental health needs and service utilization: an urban 8-year old sample. Journal of Behavioral Health Services and Research 33:474–482, 2006
Thompson R, Wiley TR: Predictors of re-referral to child protective services: a longitudinal follow-up of an urban cohort maltreated as infants. Child Maltreatment 14:89–99, 2009
Dubowitz H: Understanding and addressing the "neglect of neglect": digging into the molehill. Child Abuse and Neglect 31: 603–606, 2007