Maltreatment 219Development of self-concept
Maltreated children find it difficult to talk about themselves, and especially
about their negative feelings, possibly because they have learned it leads to
punishment at home. Measures of how they feel about themselves show
low self-worth and low self-competence ratings.
Symbolic and social development
Play is reduced in quantity, and its quality is impoverished, with an
increase in routine, stereotyped activity. Social play with other children
is impaired. These deficits correlate well with the quality and sensitivity
of mother–child interaction. Maltreated children show less sensitivity to
the emotions of others, more negative expectations of people, less trust in
them, and fewer ideas of how to initiate and maintain a social relationship.
They are more prone to construe ambiguous stimuli as aggressive, and
respond to this by becoming aggressive themselves. Observation of actual
peer relationships shows lack of competence, inappropriate aggression
in response to friendly overtures, and sometimes a mixed picture of
aggression and withdrawal that leads to particularly strong rejection by
the peer group. There is some evidence that this represents a disorganised
‘fight or flight’ response developed in the face of repeated overwhelmingly
frightening experiences.
Cognitive development
Both language and non-verbal abilities are less well developed than in
non-abused controls, and school attainments are even more reduced. This
may be due to a number of mechanisms, including impaired cognitive
development in a home environment lacking in rewarding reciprocal
exchanges and stimulation; the inheritance of cognitive disabilities from
similarly disabled parents, poor ability to concentrate on schoolwork and
organise it; and apathy and lack of motivation.
Emotional and behavioural disorders
These are common in abused children. By adolescence this can result
in extreme cases, both of violence with psychopathic personality, and of
suicide and deliberate self-harm. An increased incidence of post-traumatic
stress disorder is additionally reported in victims of severe physical abuse.
Although these findings emerge from studies that compare maltreated
children with controls from similar socio-economic groups and neighbour-
hoods, the families of the abused children often had disproportionately
high levels of ongoing, chronic adversity and deprivation. It is therefore
sometimes hard to disentangle the effect of the abuse from the chronic
deprivation. Where there are multiple stressors of this kind, the rate of
psychopathology may increase disproportionately.