Whether or not child maltreatment results in long-term consequences depends on the child's age and development when the maltreatment occurred; the type of maltreatment; the frequency, duration, and severity of the maltreatment; and the relationship between the victim and the abuser. The physical consequences of shaken baby syndrome, a common form of child abuse in infants, can result in the long-term consequences of blindness, learning disabilities, mental retardation, cerebral palsy, or paralysis. Other long-term physical consequences of child maltreatment in general are impaired brain development and long-term poor physical health related to the type and severity of the maltreatment. Regarding the psychological consequences of child maltreatment, long-term effects can include low self-esteem, depression, and difficulties in forming secure attachments and intimate relationships. Although not all victims of child maltreatment will have long-term behavioral difficulties, victims are at risk of difficulties during adolescence, juvenile delinquency and adult criminality, alcohol and other drug abuse, and engaging in abusive behavior with others. Regarding long-term societal consequences, direct costs of child maltreatment include the maintenance of a child welfare system that investigates allegations of child maltreatment and the costs of health and criminal justice systems that must deal with cases that stem from child maltreatment. Indirect costs involve juvenile and adult criminal activity, mental illness, substance abuse, and domestic violence, as well as loss of productivity due to unemployment and underemployment. 22 references