Child neglect

Definition

Neglect is difficult to define, since there are no clear, cross-cultural standards for desirable or minimally adequate child-rearing practices. Research shows that neglect often coexists with other forms of abuse and adversity. While neglect generally refers to the absence of parental care and the chronic failure to meet children's basic needs, defining those needs has not been straightforward. In "Working Together", the Department for Education and Skills (United Kingdom) defined neglect in 2006 as:

...the persistent failure to meet a child's basic physical and/or psychological needs, likely to result in the serious impairment of the child's health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to provide adequate food, clothing and shelter (including exclusion from home or abandonment); protect a child from physical and emotional harm or danger; ensure adequate supervision (including the use of inadequate care-givers); or ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.

Child neglect (also called psychological abuse) is commonly defined as a failure by a child's caregiver to meet a child's physical, emotional, educational, or medical needs. Forms of child neglect include: Allowing the child to witness violence or severe abuse between parents or adult, ignoring, insulting, or threatening the child with violence, not providing the child with a safe environment and adult emotional support, and showing reckless disregard for the child's well-being.

Other definitions of child neglect are:

Summary:

The definition of child neglect is broad. There are no specific guidelines that determine when a child is being neglected; therefore, it is up to state government agencies and professional groups to determine what is considered neglect. In general, child neglect is considered the failure of parents or caregivers to meet the needs that are necessary for the mental, physical, and emotional development of a child.

Child neglect is one of the most common forms of child maltreatment, and it continues to be a serious problem for many children. Child neglect tremendously affects the physical development, mental development, and emotional development of a child causing long term consequences, such as poor academic achievement, depression (mood), and personality disorders. These consequences also impact society, since it is more likely that children who suffered from child neglect will have drug abuse problems and educational failure when they grow up.

Types

There are various types of child neglect.

Child neglect can also be described by degrees of severity and the responses considered warranted by communities and government agencies.

Experience

Children may be left at home alone, which can result in negative consequences. Being left at home alone can leave young people feeling scared, vulnerable and not knowing when their parents are going to return. The frequency and duration of being left at home alone may range from every evening, to several days or even weeks at a time.

Also, young children may not be provided with a suitable amount of decent food to eat, which is another form of neglect. Children have reported being provided with moldy food, or not having any food in the house, or they were given an insufficient amount of food.

Causes

The causes of child neglect are complex and can be attributed to three different levels: an intrapersonal, an inter-personal/family, and a social/economic level. Although the causes of neglect are varied, studies suggest that, amongst other things, parental mental health problems, substance use, domestic violence, unemployment, and poverty are factors which increase the likelihood of neglect. Children that result from unintended pregnancies are more likely to suffer from abuse and neglect. They are also more likely to live in poverty. Neglectful families often experience a variety or a combination of adverse factors.

Intra-personal

At the intra-personal level, the discussion around neglectful parents' characteristics often focuses on mothers, reflecting traditional notions of women as primary caregivers for children. "Neglectful attributes" have included an inability to plan, lack of confidence about the future, difficulty with managing money, emotional immaturity, lack of knowledge of children's needs, a large number of children, being a teenage mother, high levels of stress and poor socioeconomic circumstances. Mental health problems, particularly depression, have been linked with a parent's inability to meet a child's needs. Likewise, substance misuse is believed to play a crucial role in undermining a parent's ability to cope with parental responsibilities. While the literature largely focuses on mothers, the role of fathers in neglect as well as the impact of their absence remains largely unexplored. There is still little known about whether mothers and fathers neglect differently and how this affects children. Similarly, not much is known about whether girls and boys experience neglect differently.

Inter-personal/family

At the inter-personal/family level, a significant number of neglectful families are headed by a lone mother or have a transient male. Unstable and abusive relationships have also been mentioned as increasing the risk of child neglect. The impact of living with domestic violence on children frequently includes either direct violence or forced witnessing of abuse, which is potentially very damaging to children. While the UK Department of Health connects children's exposure to domestic violence to parents' failure to protect them from emotional harm, the notion of "failure to protect" has been challenged as it focuses primarily on the responsibility of the abused parent, usually the mother, who is often herself at significant risk. A recent reform to the Domestic Violence, Crime and Victims Act (2004) has introduced a new offence of causing or allowing the death of a child or vulnerable adult, thus reinforcing the notion of "failure to protect". Research on domestic violence, however, has consistently shown that supporting the non-abusive parent is good child protection. There is some indication of the cyclical and inter-generational nature of neglect. A study on childhood abuse and the mother's later ability to be sensitive to a child's emotions showed that mothers with a self-reported history of physical abuse had higher indications of insensitivity and lack of attunement to infants’ emotional cues than mothers with no history of abuse. Although the literature suggests that neglectful parents may have been affected adversely by their own past experiences, more research is needed to explore the link between past experiences of maltreatment and neglectful parenting behaviours. Alcohol and drug abuse in caregivers are important risk-factors for recurrent child maltreatment after accounting for other known risk factors; the increased risk appears to be similar between alcohol and drug abuse.

Social/economic

At the social/economic level, the association between poverty and neglect has frequently been made. A study of the maltreatment of children by the National Society for the Prevention of Cruelty to Children supports the association between neglect and lower socio-economic class. US studies have shown that less affluent families are more likely to be found to maltreat their children, particularly in the form of neglect and physical abuse, than affluent families. Some argue that many forms of physical neglect, such as inadequate clothing, exposure to environmental hazards and poor hygiene may be directly attributed to poverty whereas others are more cautious in making a direct link. Studies have shown that parents in a low socioeconomic level are less likely to purchase resources needed for their children, which makes them experience school failure at a more frequent level. While poverty is believed to increase the likelihood of neglect, poverty does not predetermine neglect. Many low-income families are not neglectful but provide loving homes for their children. However, when poverty coexists with other forms of adversity, it can negatively impact parent's ability to cope with stressors and undermine their capacity to adequately respond to their child's needs. It can also mean that parents who want to work are faced with the choice between being unemployed and leaving their children at home. McSherry argues that the relationship between child neglect and poverty should be seen as circular and interdependent. Where caregiver alcohol abuse is identified, children are significantly more likely to experience multiple incidents of neglect compared with children where this is not identified, as were children where other family risk factors (including markers of socioeconomic disadvantage) are found.

Taboo

There is some evidence to suggest that there is a cultural taboo around acknowledging child neglect in one's own family. In one research study parents who accessed a service focused on families where child neglect is a concern never mentioned the word 'neglect' during interviews designed to find out about their experience of the service. In an analysis of NSPCC Childline data, John Cameron, the Head of Helplines reported that many of the neglected children who contacted the line did not use the word neglect and did not indicate that they were being neglected when they first spoke to a member of Childline.

Effects

Effects of child neglect can differ depending on the individual and how much treatment is provided, but generally speaking child neglect that occurs in the first two years of a child's life may be more of an important precursor of childhood aggression compared to later neglect, which may not have as strong a correlation. Children who suffer from neglect most often also have attachment difficulties, cognitive deficits, emotional/behavioral problems, and physical consequences as a result of neglect. Early neglect has the potential to modify the body's stress response, specifically cortisol levels (stress hormones) which can cause abnormalities and alter the body's overall health. Research has shown that there is a relationship between neglect and disturbed patterns of infant-caretaker attachment. If parents lack sensitivity to their baby's needs, the baby may develop insecure-anxious attachment. The neglectful behavior the child experiences will contribute to their attachment difficulties and formation of relationships in the future, or lack thereof. In addition to biological and social effects, neglect affects intellectual ability and cognitive/academic deficits. Also, children who suffer from child neglect may also suffer from anxiety or impulse-control disorders. Another result of child neglect is what people call "failure to thrive". Infants who have deficits in growth and abnormal behaviors such as withdrawal, apathy and excessive sleep are failing to thrive, rather than developing to become "healthy" individuals (Barnett et al., p 86)..

A study by Robert Wilson, a professor at Rush University Medical Center in Chicago, and his colleagues, showed for the first time that children under the age of 18 when they were moderately neglected in some manner by their caregivers had a 3 times likely risk of stroke over those with moderately low levels, after controlling for some common risk factors (they interviewed 1,040 participants ages 55 or older; after 3 1/2 years, 257 of them died and 192 were autopsied, with 89 having stroke evidence upon autopsy and another 40 had a history of it). Neglect, bullying, and abuse have previously been linked to changes in the brain's grey matter and white matter and to accelerated aging. For further information, please see the link to the online news story article on the study, from the NBCNews.com Health VITALS blog, by unnamed LiveScience staff.

Statistics

In terms of who is reported for neglectful behavior, it is most often women. The higher proportion of females reported for neglect may reflect the social attitude that mothers are responsible for meeting the needs of their children. In recent years, latent issues for child development and for the culture and political economy that are associated with paternal neglect have received more attention, however. Neglecting parents interact less with their children, engage in less verbal instruction and play behavior, show less affection and are involved in more negative interactions with their children, for example verbal aggression. Often parents who neglect their children are single parents or disabled mothers who already have to care for themselves, and therefore the child is an additional stress. This additional stress is often neglected. Family size can contribute to child neglect. If a family has several children, they may not be able to give all the children all the basic necessities needed to survive and thrive. Unfortunately, if the family cannot provide for all their children, children can suffer neglect. Family history can play a role in parents’ neglectful behavior. If parents were neglected as children meaning they learned neglectful behavior from their own parents, they often internalize and believe those behaviors to be the "norm", which results in neglecting their own children (Barnett et al., p. 92). In one study done in 2011, results showed that one in four mothers were neglectful, and neglect was four times as likely with a maternal history of physical abuse in childhood than with no history of maltreatment.

Disclosure

Research suggests that most neglected children, even when they are able to talk to a professional about their circumstances, do not use the word 'neglect' and may not even indicate that they are being neglected. It is therefore recommended that professionals are proactive in exploring for and identifying neglect.

When neglect is disclosed, action is not always taken. Equally when professionals pass concerns about neglect on to other professionals in the workplace they find those professionals do not always respond. The NSPCC recently reported on the case of a teaching assistant, who contacted the organization with concerns about a particular child. The teaching assistant asked to remain anonymous, fearing that she would be sacked by her school if they were to find out that she'd made the disclosure.

Assessing and identifying

Assessing and identifying neglect pose a number of challenges for practitioners.

Selecting the right method to identify neglect can be helped by having a clear conceptualization of neglect. Neglect is a process whereby a child experiences developmental delay owing to the fact of not having received sufficient levels of any combination of care, stimulation or nutrition, what collectively can be referred to as nurturance. Given that neglect is a dynamic between the child's development and levels of nurturance, the question in identifying neglect, becomes one of where do you start, with the child's development or with the levels of nurturance?

Development focused methods

Some professionals identify neglect by measuring the developmental levels of a child, for if those developmental levels are normal, one can, by definition, conclude that a child is not being neglected. Areas of development that could be measured include weight, height, stamina, social and emotional responses, speech and motor development. All these features go up to make a medical assessment of whether a child is thriving, so that a professional looking to start an assessment of neglect, might reasonably start with information collected by a doctor. Infants are often weighed and measured when seen by their physicians for well-baby check-ups. The physician initiates a more complete evaluation when the infant's development and functioning are found to be delayed. What this suggests is that social work staff could consult medical notes to establish if the baby or child is failing to thrive, as a first step in a pathway towards identifying neglect. If developmental levels are subnormal, then the identification of neglect requires the professional establish if those subnormal levels of development can be put down to the level of nurturance experienced by the child. One needs to discount that the developmental delay was caused by some genetic condition or disease.

Starting the assessment by examining the nurturance received by child

Another way of beginning the process of identifying neglect is to identify if the child in question is experiencing a level of nurturance lower than that considered necessary to support normal development. In part, this requires a knowledge of the level of nurturance required by the child to sustain normal development, which might be particular to his or her age, gender and other factors. However, quite how one ascertains what a particular child needs, without referring back to their level of development, is not something theory and policy on neglect is clear about. Furthermore, ascertaining whether a child is getting the requisite level of nurturance needs to take into account not just the intensity of the nurturance, but also, given that the intensity of certain forms of nurturance can carry across time, the duration and frequency of the nurturance. It is OK for a child to experience varying and low levels of certain types of nurturance across a day and from time to time, however, it is not OK if the levels of nurturance never cross thresholds of intensity, duration and frequency. For this reason, professionals are minded to keep detailed histories of care provision, which demonstrate the duration to which the child is exposed to periods of subnormal exposure to care, stimulation and nutrition.

Starting the assessment by examining the nurturance provided by the carer or parent

Professionals should focus on the levels of nurturance provided by the carers of the child, where neglect is understood as an issue of the parents' behaviour. Some authors feel that establishing the failure of parents and caregivers to provide care would be sufficient to conclude that neglect was occurring. Action for Children state that, "A child experiences neglect when the adults who look after them fail to meet their needs" clearly defining neglect as a matter of parental performance. This raises the question about what level of nurturance, a carer or parent needs to fall under, to provoke developmental delay, and how one goes about measuring that accurately.

The method, which focuses on the stimulation provided by the carer, can be subject to critique. Neglect is about the child's development being adversely affected by the levels of nurturance, but the carers' provision of nurturance is not always a good indicator of the level of nurturance received by the child. Neglect may be occurring at school, outside of parental care. The child may be receiving nurturance from siblings or through a boarding school education, which compensates for the lack of nurturance provided by the parents.

Linking development to stimulation

Neglect is a process whereby children experience developmental delay owing to experiencing insufficient levels of nurturance. It has been argued that in principle, this means that when starting an assessment of neglect by identifying developmental delay one needs to then check the levels of nurturance received by the child. Certainly, where guidance on identifying neglect does urge for practitioners to measure developmental levels, some guidance urges practitioners to focus on how developmental levels can be attributed to parental behaviour. However the narrow focus on parental behaviour can be criticised for unnecessarily ruling out the possible impact of institutionalised neglect, e.g. neglect at school.

If one starts by concluding that the levels of nurturance received by the child are insufficient, one then needs to consider the developmental levels achieved by the child.

Further challenges arise however. Even when one has established developmental delay and exposure to low levels of nurturance, one needs to rule out the possibility that the link between the two is coincidental. The developmental delay may be caused by a genetic disorder, disease or physical, sexual or emotional abuse. Of course the developmental delay may be caused by a mixture of underexposure to nurturance, abuse, genetics and disease.

Practical tools for measuring

The Graded Care Profile Tool is a practice tool which gives an objective measure of the quality of care in terms of a parent/carer's commitment. It was developed in the UK.

The North Carolina Family Assessment Scale is a tool which can be used by a practitioner to explore whether neglect is taking place across a range of family functioning areas.

Evidence for the effectiveness of assessment in child neglect cases

Professionals conducting assessments of families where neglect is taking place are said to sometimes make the following errors:

Intervention programs

Early intervention programs and treatments in developed countries include individual counselling, family, group counselling and social support services, behavioural skills training programs to eliminate problematic behaviour and teach parents "appropriate" parenting behaviour.

Video Interaction Guidance

Video interaction guidance is a video feedback intervention through which a "guider" helps a client to enhance communication within relationships. The client is guided to analyse and reflect on video clips of their own interactions. Video Interaction Guidance has been used where concerns have been expressed over possible parental neglect in cases where the focus child is aged 2–12, and where the child is not the subject of a child protection plan.

SafeCare

The SafeCare programme is a preventative programme working with parents of children under 6 years old who are at risk of experiencing significant harm through neglect. The programme is delivered in the home by trained practitioners, over 18 to 20 sessions and focuses on 3 key areas: parent-infant/child interaction; home safety and child health.

Triple P

Triple P (Parenting Program) is a positive parenting program. It is a multilevel, parenting and family support strategy. The idea behind it is that if parents are educated on "proper" parenting and given the appropriate resources, it could help decrease the amount of child neglect cases. When deciding whether to leave a child home alone, caregivers need to consider the child's physical, mental, and emotional well-being, as well as state laws and policies regarding this issue.

Effectiveness of intervention programs

Evidence for the effectiveness of intervention programs can be divided into two types. One type is impact studies where the aim of the evaluation is to demonstrate a statistically significant improvement in outcomes on a population, which can be attributed to the intervention. A second type is qualitative studies which aim to illuminate the mechanisms through which program participants can access the resources and help offered in the program to achieve better outcomes.

Impact studies

Several interventions aimed at families where child neglect is occurring, have been subject to an impact study.

Video interaction guidance

Video Interaction Guidance has been used where concerns have been expressed over possible parental neglect in cases where the focus child is aged 2–12, and where the child is not the subject of a child protection plan. Am evaluation of the project demonstrated that VIG produced a significant change in the emotional and behavioural difficulties of the population of children who received the service, and improvement in reported level of parenting and reported parental relationship with their children in the population of parents whose children received the service. The data excludes to parents who failed to complete the programme, parents who completed the programme but decided not to complete evaluation measures, and on some measures parents who completed measures but whose feedback was adjudged to have been positively biased.

SafeCare

The SafeCare programme has been provided to families in the United Kingdom where a professional has judged there is a risk of experiencing significant harm through neglect. Outcome data shows that on average families who participated in the evaluation of the programme improved parenting skills and reduced neglectful behaviours. Furthermore, all referrers reported see positive changes in the families they referred, particularly in home safety, parent child interaction and health. However, in the absence of a comparison group it was not possible to attribute the changes to SafeCare.

Triple P

Triple P has also been provided to families in the United Kingdom where neglect is a concern. The findings from this service showed that, on average the children who participated in the evaluation experienced improved emotional and behavioural outcomes. However this positive change could not be attributed to Triple P because a control group had not been established.

Mechanisms to stop neglect

Qualitative research studies have also illuminated some of the ways in which programs can help individual parents.

Social learning theory

Evaluations have demonstrated that in certain cases parents have learned to improve their parenting in the way described by social learning theory. Social Learning Theory suggests people learn by observing positive desired outcomes resulting from the observed behaviour. An evaluation of the Triple P intervention highlighted how many parents were able to improve the way in which they related to their children after having received advice about how to be clear and boundaried with their children, and in some cases after having tried and seen the effects of such approaches for themselves, first-hand, and often for the first time. Parents, with several children, who traditionally spent all their time with the children with the children together in the group, started spending one-to-one time with individual children, after having been required by Video Interaction Guidance, to do one-on-one activities with a particular child, for the first time. Some parents started to do activities with their children, which involved a small element of risk, after having agreed to do them for the first time as part of Video Interaction Guidance.

Relationship between practitioner and parent

A common finding across evaluations of programmes designed to help families where neglect is a concern is that the principal factor which influences parents' engagement and perception is the quality of the relationship that they are able to build up with the practitioner delivering the programme. Key factors in helping practitioners engage parents into the intervention include:

In the case of Video Interaction Guidance, when parents were asked about their experience of the intervention, parents invariably referred to the care and support provided by the practitioner. Effectively the intervention is experienced as an aspect of the overall relationship of care.

Children's responses

Children take a variety of actions to help minimise the neglect they experience.

Some children attempt to talk about the neglect to their parents. In some cases the parents may respond aggressively or abusively to such attempts to resolve the issue.

Some children steal money from their parents' purses in order to feed themselves.

Babies are too young to ameliorate parental neglect, however in some cases siblings will step in and take care of them. Some older siblings go without food so that their younger siblings can eat.