Child neglect is the most frequent form of child maltreatment and results in more fatalities than all other types of child maltreatment in the United States. Child abuse often involves acts of commission, but child neglect often involves chronic acts of omission in care by a parent or caregiver which cause (the harm standard) or create an imminent risk (the endangerment standard) of serious physical or mental harm to a child under 18 years of age. Neglect may be physical, medical, educational, or emotional. It may involve a failure to provide for a child’s basic needs of nutrition, clothing, hygiene, safety, or affection. It may involve abandonment, expulsion, inadequate supervision, permitted substance abuse, chronic school truancy, or failure to enroll a child in school. Many neglected children experience various forms of abuse as well. School personnel, law enforcement officers, and medical personnel are the most frequent reporters of child neglect.
Epidemiology of Child Neglect
The youngest (most dependent) children are the most frequent victims of neglect, with boys being significantly more emotionally neglected than girls. Mothers (birth parents) are the most frequent perpetrators, given that women tend to be primary caregivers. Studies using the most varied and nationally representative sources of information report no significant race differences in the overall incidence of child maltreatment. Children from single-parent families, those from the lowest income strata (less than $15,000 in the 1990s), and children in the largest families (four or more children) are most likely to be neglected.
Correlates of Child Neglect
A systemic perspective (including the society, community, family, and individual) best encompasses the variety of factors correlated with child neglect. Poor parenting knowledge and skills, such as not engaging in discussions of emotional issues and showing a high degree of negative emotions; parental psychological disorders, especially depression and substance abuse; and a family history of maltreatment are often observed in neglectful parents. When the mother’s partner is not the child’s father, when there is domestic violence, and when the parents lack support or are socially isolated, the possibility of child neglect increases. Many of these factors are highly correlated with social class and neighborhood characteristics and are more often observed in individualistic than in collectivistic cultures and in societies, such as the United States, which have lower levels of systemic supports (e.g., national health care) for families.
Effects of Child Neglect
Effects of child neglect depend on the severity, duration, and type of neglect; the age, temperament, and other characteristics of the child; the number of risk factors; and the strengths of the child, family, and larger context.
Child neglect correlates with many physical and psychological problems. Research findings include delayed body and head circumference growth, increased rates of infection and failure to thrive, somatization (expressing emotional problems through bodily ones), and a higher frequency of heart and liver disease in adults who were maltreated as children.
Delayed intellectual, motor, and linguistic development often characterizes neglected children. Neuropsychological tests show deficits in attention, executive functions (e.g., planning), memory and learning, visual-spatial abilities, and sensorimotor functions. Research findings also include poor school performance and lower IQ and academic achievement in adults who were maltreated as children.
Neglected children exhibit both externalizing and internalizing problems. Externalizing problems involve acts that adversely affect others (e.g., aggression). Internalizing problems involve those that adversely affect primarily the child (e.g., depression and anxiety). Neglected children often have difficulty with behavioral and emotional regulation (e.g., the ability to inhibit impulsive behavior) and are more prone to substance abuse as adults.
Neglected children are at a higher risk of social-relational problems. They often demonstrate lower levels of emotional understanding, withdrawal from social interactions, excessive attention seeking, or attachment problems. Childhood neglect is a risk factor for violence against a dating partner and for difficulty in forming intimate relationships in adulthood. The psychological assaults on the child’s sense of safety, trust, and self-worth can have long-term consequences for interpersonal relations with peers and adults.
Child neglect is a risk factor for psychopathology. Diagnoses include post-traumatic stress disorder, hyperactivity and inattention, and oppositional-defiance, conduct, and separation anxiety disorders. Various anti-social behaviors also occur in adolescence and adulthood. Adult victims of child neglect use medical, correctional, social, and mental health services more frequently than do non-neglected individuals. People with childhood histories of trauma and maltreatment make up almost the entire criminal justice population in the United States.
Results of recent neuroimaging studies suggest that the brains of children may be negatively impacted by maltreatment. Negative environmental circumstances, such as neglect, may cause anxiety and distress, which impact the neurotransmitter, neuroendocrine, and immune systems. These systems impact the brain’s development, adversely affecting the child’s psychological and educational development.
Child Neglect Intervention
Most studies on intervention address abuse rather than neglect. However, findings of multisystemic contributions to the etiology of child neglect suggest that intervention has to be multisystemic as well. Earlier intervention enhances the likelihood of success.
Given that children are emotionally attached, even to neglectful parents, intervention work should first help the parents become more caring and responsive caregivers. Intervention starts with an assessment of a family’s strengths as well as the factors that contribute to child neglect. Strengths need to be supported and used to address any deficits. Basic needs, such as jobs and housing, and parental problems, such as substance abuse, domestic violence, and psychopathology, need to be addressed. Multidisciplinary teams are often necessary, and intervention work is difficult.
Support is fundamental in effective parenting. Fathers and father figures need support to be involved in child care and to learn appropriate parenting. The availability of supportive others (e.g., relatives, neighbors, teachers) needs to be explored and supported. Provision of child care or parent aides can reduce the stresses on parents; parent support groups can be helpful as well. Provision of opportunities for family fun can also be healing.
Once parents feel supported, they may be more able to address their children’s needs. Parenting classes, video feedback, and direct intervention in the family may be helpful. A therapist can observe family interactions and interpret the child’s actions for parents in ways that clarify the child’s developmental needs for support and limits and age-appropriate ways that parents can address these needs. The parents’ own past experience of neglect can be an obstacle that needs to be therapeutically addressed as well.
Therapeutic work with the child varies with the child’s age. Identification of children’s strengths is important. Play and art therapy allow for nonverbal means through which younger children can express themselves and work through their anxieties or depression. Storytelling techniques can help older children. Adolescents and adults, with more developed verbal skills and rational thought, can work through their experiences in a more traditional verbal therapeutic setting. Children can be taught to express their needs clearly and appropriately and can be offered sources of support in addition to their parents. Big Brother and Big Sister programs can offer attachment opportunities. Peer relations can be fostered through the teaching of social skills and through support groups. Positive experiences with other adults and children and opportunities for pleasure and mastery can provide reparative experiences for neglected children.
Various states have developed time limits for parental change in the cases of child maltreatment. If neglect is severe or if changes are not sufficient or rapid enough to ensure the child’s safety, the child may be placed in foster care or placed for adoption. At these times, psychological issues related to separation, reunification, and termination need to be addressed.
Child Neglect Prevention
Prevention programs should reduce risk factors and promote protective factors in the society, community, family, parent, and child. Community-based service programs that help at-risk families in their homes and neighborhoods, even for only 3 months, have shown positive effects in reducing risk (e.g., parental depression) and in promoting protective factors (e.g., parenting competence). These programs offer information, emergency services, parenting support, and education, and they also address existing mental health and substance abuse problems.
Realignment of national budget priorities toward more support for families is vital. Social changes, such as fair living wages and increased availability of quality low-income housing, address poverty issues that affect many neglectful parents. A national health (including mental health) care system and universal quality child care will ease pressures that make it more difficult to be a caring parent. Child Protective Services investigate only a fraction of children reported to them, suggesting that they need additional resources. Increased services to families, such as home visits, early childhood and parenting education, and heightened awareness and resources for work with domestic violence and substance abuse, are essential, as is educating the public about child neglect.
- Dubowitz, Howard, ed. 1999. Neglected Children: Research, Practice and Policy. Thousand Oaks, CA: Sage.
- Gaudin, James M., Jr. 1993. Child Neglect: A Guide for Intervention. Washington, DC: U.S. Department of Health and Human Services.
- Pelton, Leroy H. 1985. The Social Context of Child Abuse and Neglect. New York: Human Sciences Press.
- Sedlak, Andrea J. and Diane D. Broadhurst. 1996. Executive Summary of the Third National Incidence Study of Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Services.
- Winton, Mark A. and Barbara A. Mara. 2001. Child Abuse and Neglect. Boston: Allyn & Bacon.
- Zielinski, David S. and Catherine P. Bradshaw. 2006. “Ecological Influences on the Sequelae of Child Maltreatment: A Review of the Literature.” Child Maltreatment 11(1):49-62.
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