- » Child Neglect: A Guide for Prevention, Assessment, and Intervention
- » Impact of Neglect
Child Neglect: A Guide for Prevention, Assessment and Intervention.
Office on Child Abuse and Neglect, Children's Bureau. DePanfilis, Diane.|
|Year Published: 2006|
Impact of Neglect
The impact of neglect on a child may not be apparent at an early stage except in the most extreme cases. However, the effects of neglect are harmful and possibly long-lasting for the victims. Its impact can become more severe as a child grows older and can encompass multiple areas, including:
- Health and physical development;
- Intellectual and cognitive development;
- Emotional and psychological development;
- Social and behavioral development.
Although there are four categories of neglect's effects on an individual, they often are related. For example, if a child experiences neglect that leads to a delayed development of the brain, this may lead to cognitive delays or psychological problems, which may manifest as social and behavioral problems. Because neglected children often experience multiple consequences that may be the result of neglect and related circumstances in their lives, it may be difficult to determine if the impact is related specifically to the neglect, is caused by another factor, or arises from a combination of factors. The impact of neglect can vary based on:
- The child's age;
- The presence and strength of protective factors;
- The frequency, duration, and severity of the neglect;
- The relationship between the child and caregiver.62
The negative impacts of neglect are often associated with the various outcomes children experience in the child welfare system. For example, some of the developmental and health problems linked to neglect are related to higher rates of placement in out-of-home care, a greater number of out-of-home placements, longer out-of-home placements, and a decreased likelihood of children residing with their parents when discharged from foster care.63
Research shows that the first few years of children's lives are crucial and sensitive periods for development. During these years, neural synapses are formed at a very high rate. After the age of 3, synapses start to be "pruned," and certain pathways that are not used may be discarded. Studies supporting the idea of a sensitive developmental period show that maltreated infants suffer from greater developmental disabilities than those children who were maltreated later in childhood.64 One example of this is the ability to form attachments with one's primary caregiver. If this process is disrupted early in children's lives, they may have difficulty forming healthy relationships throughout their lives. Although learning can happen throughout life, it often is more difficult for children who were deprived of certain types of early stimulation.
Programs, such as Early Head Start and other infancy and early childhood programs, acknowledge that the first few years of life are extremely significant for development. (For more information on Early Head Start, see Chapter 6, Child Neglect Prevention and Intervention.) Child welfare laws and interventions, however, often do not provide or authorize the resources necessary to protect children from neglect during these critical years. Unless children show clear physical signs of neglect, intervention often is unlikely to be mandated. Thus, for many cases of emotional neglect, and especially for young children who cannot tell others about the neglect, interventions may occur too late or not at all. If interventions finally occur, the children may be past critical developmental points and could suffer from deficiencies throughout their lives.65 Therefore, it is important that professionals working with young children be able to recognize the possible signs of neglect in order to intervene and to keep children from suffering further harm.
Health and Physical Development
Studies show that neglected children can be at risk for many physical problems, including failure to thrive, severe diaper rash and other skin infections, recurrent and persistent minor infections, malnourishment, and impaired brain development. Because neglect includes medical neglect, other health problems can arise from the failure of the parents to obtain necessary medical care for their children. If children do not receive the proper immunizations, prescribed medications, necessary surgeries, or other interventions, there can be serious consequences, such as impaired brain development or poor physical health. The impact of a delay in or lack of treatment might be noticeable immediately or may not be apparent for several weeks, months, or even years.66 For example, a child who does not receive proper dental care might be all right in the short term, but suffer from tooth decay and gum disease later in life. Children with diabetes may be fine without treatment for a short while, but an extended delay in treatment could have serious consequences and possibly result in death.
Impaired Brain Development
In some cases, child neglect has been associated with a failure of the brain to form properly, which can lead to impaired physical, mental, and emotional development. The brain of a child who has been maltreated may develop in such a way that it is adaptive for the child's negative environment, but is maladaptive for functional or positive environments. A maltreated child's brain may adapt for day-to-day survival, but may not allow the child to develop fully healthy cognitive and social skills.67 In one study, neglected children had the highest proportion of later diagnoses of mental retardation, which may be due to not getting the necessary care and stimulation for proper brain development. Children who are neglected early in life may remain in a state of "hyper-arousal" in which they are constantly anticipating threats, or they may experience dissociation with a decreased ability to benefit from social, emotional, and cognitive experiences. To be able to learn, a child's brain needs to be in a state of "attentive calm," which is rare for maltreated children. If a child is unable to learn new information, this may cause some areas of the brain to remain inactive, possibly resulting in delayed or stunted brain growth. It also can impair functioning later in life and may lead to the child being anxious, acting overly aggressive, or being withdrawn.68
Children who have experienced global neglect, defined as neglect in more than one category, may have significantly smaller brains than the norm. This could be indicative of fewer neuronal pathways available for learning and may lead the children to be at an intellectual disadvantage for their entire lives.69
Poor Physical Health
The physical problems associated with neglect may start even before an infant is born, such as when the mother has had little or no prenatal care or smoked during pregnancy. These children may be born prematurely and have complications at birth. Neglected children also can have severe physical injuries, possibly due to the inattention of their parents, such as central nervous system and craniofacial injuries, fractures, and severe burns. They also may be dirty and unhygienic, leading to even more health problems, such as lice or infections. Children also may be exposed to toxins that could cause anemia, cancer, heart disease, poor immune functioning, and asthma. For example, exposure to indoor and outdoor air pollutants, such as ozone, particulate matter, and sulphur dioxide, can cause the development of asthma or increase the frequency or severity of asthma attacks.71 Additionally, children may have health problems due to a lack of medical attention for injury or illness, including chronic health problems. Neglected children may suffer from dehydration or diarrhea that can lead to more severe problems if unattended.
A medical condition associated with child neglect is "failure to thrive," which can be defined as "children whose growth deviates significantly from the norms for their age and gender."72 This condition typically occurs in infants and toddlers under the age of 2 years. Failure to thrive can be manifested as significant growth delays, as well as:
- Poor muscle tone;
- Unhappy or minimal facial expressions;
- Decreased vocalizations;
- General unresponsiveness.73
Failure to thrive can be caused by organic or nonorganic factors, but some doctors may not make such a sharp distinction because physical and behavioral causes often appear together. With organic failure to thrive, the child's delayed growth can be attributed to a physical cause, usually a condition that inhibits the child's ability to take in, digest, or process food. When failure to thrive is a result of the parent's neglectful behavior, it is considered nonorganic.
Treatment for failure to thrive depends on the cause of the delayed growth and development, as well as the child's age, overall health, and medical history. For example, delayed growth due to nutritional factors can be addressed by educating the parents on an appropriate and well-balanced diet for the child. Additionally, parental attitudes and behavior may contribute to a child's problems and need to be examined. In many cases, the child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral, and psychosocial treatment plan.74 Even with treatment, failure to thrive may have significant long-term consequences for children, such as growth retardation, diminished cognitive ability, mental retardation, socio-emotional deficits, and poor impulse control.75
|Exposure to alcohol and drugs in utero may cause impaired brain development for the fetus. Studies have shown that prenatal exposure to drugs may alter the development of the cortex, reduce the number of neurons that are created, and alter the way chemical messengers function. This may lead to difficulties with attention, memory, problem solving, and abstract thinking. However, findings are mixed and may depend on what drug is abused. Alcohol abuse has been found to have some of the most detrimental effects on infants, including mental retardation and neurological deficits. One problem with determining the impact of substance abuse on a fetus is isolating whether the negative outcomes are directly associated with the alcohol or drug exposure or with other factors, such as poor prenatal care or nutrition, premature birth, or adverse environmental conditions after birth.70|
Malnutrition, especially early in a child's life, has been shown to lead to stunted brain growth and to slower passage of electrical signals in the brain. Malnutrition also can result in cognitive, social, and behavioral deficits.76 Iron deficiency, the most common form of malnutrition in the United States, can lead to the following problems:
Intellectual and Cognitive Development
Research shows that neglected children are more likely to have cognitive deficits and severe academic and developmental delays when compared with non-neglected children. When neglected children enter school, they may suffer from both intellectual and social disadvantages that cause them to become frustrated and fall behind.78 One study found that individuals at 28 years of age who suffered from childhood neglect scored lower on IQ and reading ability tests, when controlling for age, sex, race, and social class, than people who were not neglected as children.79 Other studies have found that, although both abused and neglected children exhibited language delays or disorders, the problems were more severe for neglected children.80 Furthermore, neglected children have the greatest delays in expressive and receptive language when compared with abused and nonmaltreated children.81 When compared to physically abused children, neglected children have academic difficulties that are more serious and show signs of greater cognitive and socio-emotional delays at a younger age. These academic difficulties may lead to more referrals for special education services.83
There are also language problems associated with neglect. In order for babies to learn language, they need to hear numerous repetitions of sounds before they can begin making sounds and eventually saying words and sentences. Language development may be delayed if the parent or other caregiver does not provide the necessary verbal interaction with the child.
Neglect can negatively affect a child's academic performance. Studies have found that:
Emotional, Psychosocial, and Behavioral Development
Neglect can have a strong impact on, and lead to problems in, a child's emotional, psychosocial, and behavioral development. As with other effects already mentioned, these may be evident immediately after the maltreatment or not manifest themselves until many months or years later. Exhibit 3-1 is a listing of emotional, psychosocial, and behavioral problems associated with neglect.
Emotional and Psychosocial Consequences
All types of neglect, and emotional neglect in particular, can have serious psychosocial and emotional consequences for children. Some of the short-term emotional impacts of neglect, such as fear, isolation, and an inability to trust, can lead to lifelong emotional and psychological problems, such as low self-esteem.84
A major component of emotional and psychosocial development is attachment. Children who have experienced neglect have been found to demonstrate higher frequencies of insecure, anxious, and avoidant attachments with their primary caregivers than nonmaltreated children.85 In fact, studies have demonstrated that 70 to 100 percent of maltreated infants form insecure attachments with their caregivers.86 Often, emotionally neglected children have learned from their relationships with their primary caregivers that they will not be able to have their needs met by others. This may cause a child not to try to solicit warmth or help from others. This behavior may in turn cause teachers or peers not to offer help or support, thus reinforcing the negative expectations of the neglected child.87 One mitigating factor, however, may be having an emotionally supportive adult, either within or outside of the family, such as a grandparent or a teacher, available during childhood. Another mitigating factor may be having a loving, accepting spouse or close friend later in life.88
Neglected children who are unable to form secure attachments with their primary caregivers may:
- Become more mistrustful of others and may be less willing to learn from adults.
- Have difficulty understanding the emotions of others, regulating their own emotions, or forming and maintaining relationships with others.
- Have a limited ability to feel remorse or empathy, which may mean that they could hurt others without feeling their actions were wrong.
- Demonstrate a lack of confidence or social skills that could hinder them from being successful in school, work, and relationships.
- Demonstrate impaired social cognition, which is one's awareness of oneself in relation to others and an awareness of other's emotions. Impaired social cognition can lead a person to view many social interactions as stressful.89
Neglect and Emotional, Psychosocial, and Behavioral Problems
Neglected children, even when older, may display a variety of emotional, psychosocial, and behavioral problems which may vary depending on the age of the child. Some of these include:
|Society pays for many of the consequences of neglect. There are large monetary costs for maintaining child welfare systems, judicial systems, law enforcement, special education programs, and physical and mental health systems that are needed to respond to and to treat victims of child neglect and their families. Many indirect societal consequences also exist, such as increased juvenile delinquency, adult criminal activity, mental illness, substance abuse, and domestic violence. There may be a loss of productivity due to unemployment and underemployment associated with neglect. Additionally, supporting children who have developmental delays because of malnutrition often is much more costly than providing adequate nutrition and care to poor women and children.91|
Neglected children may suffer from particular behavioral problems throughout life. Research shows that children who are exposed to poor family management practices are at a greater risk of developing conduct disorders and of participating in delinquent behavior.92 Neglected children also may be at risk for repeating the neglectful behavior with their own children. Research also shows that neglected children do not necessarily perceive their upbringing to be abnormal or dysfunctional and may model their own parenting behavior on the behavior of their parents. One study estimates that approximately one-third of neglected children will maltreat their own children.93
|The incidence of neglect and the harm it does to children can be reduced or mitigated through early prevention and intervention programs. Although the effectiveness of these programs has not been studied adequately, they are most effective when they are comprehensive and long-term.94 With the effects of neglect being especially damaging during infancy, it also is important to work with families as early as possibleeven before the baby is born.95 Two promising early prevention and intervention programs are the Olds model and Project STEEP (Steps Toward Effective, Enjoyable Parenting). The Olds model utilizes intensive nurse home visiting during pregnancy and through age 2 of the child. The program had positive effects on parenting attitudes and behavior and on reports of child maltreatment.96 Project STEEP includes home visitation and group support and education for expectant mothers and seeks to enhance mother-infant relationships. In the initial implementation of this program, mothers in the experimental group demonstrated a better understanding of child development, better life management skills, fewer depressive symptoms, fewer repeat pregnancies within 2 years of the birth of their baby, and greater sensitivity to their child's cues and signals.97|
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.