Child Neglect: A Guide for Intervention
U.S. Department of Health and Human Services Gaudin, J. M., Jr.|
|Year Published: 1993|
Understanding the Causes of Neglect
Effective intervention to prevent or remedy child neglect requires an understanding of the causes. However, specification of the causes of neglect is hampered by the limited research on child neglect. Most studies of child maltreatment include both neglectful and abusive families and fail to differentiate between the groups, thus making it impossible to identify results specifically related to neglect. The numbers of studies that focus specifically on child neglect are few in comparison to studies on other types of maltreatment. Studies are most often based on small, selected samples of reported and verified neglect, composed almost exclusively of very low-income families. For these reasons, the information about causes of neglect is limited and must be considered as only suggested by the existing research.
Nevertheless, it is clear from existing studies and from the experience of practitioners that there is no single cause of the inadequate parenting we term child neglect. Thus, understanding the causality of child neglect requires that it be viewed from a broad ecological-systems perspective. Building on the previous work of child development experts, Urie Bronfenbrenner, James Garbarino, and others, Belsksy has proposed that the causes of child maltreatment be considered in such an ecological framework.23 Belsky and Vondra24 have proposed that the determinants of adequate parenting arise from three sources:
- parents' own developmental history and resultant personal psychological resources,
- characteristics of the family and child, and
- contextual sources of stress and support.
Belsky and Vondra suggest that these factors interact to influence parenting as illustrated in Figure 1. The model illustrates that the sources of influence on parenting are interactive and often reciprocal. The developmental experiences of parents influence their personality and psychological resources, which directly influence both their parenting attitudes and behavior and their ability to develop supportive relationships with others. Parenting behavior influences the child's personality and behavior, which reciprocally influences parents' response to the child. The social context of the parent-child relationship, which includes the marital relationship, social network supports, and work-related factors, is highly influential on parenting. The model provides an organizing framework for examining the contributing causes of neglect suggested by the existing research.
Parents' Developmental History and Personality Factors
The ability of a parent to provide adequate care for a child depends partly on his/her emotional maturity, coping skills, knowledge about children, mental capacity, and parenting skills.
Belsky and Vondra review evidence from numerous studies that provide support for the conclusion that "at least under certain stressful conditions, developmental history influences psychological well-being, which in turn affects parental functioning and, as a result, child development."25
These authors cite, among others, the Berkeley Growth Study, which provided data to support the linkages between personality, parenting, and then to child development. Growing up in unstable, hostile, nonnurturing homes led to unstable personalities when the children became adults, which led to stressful marriages and abusive parenting practices with their own children. Belsky and Vondra conclude from their review of relevant research that parental personality is the most influential factor on parenting because the personal psychological resources of the individual are also influential in determining the marital partner, the quality of the marital relationship, and the amount of social support one receives.
Child development researchers have used attachment theory to shed light on the personality development of abusive and neglectful mothers. Egeland and colleagues have concluded from their longitudinal study of high-risk mothers and children that the mothers' lack of secure psychological attachment and psychological immaturity result from inadequate care received as children. They found that regardless of level of stress or the availability of emotional supports for parenting, the emotional stability of the mother was the most significant predictor of maltreatment. Mothers who were no longer maltreating their children at a 6-year followup were "more outgoing, more mature and less reactive to their feelings, more realistic in problem solving" than those who continued to neglect and abuse.26 Others have also concluded that anxious or insecure emotional attachment between children and their parents results from interactions with parents who are physically or emotionally inaccessible, unresponsive, or inappropriately responsive to their children.27 The conclusion of these studies is that it is not so much the inadequate or abusive nurturing experienced as children, but the unacknowledged deprivations and unresolved feelings around these early experiences that leave the parents unable to offer their children the consistent nurturing needed for the development of secure psychological attachments.
A cycle of neglect is suggested in numerous studies.28 In Egeland et al.'s longitudinal study of maltreatment, only two out of the eight mothers who had been physically neglected as children were providing adequate care for their children. For the 35 mothers who had grown up in emotionally supportive homes, 20 were providing adequate care for their children; only 1 was maltreating her child.29 Results of a study by Main and Goldwyn of 30 middle class women, not known to be abusive or neglectful, indicated that a mother's rejection by her own parents in childhood was strongly related to her own infant's avoidance of her following brief separations.30 Over 56 percent of the 46 neglectful mothers in Polansky's study felt unwanted as children, and 41 percent had experienced some long-term out-of-home care as a child.31 Nevertheless, the direct cause-effect relationship between parental history of neglect and subsequent neglect of children is not clearly established by the research. Most of the studies cited above are based on high risk or clinical samples or retrospective studies of identified neglectful parents who are not representative of the population of neglect victims.
Indeed, the indication is that there are important mediating factors in the transmission of neglect from one generation to the next. Victims of neglect who do not repeat the cycle have fewer stressful life events; stronger, more stable and supportive relationships with husbands or boyfriends; physically healthier babies; and fewer ambivalent feelings about their child's birth. They are also less likely to have been maltreated by both parents and more apt to have reported a supportive relationship with one parent or with another adult.32 These mediating factors provide critical indicators for interventions to improve parenting potential.
Polansky and colleagues identified distinguishing psychological characteristics of neglectful mothers, first among poor whites in rural areas of the South, then among poor whites in Philadelphia.33 From the research with rural, Appalachian mothers, Polansky et al. identified five distinct types of neglectful mothers:
- impulse-ridden mothers,
- apathetic-futile mothers,
- mothers suffering from reactive depression,
- mentally retarded mothers, and
- psychotic mothers.34
The subsequent study in Philadelphia confirmed the first two classifications of neglectful mothers and identified character disorders, rather than neuroses or psychoses, as the predominant psychiatric diagnosis of neglectful mothers. Polansky and colleagues described the characteristic "modal personality" for neglectful mothers as:
"Less able to love, less capable of working productively, less open about feelings, more prone to living planlessly and impulsively, but also susceptible to psychological symptoms and to phases of passive inactivity and numb fatalism."35
Polansky et al. referred to the personalities of neglectful parents as "infantile or narcissistic" to reflect their markedly immature personality development resulting from early emotional deprivation. Many neglectful mothers are indeed psychologically immature and childlike in their inabilities to consider the needs of others, postpone gratification of basic impulses, and to invest themselves emotionally in another person. Polansky and colleagues found impulsivity to be the personality characteristic that was most highly correlated with neglect among the low-income white mothers studied.36
This characteristic of neglectful mothers is corroborated by Friedrich, Tyler, and Clark's study of the personality characteristics of low-income, abusive, neglectful, and nonmaltreating control mothers.37 The authors found that the neglectful mothers, when compared with the other two groups on standard psychological measures, were the most pathological of the three groups and were characterized as "the most hostile, most impulsive, under most stress, and the least socialized."38 The neglectful mothers as a group were judged to be "more dysfunctional than the abusive mothers, less socialized, more angry, more impulsive, more easily aroused (by infant cries) and have greater difficulty habituating to stressful and nonstressful stimuli."39
Neglecting parents also score significantly higher on the rigidity, loneliness, unhappiness, and the negative concept of self and child dimensions of Milner's Child Abuse Potential Inventory.40
Although not consistently supported by research, clinical depression has also been associated with mothers who neglect. Studies of depressed women by psychiatric researchers have consistently found that depressed mothers are more likely than nondepressed mothers to be hostile, rejecting, and indifferent toward their children and to be neglectful especially with respect to feeding and supervision.41
Evidence for the association of depression and neglect from studies of neglect is mixed. Polansky's descriptions of neglectful mothers in Appalachia paint a picture of depressed women.42 But only two controlled studies of neglectful mothers have specifically examined the relationship between depression and neglect. One study did not find a significant difference between small samples of neglectful, abusive, and normal mothers on a measure of psychopathology that included depression.43
Zuravin's more recent study of neglecting and nonneglecting AFDC mothers did find a significant relationship between depression and neglect.44 Results of a controlled study of neglectful families currently in progress adds further support for the relationship between depression and neglect. Scores on a standardized measure of depression indicated that 60 percent of neglectful mothers versus only 33 percent of a comparison group of low-income nonneglecting mothers had a "clinically significant" problem with depression.45 Further research is needed to firmly establish the relationship of clinical depression and neglect, but such a diagnosis should be considered when assessing child neglect and appropriate clinical treatment offered if indicated.
Poor Social Skills
As Polansky et al. suggest, neglectful parents are typically not only deficient in their parenting skills, but have pervasive deficiencies in coping skills in many areas of living.46 The researchers' initial studies of neglectful mothers in Appalachia revealed that deficiencies in social skills and poor self-esteem resulted in neglectful mothers selecting equally ineffectual, unsuccessful male partners, who only served to confirm and compound their deficiencies.47 A subsequent study, which included neglectful fathers, revealed deficiencies in social participation and in their abilities to invest themselves emotionally in another person and in productive work.48
In Egeland et al.'s longitudinal mother-child study, the existence of an intact, long-term, stable relationship with a husband or boyfriend was found to be the critical factor distinguishing mothers who discontinued maltreating their children from those who continued to maltreat.49 Belsky has suggested that the relationship between mother and spouse or boyfriend is the most critical supportive linkage for parents.50 The majority of neglectful mothers lack this critical support.
Neglectful mothers also have significant deficiencies in their social-communication and problem-solving skills.51 Polansky has characterized neglectful mothers as "verbally inaccessible." They lack the ability to express their own feelings in words, and therefore are not good candidates for traditional psychotherapy. He explains that they are psychologically detached or "split off" from their own feelings, and thus, are unable to recognize feelings and put them into words.52
Neglectful parents have also been found to lack knowledge of and empathy for children's age-appropriate needs.53 They have more unrealistic and more negative expectations of their children than nonneglecting parents.54
Abuse of alcohol or drugs is often present in cases of child neglect. Recent reports from urban CPS agencies indicate that substance abuse is a factor in a growing percentage of child neglect cases. Estimates range from a low of less than 24 percent55 to 80 to 90 percent of all child maltreatment reports.56 An earlier study found that 52 percent of the children removed from their homes for severe child abuse or neglect had at least one parent with a history of alcoholism.57 A study of women served in a Chicago alcoholism treatment program reported that 65 to 75 percent of the women were neglectful toward their children.58 The epidemic of cocaine addiction in urban inner-city areas has resulted in large increases in the numbers of neglect reports. The alarming increase of cocaine-affected infants has placed large burdens on the already overtaxed child welfare system.59 In spite of these associations, there is yet insufficient data to conclude that substance abuse causes neglect, but it is an increasingly significant contributing factor.
Characteristics of Children and Family System Factors
Research suggests that certain factors in family composition, size, and patterns of interaction contribute to child neglect. Even some characteristics of children may contribute to neglectful parenting.
Studies have not identified unique characteristics of neglected children that contribute to neglect. However, Crittenden's studies of parent-child interactions in abusive and neglectful families suggest that the children in neglectful families develop behavior patterns as a result of the interactions that make them more likely to experience further neglect.60 As a result of the mother's inattention, the neglected child often develops patterns of either extremely passive, withdrawing behavior or random, undisciplined activity. Both of these patterns are likely to result in further inattention and distancing on the part of the child's neglectful parent. Studies have not clearly established the relationship between handicapped children and neglect. However, Belsky and Vondra cite numerous studies that support the association of prematurity, "difficult" temperament, and mentally handicapped children with tendencies of their parents to be less responsive, less attentive to their needs.61 Younger children are more vulnerable to serious injury from neglect, but when educational neglect is included, older children are more often neglected.62
Most neglectful families are single-parent families. The absence of the father in the majority of neglectful families means lower income and less tangible resources to provide for children's needs. Polansky, Chalmers, Buttenweiser, and Williams found that neglectful families with fathers present in the household had significantly higher income and provided better physical care than the single-parent families, but not better emotional/cognitive care.63 The physical absence or emotional disengagement of the father has been identified as contributing to deprived parenting in families of failure to thrive infants.64 Beyond these studies, little research attention has been focused on fathers or adult males in neglectful families.
Chronic neglectful families tend to be large families with fewer resources to meet basic needs than other families. Numerous studies have discovered that neglectful families on the average have more children than nonneglecting families. Studies of neglectful families by Polansky in Philadelphia and in Georgia found that neglectful families averaged 3.5 or more children, compared to significantly fewer children in similarly situated (low socioeconomic status [SES]) nonneglecting control families.65 Similar patterns of larger than average number of children in neglectful families were discovered by Giovannoni and Billingsley and by Wolock and Horowitz.66 The Study of National Incidence and Prevalence of Child Abuse and Neglect reported that the estimated rate of neglect among families with four or more children was almost double the rate among families with three or fewer children.67
Family Interaction Patterns
Patterns of verbal and nonverbal communication between neglectful parents and children have been characterized as infrequent and predominantly negative. Burgess and Conger found that there were significantly fewer positive interactions and more negative interactions between neglectful parents and their children than in either abusive or in nonmaltreating families studied.68 These researchers found that, compared with abusive mothers and nonmaltreating controls, the neglectful mothers stood out as the most negative and least positive in their relationships with other family members.
Crittenden similarly concluded that "neglecting mothers offered so little stimulation and responded to so few infant signals that they left their infants socially powerless and largely responsible for their own stimulation. Their infants showed correspondingly depressed levels of activity which reduced both the stimulations and feedback available to the already unresponsive mother. Mutual passivity was easily maintained."69 This low level of positive interaction and stimulation between neglectful mothers and their children was confirmed by a series of studies by Crittenden and others.70
Crittenden describes distinctive patterns of interaction in neglecting, abusing and neglecting, and in marginally maltreating families observed in a small sample of these families.71 The neglecting families in this study were largely young families with few children, with more than one adult caretaker, usually the maternal grandmother or mother's boyfriend. Parental coping strategies were withdrawal, deference to others whenever possible, or leaving tasks undone. Discipline was rarely used with the children. The parents' informal support networks were characterized by almost daily contact with relatives, who offered some tangible, but not emotional, support.
The neglecting parents are characterized by Crittenden as unresponsive and withdrawn: "They responded to few of their children's overtures when interacting with them and initiated almost no activity... Their children responded with a reduction in communicative activity."72 Toddlers in the neglectful homes, as soon as they were able to walk, sought out their own stimulation through uncontrolled exploratory activity. Neglectful mothers largely ignored these "toddlers on the loose," only infrequently and ineffectively attempted to exercise some control by yelling at them, often without bothering to observe the results. The children merely imitated the parent's disregard.
Neglecting families who were also abusive were typically large, very unstable, and disorganized, with children sired by several different fathers. The mother had often lived with a series of men, been alone, and lived with her own mother for periods of time. "The only certainty was that the present structure, too, would change."73 The parent-child interactions in these families vacillated from the extremes of nonsystematic, unpredictable, violent episodes of physical punishment in an effort to control the children's behavior to sullen withdrawal. The goal was momentary peace and quiet relief from the chaos in the family. Children react to their highly unpredictable environment by being always on guard and chronically anxious. The need to be ever vigilant to unpredictable violent adult reactions resulted in the children experiencing significant developmental delays.
The marginally maltreating families were typically two-parent families, but with different fathers for the children. The mother-partner relationships were unstable and often physically abusive. These families were disorganized and chaotic, constantly reacting to a series of day-to-day crises with frantic, ineffectual activity. There were no consistent rules or expectations of the children, and discipline was an expression of parents' frustration. The marginally maltreating parents were not able to engage in systematic problem solving, but instead stumbled from crisis to crisis trying to cope with whatever limited methods and help they could muster. These mothers were not always angry and could respond empathetically to their children's distress when it was expressed dramatically through tears or tantrums. Consequently, tears and tantrums were frequent, but the solace that resulted was short-lived and not secure.
These distinctively different patterns of interaction in contrasting types of neglecting families reinforce the need to assess each neglectful family independently. Individualized family patterns suggest the need for individualized interventions to remedy the neglect.
Contextual Sources of Stress and Support
Neglectful families do not exist in a vacuum. The availability of formal and informal supports for parenting from outside the family system are critical determinants of the adequacy of parenting. Schools, churches, work settings, neighborhoods, and communities can supplement parents' resources for providing adequate care for children. On the other hand, these systems can produce additional demands and stressors, which make parenting more difficult.
Unemployment, which causes psychological and economic stress, is frequent in neglectful families.74 Neglectful families are less likely to be involved in church or other formal organizations that might be sources of tangible or psychological support. Neglectful families tend to live in impoverished neighborhoods and view their neighborhoods as less helpful and less supportive than do nonneglectful parents. Chronically neglecting families are viewed as deviant, even by their similarly impoverished neighbors, who avoid social contacts with them.75 Families of color, who are overrepresented in child neglect statistics, must also cope with the stress of racial prejudice in many communities.
Informal Support Systems
Most parents must rely at times on supportive relationships with spouses, other relatives, neighbors, and friends to cope with demanding parenting tasks, especially in times of illness, loss of income, or other life crises. Supportive linkages are particularly critical when the parent or child is handicapped by physical or emotional disabilities, or when there are many children to care for and few economic resources. Neglectful parents typically lack strong informal helping resources.76 The social networks of neglectful mothers tend to be dominated by relatives who are critical, rather than supportive. Interactions with relatives may be frequent, but not very helpful. Because neglectful parents often lack the necessary social skills to maintain relationships, already weak linkages tend to break down, leaving the parents isolated and lonely.77
The coping abilities of neglectful families are severely taxed by stressful life circumstances. As indicated above, the majority of neglectful families are poor, and not only poor, but usually the poorest of the poor. A high proportion of reported neglectful families are dependent upon public assistance for income, and they have the lowest income and the fewest material resources even among AFDC recipient families.78
Although chronic neglectful families are poorer and have more problems, the "new" neglectful families are under greater stress. For example, Nelson et al. found that 75 percent had experienced a serious illness or injury within the previous 3 years.79
People of color are overrepresented in neglectful families.80 However, because of the higher incidence of poverty among Native Americans, Hispanics, and African-Americans, this overrepresentation seems to disappear when SES is held constant.81 The ethnic and cultural differences in child maltreatment are small or nonexistent when families have adequate economic and social resources, but the combination of racial discrimination and poverty places unusual stresses on families of color that frequently overwhelm their coping resources.82
In summary, the causes of child neglect are multiple and complex. Most often neglect is the result of a combination of personal deficits in parents, conflictual, nonsupportive family systems and informal support networks, highly stressful life circumstances, and absence of environmental supports for parenting.
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