Child Neglect: Challenges and Controversies

Disentangling Poverty From Neglect: Using a Person-Centered Approach to Examine Risk Factors for Neglect Among Families in Poverty

Approximately 18% of U.S. children under 5 years old live in poverty, which is one of the strongest predictors of child neglect. However, most families in poverty do not engage in neglect and this may be due to heterogeneity in risk factors. This study examined how risk factors co-occurred among families in poverty across early childhood and whether risk profiles were differentially related to physical and supervisory neglect across time. Results suggested there were four risk profiles across early childhood (i.e., years 1 and 3). At year 1, the four profiles in order of prevalence were: Low Risk, High Risk, Depressed and Uninsured, and Stressed with Health Problems. At year 3, the profiles were: Low Risk, High Risk, Depressed with Residential Instability, and Stressed with Health Problems. Overall, the High Risk profile was associated with more physical and supervisory neglect across time compared to the Low Risk profile; however, the Stress with Health Problems profile was also associated with greater physical neglect. These findings illustrate heterogeneity in the risk factors among families in poverty and demonstrate the differential impact of risk exposure on later neglect. Results also provide evidence to practitioners and policymakers about target risk experiences to prevent neglect.

Bidirectional spillover between maladaptive parenting and peer victimization and the mediating roles of internalizing and externalizing problems: A within-person analysis among Chinese early adolescents

Parenting practices and relationships with peers are crucial aspects of youth socialization. Although theoretically expected reciprocal associations between changes in maladaptive parenting and adolescent peer victimization exist, there is a lack of studies that examine this link and address the mediating mechanisms at the within-person level. This longitudinal study examined reciprocal relations between peer victimization and two types of maladaptive parenting including harsh punishment and psychological control, and the potential mediating roles of internalizing and externalizing problems within these relations, by disentangling between- and within-person effects. A total of 4,731 Chinese early adolescents (44.9% girls; M age = 10.91 years, SD = 0.72) participated in a four-wave longitudinal study with 6-month intervals. The results of random intercept cross-lagged panel modeling showed: (a) harsh punishment did not directly predict peer victimization, and vice versa; (b) psychological control directly predicted peer victimization, and vice versa; (c) psychological control indirectly predicted peer victimization via internalizing problems, and peer victimization also indirectly predicted psychological control via internalizing problems. These findings provide evidence of a bidirectional spillover effect between psychological control and peer victimization at the within-person level, suggesting Chinese early adolescents may become caught in a vicious cycle directly or indirectly via their internalizing problems.

Interventions to Support Children's Recovery From Neglect-A Systematic Review

Earlier reviews to discover research on interventions for children after neglect have concluded little was available, despite the well-documented prevalence and harmful effects of neglect on children. We revisited this question through a systematic literature review to discover the state of research on interventions for children who have experienced neglect. We searched MEDLINE, PsycINFO, ERIC, Sociological Abstracts and EMBASE for studies published between 2003 and 2021. Studies were included if neglect could be distinguished, and child outcomes reported. Eight reports describing six studies about six interventions were identified. These studies differed in interventions, age-groups, definitions of neglect, and outcomes. Four studies reported positive child outcomes though with varying degree of quality. More research is needed to inform a coherent theory of change following neglect. There remains an urgent need for research on interventions to help children recover from neglect.

Profiles of family maltreatment and peer victimization: Associations with psychosocial adjustment in Chinese children

BACKGROUND

Although the family and peer systems are both important for children's development, few studies have simultaneously considered the impact of adversity experienced in these systems on children.

OBJECTIVE

The first purpose of this study was using latent profile analysis (LPA) to identify profiles of family maltreatment (i.e., physical abuse, emotional abuse, and neglect) and peer victimization (i.e., physical victimization and relational victimization) among Chinese elementary school children. The second purpose was to examine associations between the identified profiles and short-term psychosocial adjustment (i.e., self-esteem, depression symptoms, prosocial behavior, and externalizing behavior).

PARTICIPANTS AND SETTING

The sample included 4313 children (45.6 % girls) with an average age of 10.9 years (SD = 0.49) from a large city in China.

METHOD

Assessments were conducted on two occasions six months apart. Family maltreatment and peer victimization were assessed at Time 1. Psychosocial adjustment was assessed at Time 2.

RESULTS

The potential complexity of children's adversity experiences was revealed in that six profiles of family maltreatment and peer victimization in children were identified: (a) Low-risk; (b) Slight peer victimization; (c) Severe peer victimization; (d) Serious neglect; (e) Severe maltreatment; (f) Doubly disadvantaged. Children in the low-risk profile showed the best psychosocial adjustment whereas children in the doubly disadvantaged profile showed the worst psychosocial adjustment. The findings revealed additional differences in the subsequent psychosocial adjustment of the children in the six profiles.

CONCLUSIONS

The identification of multiple profiles and differing relations to psychosocial adjustment implies that interventions should be tailored to members of specific profiles.

Can early childhood education be compensatory? Examining the benefits of child care among children who experience neglect

Children that experience neglect are at risk for maladaptive outcomes. One potential resource for these children is early childhood education (ECE), but there is currently limited evidence which is compounded by data limitations. This study used data from the National Study of Child and Adolescent Well-being II (N = 1,385) to compare children's cognitive and social-emotional outcomes among children involved in child protective services that experienced either no care, informal care, or formal care, as well as moderation by type of neglect. Results suggest that ECE was related to increased cognitive and social skills and decreased behavior problems, depending on whether the child attended informal or formal care, with some associations being stronger for children that experienced neglect. These findings have implications for practitioners and policymakers in the intersection of ECE and child protective services.

Childhood neglect and academic performance in Chinese adolescents: A serial mediation model

BACKGROUND

Chinese parents and students, especially senior high school students, attach great importance to academic performance. Some studies have confirmed that childhood neglect is related to academic performance. However, the internal mechanism is relatively underexplored.

OBJECTIVE

Guided by life course theory and bioecological theory, this study examined the relationship between childhood neglect and academic performance using a serial mediation model that included belief in a just world (PBJW) and academic resilience as hypothesized mediators.

METHODS

A sample of 614 tenth grade students (297 males and 307 females, and 10 who did not report their sex; M_age = 15.75 years old, SD = 0.71 years old) completed questionnaires regarding demographics, childhood neglect, PBJW, academic resilience, and academic performance.

RESULTS

After demographic covariates were controlled for, the results revealed that: (a) childhood neglect was negatively associated with academic performance; (b) PBJW and academic resilience mediated the link between childhood neglect and academic performance in a parallel fashion; and (c) PBJW and academic resilience also mediated the link between childhood neglect and academic performance in a sequential fashion.

CONCLUSIONS

Childhood neglect is negatively related to adolescent academic performance, and the relation is mediated by PBJW and academic resilience both parallelly and sequentially.

Childhood Maltreatment and Anhedonic Symptoms: Test of a Dual-risk Model in Emerging Adults

Anhedonia, defined as deficits in positive affect and approach related behaviors, remains an understudied trauma response. As anhedonic responses to interpersonal violence are associated with a more severe course of psychopathology that is more difficult to treat, an increased focus on risk factors for anhedonia is necessary. The present study sought to address this gap in the literature by testing a theoretical model that highlights two transdiagnostic pathways leading to anhedonic responses in emerging adults attending college. Specifically, our study examined how childhood maltreatment subtypes (a) uniquely associate with depressive and post-traumatic stress (PTS) manifestations of anhedonia and (b) how temperament (i.e., anticipatory positive affect) and distress (i.e., negative mood) explain these relations. At baseline, a racially diverse sample of 462 emerging adults (Age_Mean = 19.45; 75.5% female; 45.5% White) completed self-report forms on childhood abuse and neglect, anticipatory positive affect, negative mood, and anhedonia. Individuals completed measures of temperament and psychological distress again 6-weeks, and 12-weeks later. Latent growth curve models were utilized to test our model. Consistent with hypotheses, deficits in anticipatory positive affect uniquely explained the relation between neglect and depressive/PTS anhedonic symptoms. Meanwhile, negative mood mediated the relation between abuse and both forms of anhedonia. These findings support the theory that two separate risk pathways lead to anhedonia. Support for our model suggests that distinguishing between pathways for anhedonic responses may be the key to a more targeted, transdiagnostic, trauma-informed approach for treating and preventing these deleterious, treatment-resistant, internalizing symptoms.

Protective factors against child neglect among families in poverty

BACKGROUND

Despite neglect being the most common form of maltreatment, it is still understudied relative to other maltreatment types. Further, there is limited evidence on mechanisms through which to prevent child neglect and on mechanisms that might buffer the risk of poverty.

OBJECTIVE

The current study estimated how different protective factors decreased subtypes of neglect, both physical and supervisory, across early childhood and in relation to poverty.

PARTICIPANTS AND SETTING

The final sample included 2980 mothers from the Fragile Families and Child Wellbeing Study.

METHODS

The current study used linear regressions in a structural equation modeling framework to estimate how protective factors at years 1 and 3 were related to neglectful parenting at years 3 and 5, as well as whether protective factors buffered the association between poverty and neglect.

RESULTS

Mothers' perceived instrumental social support, part-time employment, and full-time employment were associated with less physical neglect at both time points (β range from -0.15 to -0.05; all p < 0.05). Perceived instrumental social support was also related to less supervisory neglect at both times (β = -0.05, p < 0.05 for both times). Perceived instrumental social support significantly moderated the association between poverty at year 1 and physical neglect at year 3 (β = 0.06, p < 0.01).

CONCLUSIONS

These findings provide important information to practitioners and policymakers on potential mechanisms to reduce neglect, as well as reducing neglect among economically disadvantaged families.

Childhood Disability-Related Abuse: A Retrospective Proof-of-Concept Study

Although the phenomenon of disability-related abuse has been well-documented in adults with disabilities, the occurrence of disability-related abuse in childhood has not been studied. Therefore, the purpose of this study was to establish proof of concept for childhood disability-related abuse. American adults (n = 485) retrospectively report on physical, sexual, and disability-related abuse that they experienced before the age of 18. The sample consisted of 382 participants with no disability, 55 participants with an adult-onset disability, and 48 participants with a childhood-onset disability. Disability-related abuse was conceptualized as involving either (a) the denial of assistive technology or (b) the denial of care, permission, or assistance with an activity of self-care. Childhood denial of assistive technology was rare in all groups (1.3%-2.1%), but denial of care, assistance, or permission was significantly higher in the childhood-onset disability group (20.8%) than either the adult-onset (7.3%) or no-disability (6.5%) groups. The three groups did not significantly differ in the rates of reported childhood physical or sexual abuse. This study provides preliminary proof-of-concept evidence for childhood disability-related abuse, particularly denial of care.

Developmental consequences of emotional abuse and neglect in vulnerable adolescents: A multi-informant, multi-wave study

BACKGROUND

Extant research and theory posit that emotional abuse and emotional neglect-exposure is uniquely harmful during adolescence. Yet, these findings are mostly based on mono-informant, retrospective studies with unselected adults that examine emotional maltreatment in the aggregate. This prevents inferences concerning the unique, prospective risk emotional abuse and neglect, as reported by multiple informants, may confer within at-risk, adolescent samples.

OBJECTIVE

In response, the present study examined how emotional abuse and emotional neglect-exposure in adolescence uniquely related to psychological symptoms and social impairment.

PARTICIPANTS AND SETTING

Our aims were tested in a child welfare system (CWS)-involved sample of adolescents (N = 657; Age_M = 12.49 at baseline) who were participating in a longitudinal study.

METHODS

A multi-informant approach was used to assess emotional abuse/neglect and mental health. Physical abuse and lifetime CWS contact represented covariates in growth curve models.

RESULTS

Emotional abuse predicted symptoms within informant, such that youth-reported emotional abuse predicted youth-reported internalizing, β = 0.21, p = .001, and externalizing, β=0.35, p = .001, symptoms while parent-reported emotional abuse predicted parent-reported externalizing, β=0.30, p <  .001, and internalizing β=0.29, p <  .001, symptoms. Meanwhile, youth-reported emotional neglect predicted heightened self-reported internalizing symptoms, β=0.29, p <  .001, parent-reported externalizing symptoms, β=0.15, p = .002 and social impairment across youth, β=-0.17, p = .01 and parent, β=-0.24, p <  .001, report.

CONCLUSIONS

This study shows the importance of distinguishing between these maltreatment subtypes in adolescence and provides measurement recommendations for future maltreatment research. The manuscript concludes by discussing adolescent emotional abuse and neglect-exposure as a maintenance, as opposed to causal risk, factors.

The global challenge of the neglect of children

BACKGROUND

The neglect of children is a serious global problem. The 1989 United Nations Convention on the Rights of the Child (CRC) was a major international achievement spurring national efforts to prevent and address neglect. However, the scope of neglect worldwide and progress in addressing it remain unclear.

OBJECTIVE

This analysis assessed the current state of child neglect through much of the world, including its prevalence and efforts to address it.

METHOD

The scope of neglect was assessed through a literature review of recent peer-reviewed research and analysis of the United Nations Children's Fund (UNICEF) child protective services (CPS) and early childhood development data. National responses to neglect in 73 countries were described in the International Society for the Prevention of Child Abuse and Neglect's World Perspectives 2016 data and through illustrative case studies of recent CRC country reports for Australia, China, India and Mozambique.

RESULTS

Neglect is prevalent throughout the world, although its extent and form vary. Most countries recognize neglect as a form of maltreatment and have basic CPS policies and some system in place, but implementation of prevention and intervention services remains inadequate even in high-income countries. Economic and other barriers inhibit progress to address the neglect of children.

CONCLUSIONS

Progress has been made in establishing basic child protections and other safeguards for neglect in most countries, but significant barriers and inadequacies remain. Implementation of the CRC is uneven and there are large gaps in needed services. Much work remains to better assess and address this serious problem, in every country.

Emotional Maltreatment and Adolescent Depression: Mediating Mechanisms and Demographic Considerations in a Child Welfare Sample

Emotional maltreatment is a risk factor for adolescent depression. Yet, it remains unclear whether commissions and omissions of emotional maltreatment (a) confer vulnerability via distinct mechanisms and (b) demonstrate similar risk across adolescent subpopulations. The present, multiwave study examined whether school engagement and peer relationships explain the depressive effects of distinct emotional maltreatment subtypes in an at-risk child welfare sample (N = 657; ages 11-14, Age_Mean  = 12.49). The findings indicated that commission subtypes of emotional maltreatment predicted increasing depressive symptoms via increasing peer relationship problems, especially for girls. Meanwhile, decreasing school engagement was a depressogenic risk pathway for Hispanic adolescents reporting omission subtypes of emotional maltreatment. The results emphasize the importance of distinguish between emotional maltreatment subtypes to identify specific risk pathways for adolescent depression.

How Do Nurses Keep Children Safe From Abuse and Neglect, and Does it Make a Difference? A Scoping Review

OBJECTIVES

To explore the extent of child protection work performed by nurses and identify which interventions hold the strongest evidence for future practice.

DESIGN

This scoping review was guided by Arksey and O'Malley's framework for scoping reviews.

DATA SOURCES

Electronic databases (CINAHL, Medline, Scopus, Web of Science) and grey literature were searched in August 2017. Further studies were identified through manual literature searching.

RESULTS

Forty-one studies from seven countries met the inclusion criteria. The studies showed nurses keep children safe primarily through the prevention of abuse (n = 32), but also through detection of abuse (n = 1) and interventions to mitigate the effects of abuse (n = 8). Nurses' specific interventions most frequently involved post-natal home visiting (n = 20), parent education (n = 10) and assessment and care of children or adolescents following sexual abuse (n = 4). The main findings showed that although nurses did have positive impacts upon some measures of abuse and neglect, results were not consistent across studies. In addition, some studies used indirect measures of abuse and neglect, which may not impact children's experiences of abuse. It is difficult to extrapolate these findings to the broader nursing profession as literature did not accurately represent the range of ways that nurses keep children safe from abuse and neglect.

CONCLUSIONS

This review demonstrated nurses prevent, detect and respond to abuse and neglect in many ways. However, given mixed evidence and absence of some nurse interventions in the literature, further research is needed to represent the range of ways that nurses keep children safe and determine their effectiveness.

What Is Neglect? State Legal Definitions in the United States

Neglect is the most common form of reported child maltreatment in the United States with 75.3% of confirmed child maltreatment victims in 2015 neglected. Despite constituting the majority of reported child maltreatment cases and victims, neglect still lacks a standard definition. In the United States, congruent with the pervasiveness of law in child welfare systems, every state and the District of Columbia has its own statutory definition of neglect. This study used content analysis to compare state legal statutory definitions with the Fourth National Incidence Survey (NIS-4) operationalization of neglect. The resulting data set was then analyzed using cluster analysis, resulting in the identification of three distinct groups of states based on how they define neglect: minimal, cornerstones, and expanded. The states' definitions incorporate few of the NIS-4 components. Practice and policy implications of these constructions of neglect definitions are discussed.

Child maltreatment as a function of cumulative family risk: Findings from the intensive family preservation program

This study examined child maltreatment as a function of cumulative family risk in a sample of at-risk families (N=837) who were referred to an intensive family preservation program because of child behavior problems or suspected child abuse and neglect. The goal of this intensive family preservation program is to improve parenting skills and reduce immediate family stressors that may lead to an increased risk of child abuse and neglect. The findings indicate that the most prominent family risks comprising the cumulative risk scale in our sample were socio-economic disadvantage (e.g., income, unemployment, housing instability) and parental characteristics (e.g., mental/physical health, parental use of alcohol, domestic violence). Further, the results demonstrated a strong quadratic trend in the relationship between cumulative family risk and child maltreatment, and identified a risk threshold effect at three cumulative family risks after which the child risk for maltreatment increased exponentially. These findings are interpreted in the light of the current research on differentiative interventions, supporting differentiated services to the families with low vs. higher risk for child maltreatment.

When Is Neglect, Neglect?: It Depends on Who You Ask

In order to identify victims of child neglect, social service workers rely heavily on referrals from concerned friends, neighbors, and others in the community. Little is known, however, about how lay individuals perceive child neglect and what factors influence their decision to make a referral. This study explored the effects of child, parent, and participant gender on laypersons' evaluations of child neglect. Participants read a case of neglect of a child by a custodial and absent parent and then rated the parents' culpability and intentionality and decided whether the parents' behavior met the legal definition of neglect. When evaluating the custodial parent, men but not women viewed fathers as more culpable than mothers for the neglect of their son and viewed mothers as somewhat more culpable for the neglect of their daughter. Men also perceived absent mothers as more intentionally harmful than absent fathers. Finally, both men and women were more likely to qualify parental behavior as legally neglectful when the genders of the custodial parent and child matched. Results, which suggest that gender bias may exist in laypersons' perceptions of child neglect and may influence their decisions to report, have implications for identification of and intervention for vulnerable children and families.

Childhood Neglect, Internalizing Symptoms and Adolescent Substance Use: Does the Neighborhood Context Matter?

Childhood neglect is associated with risk behaviors in adolescence, including substance use. There is evidence that internalizing behaviors may serve as a mechanism linking childhood neglect and substance use; however, further research is needed to examine this developmental pathway. According to developmental and ecological approaches, the neighborhood context and the developmental timing of maltreatment should both be considered when examining the sequelae of childhood neglect. Hence, the present study uses a longitudinal sample of youth (N = 965, 49.1% female, 59.2% African-American) to examine the influence of timing in the relationship between childhood neglect and adolescent psychopathology, and to examine the indirect effects of child neglect on substance use via internalizing symptoms in adolescence. Furthermore, the role of neighborhood disorder in this indirect effect was tested. Five data collection time points were used: Time 1(M _age  = 4.557, SD _age  = .701), Time 2 (M _age  = 6.422, SD _age  = .518), Time 3 (M _age  = 12.370, SD _age  = .443), Time 4 (M _age  = 14.359, SD _age  = .452), and Time 5 (M _age  = 16.316, SD _age  = .615). The findings showed that internalizing problems mediated the link between the severity of neglect in early childhood and adolescent substance use, and this pathway was moderated by neighborhood disorder. These results have implications for preventative interventions aimed toward reducing substance use for at-risk adolescents.

The distal consequences of physical and emotional neglect in emerging adults: A person-centered, multi-wave, longitudinal study

Despite being the most prevalent form of child maltreatment, the correlates and consequences of neglect are poorly understood, particularly during early adulthood. The present multi-wave, longitudinal study sought to address this gap in this literature by examining physical and emotional neglect in emerging adults in a diverse community sample. 580 adolescents (Age_Mean=18.25; Age_SD=0.59; 58.3% female; 31% Hispanic, 28.9% Caucasian; 26.2% African-American; 13.9% other) completed self-report measures for child maltreatment at baseline, and measures for depression, posttraumatic stress disorder, generalized anxiety disorder, and substance use every year for three years. For our analyses, we used both variable-centered (mixed-level modeling) and person-centered (latent profile analysis) analyses to best understand a) how physical and emotional neglect relate to other forms of maltreatment and b) to determine physical and emotional neglect's unique impact on prospective mental health functioning. Our person-centered analyses revealed that a three-profile model provided the best solution for our data ("No Trauma," "Abuse", and "Neglect"). In longitudinal analyses, the "the neglect" group had significantly elevated scores compared to the "no trauma" group on all outcomes except alcohol use (p<0.01). Results from our variable-centered analyses showed comparable findings between physical and emotional neglect, with higher scores corresponding to elevated symptoms of depression, PTSD, illicit substance use, and cigarette use over time (p<0.01). In conclusion, our results suggest that early neglect-exposure poses a risk for the subsequent development of internalizing symptoms and substance use behaviors among emerging adults.

The association between childhood maltreatment experiences and the onset of maltreatment perpetration in young adulthood controlling for proximal and distal risk factors

The evidence for association between child maltreatment victimization and later maltreatment perpetration is both scant and mixed. The objective of the present study was to assess the association between childhood maltreatment experiences and later perpetration of maltreatment in young adulthood controlling for proximal young adult functioning, prior youth risk behaviors, and childhood poverty. The study included 6,935 low-income children with (n=4,470) or without (n=2,465) maltreatment reports prior to age 18 followed from ages 1.5 through 11 years through early adulthood (ages 18-26). Administrative data from multiple regional and statewide agencies captured reports of maltreatment, family poverty and characteristics, system contact for health, behavioral risks and mental health in adolescence, and concurrent adult functioning (crime, mental health and poverty). After controlling for proximal adult functioning, repeated instances of neglect or mixed type maltreatment remained associated with young adult perpetration. Females and subjects with adolescent history of runaway, violent behaviors or non-violent delinquency also had higher risk. Greater caregiver education remained associated with reduced risk. The study concludes that prevention of recurrent neglect and mixed forms of maltreatment may reduce risk of maltreatment for future generations. Intervening to increase parental education and decrease adolescent risk behaviors may offer additional benefit.

Inadequate child supervision: The role of alcohol outlet density, parent drinking behaviors, and social support

Supervisory neglect, or the failure of a caregiver to appropriately supervise a child, is one of the predominant types of neglectful behaviors, with alcohol use being considered a key antecedent to inadequate supervision of children. The current study builds on previous work by examining the role of parental drinking and alcohol outlet densities while controlling for caregiver and child characteristics. Data were obtained from 3,023 participants via a telephone survey from 50 cities throughout California. The telephone survey included items on neglectful parenting practices, drinking behaviors, and socio-demographic characteristics. Densities of alcohol outlets were measured for each of the 202 zip codes in the study. Multilevel Bernoulli models were used to analyze the relationship between four supervisory neglect parenting practices and individual-level and zip code-level variables. In our study, heavy drinking was only significantly related to one of our four outcome variables (leaving a child where he or she may not be safe). The density of on premise alcohol outlets was positively related to leaving a child home alone when an adult should be present. This study demonstrates that discrete relationships exist between alcohol related variables, social support, and specific supervisory neglect subtypes at the ecological and individual levels.