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CHILD NEGLECT: definitions, causes, consequences and interventions

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Title: CHILD NEGLECT: definitions, causes, consequences and interventions


1
CHILD NEGLECT definitions, causes,
consequences and interventions
  • Annlis Söderholm
  • PhD, paediatrician
  • The Fifth Nordic Congress on Child Abuse and
    Neglect
  • 18-21 May 2008, Reykjavik, Iceland

2
Ambroise Tardieu 1818-1879
  • Professor in forensics in Paris studied and
    described the classical features of almost all
    forms child abuse and neglect
  • sexual abuse
  • physical abuse
  • neglect deprivation
  • children in factories and coal mines (England,
    Scotland)
  • physical abuse of small children death rates
  • After his death child maltreatment was forgotten
    and the opinion that
    allegations of maltreatment were mainly the
    conseguences of childrens inventiveness
    prevailed both inside and outside medicine for
    almost 100 years
  • Part of his works was recently translated and
    published (2005) into English and so became
    available for professionals outside the
    French-speaking area.
  • Child Abuse Neglect 200529311-334

3
Neglect
  • is a social as well as a medical, legal and
    psychological
  • problem
  • occurs in all countries and social groups
  • more children are neglected than abused
  • the true prevalence is unknown
  • especially detrimental for infants and toddlers
  • easier to neglect the problem than to intervene -
    neglect of neglect
  • the majority of maltreatment studies do not
    specifically address neglect
  • the role of fathers/father figures in neglect is
    insufficiently studied

4
The basic needs of the child
  • love, care and nurturance
  • respect and acceptance
  • being seen and heard
  • adequate nutrition, clothing, hygien
  • safety and protection
  • stimulation
  • education
  • health care (physical, mental, dental)

5
Definitional ambiquities
  • The issue of defining abuse and neglect is one
    of central
  • importance and logically precedes a disscussion
    of
  • incidence, etiology (sequele), and treatment. The
  • vagueness and ambiquities that surround the
    definition of
  • this particular problem touch every aspect of the
  • field reporting system, treatment program,
    research, and
  • policy planning"
  • Harold P. Martin. 1977 Analysis of child abuse
    and neglect research, U.S, Childrens Bureau,
    Administration for children, youth and families,
    U.S. Department of Health, Education and Welfare
    1978

6
Neglect by caregiver
  • the failure of the childs parent or
    caretaker, who has the material resources to do
    so, to provide minimally adequate care in the
    areas of health, nutrition, shelter, education,
    supervision, affection or attention and
    protection
  • Wolock I, Horowitz B. Child maltreatment as a
    social problem The neglect of
  • neglect. American Journal of Ortopsychiatry
    198454530-543

7
Definition of child neglect
  • Neglect is a condition in which a childs basic
    needs are
  • not met regardless of cause
  • Dubowitz H, Black M, Starr RH, Zuravin S. A
    conceptual definition of child neglect. Criminal
    justice and behaviour 1993208-26

8
Subtypes of neglect
  • Physical neglect
  • Emotional neglect and abuse
  • Neglect of health care (physical, mental, dental)
  • Educational neglect
  • -----------------------------
    --
  • Structural, societal neglect
  • a society is contributing to child neglect by
    neglecting the poor
  • Professional neglect (neglect of child neglect)

9
Emotional neglect and abuse
  • more or less present in all forms of maltreatment
    x)
  • describes an attitude of the parent/caregiver
    towards the child
  • no physical contact is presupposed
  • difficult to diagnose because of absence of clear
    physical evidence
  • occurs also in families that from outside look
    socially and economically well-functioning
  • child protection authorities are often not
    involved
  • x)Claussen AH, Crittenden PM. Physical and
    psychological maltreatment relations among types
    of maltreatment. Child Abuse Neglect
    1991155-18

10
Emotional neglect and abuse
  • the issue for recognition is not whether there
    is
  • unseen or secret abuse, but rather whether what
    is
  • observed is described and named as ill-treatment
  • Glaser D. Prior V. Predicting emotional abuse
    and neglect. In K.D. Browne, H. Hanks, P.
    Stratton, C. Hamilton (eds). The early prediction
    and prevention of child abuse A handbook.
    Chichester John Wiley Sons Ltd 2002

11
Emotional neglect and abuse
  • Emotional unavailability, unresponsiveness, and
    neglect
  • Negative attributions and misattributions to the
    child
  • Developmentally inappropriate or inconsistent
    interactions with the child
  • Failure to recognize or acknowledge the childs
    individuality and psychological boundary
  • Failure to promote the childs social adaptation
  • Glaser D. Emotional abuse and neglect
    (psychological maltreatment) a
  • conceptual framework. Child Abuse Neglect
    200226697-714

12
Dental neglect
  • The dentist can be the first professional to
    suspect or
  • recognize neglect!
  • Dental neglect is the wilful failure of
    parent or guardian
  • to seek and follow through with treatment
    necessary to ensure a level of oral health
    essential for adequate function and freedom from
    pain and infection
  • American Academy of Pediatric Dentistry.
    Definition of dental neglect. Pediatric
    Dentistry 200325(suppl)7

13
Professional and societal neglect
  • Children who are neglected by their parents are
    also frequently further neglected by the services
    established to protect them from significant harm
  • Minty B, Pattinson G. The nature of child
    neglect. British Journal of Social Work
  • 199424733-747
  • If the society defines parenting as a private,
    individual act, it may rightly be judged
    neglectful, in contrast to a society that
    recognizes parenthood as a social contract
  • Garbarino J, Collins CC. Child neglect. The
    family with a hole in the middle. In
  • H. Dubowitz (ed). Neglected children. Research,
    practice and policy.
  • Thousand Oaks, CASage Publications 1999

14
Etiology
  • The basis of the ecological model is that child
    neglect and
  • abuse is multiply determined by forces at work in
    the
  • individual, in the family, in the community and
    in the society
  • and that these determinants are nested within one
    another
  • individuals
  • child
  • parents
  • family
  • community
  • societal, structural factors
  • Bronfenbrenner U. The ecology of human
    development. Cambridge MA Harvard
  • University Press 1979
  • Belsky J. Child maltreatment An ecological
    integration. American Psychologist
  • 198035320-335

15
Risk factors
  • The strongest risks of child maltreatment are
    from socio-economic deprivation and from factors
    in the parents own background - parental
    background factors are largely, but not entirely,
    mediated through their impact on socio-economic
    factors
  • Risk factors are risks and not indicators or even
    necessarily predictors
  • Sidebotham P, Heron J, The ALSPAC Study Team.
    Child maltreatment in the
  • Children of the nineties A cohort study of
    risk factors. Child Abuse Neglect
  • 200630497-522
  • Sidebotham P. Invited comments Red skies, risk
    factors and early indicators.
  • Child Abuse Review 20031241-45

16
Risk factors promotive factors
  • Potentiating factors (stressors)
  • Compensatory (promotive, protective) factors
    (supports)
  • the balance of risk factors and promotive
    factors determines whether child maltreatment
    will take place or not
  • multipathology is usually associated with a
    plenitude of risk factors and a paucity of
    promotive ones
  • Cicchetti D, Toth S. A developmental
    psychopathology perspective on child abuse and
  • neglect. Journal of American Academy of Child and
    Adolescent Psychiatry 199534541-565
  • Belsky J. Child maltreatment An ecological
    integration.
  • American Psychologist 198035320-335
  • Sameroff AJ. Developmental systems of
    psychopathology.
  • Development and Psychopathology 200012297-312

17
  • Dynamic ecological models may be essential for
  • understanding the sources of health and disorder
    that are
  • the central concern of developmental
    psychopathology.
  • In these wiews if we find simplicity, it is an
    artifact
  • Sameroff AJ. Developmental systems of
    psychopathology. Development and Psychopathology
    200012297-312

18
Child (risk factors)
  • age
  • prematurity
  • disease or disability
  • but child characteristics alone do not account
    for
  • neglect or other forms of maltreatment!

19
Parental background (risk factors)
  • adverse childhood experiences
  • psychiatric history
  • low educational achievment
  • young parental age
  • substance abuse
  • intellectual disability x)
  • x) Lutzker JR. Behavioral treatment of child
    neglect. Behavioral Modification
  • 199014301-315

20
Family community(risk factors in the childs
environments)
  • low level of social support - insularity
  • social exclusion of families at risk
  • intimate partner violence (IPV)
  • long-term economic hardship
  • structure of the family
  • single parent
  • presence of a step-father in the family
  • large households
  • symptoms in the child due to neglect can be
    misinterpreted both in the family and in the
    childs different environments outside the home

21
Social exclusion
  • is defined as
  • the inability of our society to keep all
    groups and individuals within reach of what we
    expect as a society and the tendency to push
    vulnerable and difficult individuals into the
    least popular places
  • Power A. Social exclusion. Royal Society of Arts
    Journal 2000247-51
  • Editors choice. Social exclusion old problem,
    new name. BMJ 2001323174

22
The drivers of social exclusion
  • Low income
  • Unemployment
  • Poor educational attainment
  • Poor health
  • Poor housing
  • Problematic neighbourhoods and networks
  • Crimes
  • Bradshaw J, et al. The Drivers of Social
    Exclusion Review of the Literature
  • or the Social Exclusion Unit in Breaking the
    Cycles, Series, London Office of
  • the Deputy Prime Minister, 2004

23
Structural, societal factors
  • laws and legislation
  • culture, religion, norms, beliefs and attitudes
  • health, social and education politics
  • economic politics in society (obs. poverty!)
  • when we as a society ignore the poor, we
    contribute to child neglect
  • Garbarino J. Collins CC. Child neglect. The
    family with a hole in the middle. In H. Dubowitz
    (ed ). Neglected children. Research practice and
    policy. Thousand Oaks, CA Sage Publications 1999

24
  • Poverty is denial of all human rights
  • Mohammad Yunus
  • Nobel Peace Price Winner 2006

25
Consequencies (1)
  • Depend on
  • the subtype(s)
  • age of onset
  • severity
  • duration
  • co-occurrence of other forms of maltreatment
  • risk factors
  • (single multiple)
  • the resilience of the child
  • Depend also on
  • the different professionals willingness and
    ability to suspect or regognize neglect in a
    child and on their unwillingness to contribute to
    neglect of neglect
  • the competence in the multiprofessional handling
    of neglect

26
Consequencies (2)
  • Infants and toddlers
  • fewer positive social interactions
  • non organic failure to thrive
  • cognitive and language problems
  • Later on
  • cognitive and academic deficits
  • poor social skills - social withdrawal
  • limited peer interactions
  • low self-esteem
  • behavioral problems e.g. aggression
  • Hildyard KL, Wolfe D. Child neglectdevelopmental
    issues and outcomes.
  • Child Abuse Neglect 200226679-695
  • Kotch et al. Importance of early neglect for
    childhood aggression.
  • PEDIATRICS 2008121725-731

27
Consequencies (3)
  • The consequencies of emotional neglect
    (psychological
  • unavailable parenting) have been found to be
    greater
  • and more enduring than physical neglect and the
  • other types of maltreatment
  • Gaudin JM jr. Child neglect. Short-term and
    long-term outcomes. In In
  • H. Dubowitz (ed). Neglected children. Research,
    practice and policy.
  • Sage Publications 1999
  • Farrell Erickson M, Egeland B. Child neglect. In
    JEB Myers, L Berliner,
  • J Briere, CT Hendrix , C Jenny, TA Reid (eds).
    The APSAC Handbook
  • on Child Maltreatment. Thousand Oakes, CA Sage
    Publications 2002

28
Consequencies (4)
  • death from neglect can occur as a result of
    inadequacies in physical protection, supervision,
    nutrition, or health care
  • it can be more difficult to investigate and
    prosecute than physical and sexual abuse
  • this difficulty in determining the ultimate cause
    of death can result in a lack of protection for
    the siblings and other children in the household
  • Bonner BL, Crow SM, Logue MB. Fatal child
    neglect. In H. Dubowitz (ed).
  • Neglected children. Research, practice and
    policy. Thousand Oakes, CA Sage
  • Publications 1999

29
Intervention and prevention
  • prevention x)
  • universal prevention (aimed at the whole
    population)
  • selective prevention (interventions aimed at
    families at risk)
  • indicative prevention (aim to stop further
    maltreatment)
  • screening by asking
  • shared responsibility (family - professionals)
  • continuity of health care
  • x)
  • MacLeod J, Nelson G. Programs for the promotion
    of family wellness and the
  • prevention of child maltreatment a meta-analytic
    review. Child Abuse Neglect
  • 2000241127-1149
  • Rae Grant NI. Preventive interventions for
    children and adolescents Where are
  • we now and how far have we come. Canadian Journal
    of Community Mental
  • Health 19941317-36

30
The treatment of the child and her/his parents
  • If you want a genuine
  • dialogue avoid attitudes as
  • aggression
  • blame
  • contempt
  • infantilizing
  • lamentation
  • moralilizing
  • threat
  • uninterest
  • voyerism (unprofessional curiosity)
  • A motivating treatment
  • freedom from prejudice
  • presence
  • genuine interest
  • empathy
  • understanding
  • matter-of-factness
  • to treat child and parents as human beings

31
What does a neglected child need
  • Early intervention
  • A medical home with professionals, who are
    trained in child maltreatment issues and
    interprofessional and intersectorial working, and
    who are genuinely motivated to treat neglected
    children, and to offer them continuity of health
    care as well as long-term treatment, support and
    follow-up (primary health care paediatrics,
    child neurology, child psychiatry)
  • Child protection support and follow up
  • Experiences of the world as a safe and reliable
    place

32
Research challenges
  • Clear, detailed definition(s) of neglect
    subtype(s)
  • Exploration of age-specific risk factors and
    developmental effects of neglect
  • Research to confirm the effectiveness and
    generalizability of different forms of prevention
    and intervention treatment programmes for
    neglected children and their families
  • The role of fathers/father figures in neglectful
    families
  • Detailed longitudinal studies of risk populations
    with clear comparison groups from the normal
    population, as well as large-scale
    epidemiological studies

33
References (1)
  • Allin H, Wathen CN, MacMillan H. Treatment of
    child neglect A systematic review. The Journal
    of Canadian Psychiatry 200550497-504
  • American Academy of Pediatrics. Block RW, Krebs
    N, and the Committee on Child Abuse and Neglect,
    and the Committee on Nutrition. Failure to thrive
    as a manifestation of child neglect. PEDIATRICS
    20051161234-1237
  • Belsky J. Child maltreatment An ecological
    integration. American Psychologist
    198035320-335
  • Bronfenbrenner U. The ecology of human
    development. Cambridge MA Harvard University
    Press 1979
  • Cicchetti D, Toth S. A developmental
    psychopathology perspective on child abuse and
    neglect. Journal of American Academy of Child and
    Adolescent Psychiatry 199534541-565
  • Connell-Carrick K. A Critical review of the
    empirical literature Identifying correlates of
    child neglect. Child and Adolescent Social Work
    Journal 200320389-425
  • Christensen E.The prevalence and nature of abuse
    and neglect in children under four A national
    study. Child Abuse Review 19998109-119

34
References (2)
  • Daniel B, Taylor J. Gender and child neglect
    theory, research and policy. Critical Social
    Policy 200626426-439
  • DeBellis MD. The psychobiology of neglect. Child
    Maltreatment 200510150-172
  • Dubowitz H (ed). Neglected children. Research,
    practice and policy. Thousand Oakes, CA Sage
    publications 1999
  • Dubowitz H, Black MM. Child neglect. In R.Reece,
    ML Stephen (eds). Child Abuse. Lippincott,
    Williams Wilkins 2001
  • Dubowitz H, Papas MA, Black MM, Starr RH. Child
    neglect Outcomes in high-risk urban
    preschoolers. PEDIATRICS 20021091100-1107
  • Dubowitz H, Pitts SC, Black MM. Measuremenst of
    three major subtypes of child neglect. Child
    Maltreatment 20049344-356
  • Dubowitz H, Pitts SC, Litrovnik AJ, Cox CE,
    Runyan D, Black MM. Defining child neglect based
    on child protective service data. Child Abuse
    Neglect 200529 93-511
  • Dubowitz H. Wheres Dad? A need to understand
    fathers role in child maltreatment. Child Abuse
    Neglect 200630461-465
  • Editorial The neglect of child neglect. Lancet
    2003361443

35
References (3)
  • English DJ, Thompson J, Graham C, Briggs EC.
    Toward a definition of neglect in young children.
    Child Maltreatment 200510190-206
  • Farrell Erickson M, Egeland B. Child neglect. In
    JEB Myers, L Berliner, J Briere, CT Hendrix , C
    Jenny, TA Reid (eds). The APSAC Handbook on
    Child Maltreatment. Thousand Oakes, CA Sage
    Publications 2002
  • Garbarino J, Collins CC. Child neglect. The
    family with a hole in the middle. In H. Dubowitz
    (ed). Neglected children. Research, practice and
    policy. Thousand Oaks, CASage Publications 1999
  • Gaudin JM jr. Child neglect. Short-term and
    long-term outcomes. In H. Dubowitz (ed).
    Neglected children. Research, practice and
    policy. Thousand Oakes, CASage Publications 1999
  • Glaser D. Emotional abuse and neglect
    (psychological maltreatment) aconceptual
    framework. Child Abuse Neglect 200226697-714
  • Glaser D. Prior V. Predicting emotional abuse and
    neglect. In K.D. Browne, H. Hanks, P. Stratton,
    C. Hamilton (eds). The early prediction and
    prevention of child abuse A handbook.
    Chichester John Wiley Sons Ltd 2002

36
References (4)
  • Hildyard KL, Wolfe D. Child neglect
    developmental issues and outcomes. Child Abuse
    Neglect 200226679-695
  • Hines DA, Kaufman Kantor G, Holt MK. Similarities
    in siblings experiences of neglectful parenting
    behaviour. Child Abuse Neglect 200630619-677
  • Kellogg N, the Committee on Child Abuse and
    Neglect. Oral and dental aspects of child abuse
    and neglect. PEDIATRICS 20051161565-1568
  • Killen K. Barndomen varar i generationer. Om
    förebyggande arbete med utsatta familjer.
    Wahlström Widstrand 2000
  • Kotch et al. Importance of early neglect for
    childhood aggression.
  • PEDIATRICS 2008121725-731
  • Labbé J. Ambroise Tardieu The man and his work
    on child maltreatment a century before Kempe.
    Child Abuse Neglect 200529311-324
  • Lacharité C, Ethier L, Couture G. The influence
    of partners on parental stress of neglectful
    mothers. Child Abuse Review 1996518-33
  • McKinsey Crittenden P. Child neglect. Causes and
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References (5)
  • MacMillan H, Thomas BH, Jamieson E, Walsh CA,
    Boyle MH, Shannon HS, Gafni A. Effectiveness of
    home visitation by public-health nurses in
    prevention of the recurrence of child physical
    abuse and neglect a randomised controlled trial.
    The Lancet 20053651786-1793
  • Roche AJ, Fortin G, Labbé J, Brown J, Chadwick D.
    The work of Ambroise Tardieu The first
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  • Sidebotham P, Heron J, The ALSPAC Study Team.
    Child maltreatment in the Children of the
    nineties A cohort study of risk factors. Child
    Abuse Neglect 200630497-522
  • Sidebotham P. An ecological approach to child
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    research and practice. Child Abuse Review
    20011097-112

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References (6)
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    20049395-408
  • Söderholm A. När barn far illa. Finska
    Läkaresällskapets handlingar 2006223-35
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