Understanding child neglect

CFCA Paper No. 20 – April 2014

Risk indicators for neglect

Where direct measurement of parental or caregiver neglect is difficult, it may be possible to gain some understanding of the number of children and families affected by considering other factors, or indicators, that can be associated with neglect. The presence of these risk indicators is not conclusive for neglect but research has shown that risk indicators are more likely to be present in families of neglected children (Gaudin et al., 1996). Some of these risk indicators are discussed below.

Neglect is best viewed in an ecological context where child, parent, family, and societal factors all play a role in the risk and wellbeing of a child. While the actions of the parent (or lack thereof) are most often considered to be the cause of neglect, community, societal and professional action or inaction can also contribute to neglect (Dubowitz, 2013; Gil, 1975).

It is also important to recognise that many risk indicators are also outcomes of child neglect and for some children it is almost impossible to understand what comes first, so any attribution of risk or outcome must be carefully considered. For example, a mother may struggle to engage with her new infant, providing inconsistent care. This may result in a child who is disengaged or prone to overly dramatic responses, which results in the child being labelled as difficult by his or her mother. Research has found that mothers who neglect their children are more likely to label them as "difficult" (Alink, Euser, Van IJzendoorn, & Bakermans-Kranenburg, 2013). Thus, where a risk indicator for child neglect is a "difficult" personality, being seen as "difficult" may also be an outcome of having been previously neglected as an infant.

Socio-economic factors

It is impossible to consider neglect without including the context of poverty. Families who are experiencing poverty are also likely to be associated with higher levels of parental stress, inadequate housing, homelessness, lack of basic needs, inadequate supervision, substance abuse, and domestic violence (Dubowitz, Black, Kerr, Starr, & Harrington, 2000) all of which have been strongly associated with neglect.

Where evidence points to poverty as a strong risk indicator for neglect, then failing to address poverty at a societal level could be considered a structural neglect behaviour (Gil, 1975). This can occur through a failure to provide social support for parents, or a definition of community standards of neglect that do not account for poverty. In a seminal paper on childhood neglect, David Gil (1975) discussed children who live in poverty, suffer malnutrition, are not educated, clothed or housed appropriately, suffer poor health, live in "decaying" neighbourhoods, whose parents lack meaningful employment opportunity, and are generally alienated from mainstream society. He pointed out that these conditions are, in part, due to social policies that fail to address these issues (Gil, 1975).

Social marginalisation is also a critical factor that leads to distrust of the system designed to deliver the societal support that these families require. The ongoing marginalisation leads to family narratives that result in feelings of hopelessness, particularly if the only way of providing that support is delivered via a system that starts with an investigative rather than a cooperative perspective. The impact of poverty on parents is also inflicted on their children - therefore we cannot address one issue without accounting for and addressing other associated issues (Dubowitz, 1999).

Families who experience poverty are more likely to have larger families, be single-parent households, or have a child with a disability, and may be more likely to come to the attention of support agencies. One UK study of low-income women found that families referred for in-home services, and those where children were removed and placed in out-of-home care, had more children in their care (Brayden, Atlemeier, Tucker, Dietrich, & Vietze, 1992). This exposure to services also makes families more likely to be reported to child protection agencies. Mandatory reporting requirements may see them reported more often and for reasons that do not meet a threshold for intervention, thereby ensuring ongoing scrutiny by child protection agencies. Furthermore, those groups are also more likely to have complex needs and a scale of problems that requires long-term engagement with "the system" (e.g., disability, mental health issues, intergenerational poverty and/or trauma) (Owen & Statham, 2009).

Workforce participation

Rates of employment are lower in parents who neglect their children than in those who do not (Dufour, Lavergne, Larrivée, & Trocmé, 2008). Low socio-economic status has been strongly associated with child neglect, particularly chronic neglect. In one study, families earning incomes of less than USD$15,000 were 22 times more likely to be associated with neglect than those with incomes above USD$30,000 (Dubowitz et al., 2000). Low socio-economic status is, in turn, associated with a number of other factors that include unemployment, large numbers of children in the household, social isolation and limited education (Crittenden, 1999).

The role of ethnicity in poverty

Ethnicity and race have been linked to child neglect in a number of studies. However, research has demonstrated that in analyses where ethnicity is controlled for, the effect disappears and neglect is associated with other factors such as poverty or access to services (Connell-Carrick, 2003).

When families have adequate economic and social resources the over-representation of ethnic or cultural groups in child protection data has been found to be of little significance. However a lack of these resources, combined with racial discrimination and poverty, placed stressors on families that overwhelmed coping resources (Daniel, 1998; Saunders, Nelson, & Landsman, 1993). This lack of resources may be the source of neglect, rather than cultural or ethnic influences.

Research using the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) found maltreatment was more likely to be substantiated for Aboriginal children (50%) than non-Aboriginal (38%) or other visible minority children (41%) (Blackstock, Trocmé, & Bennett, 2004). Fifty-nine per cent of these substantiations involved a form of neglect. These children were also more likely to come from single parent households, have social benefits as the main source of income for the family, live in rental housing, and have moved more than twice in the previous 6 months. Indigenous children have historically been more likely to be removed from families for neglect and maltreatment and placed in formal care (29% compared to 7% of non-Indigenous children in Canada), but little has been done to overcome poverty, unemployment, overcrowded and substandard housing, or a lack of culturally based prevention services.

In Australia, poverty and low socio-economic status have been linked to levels of neglect in Indigenous communities (AIHW, 2011). For example, a literature review indicated that changes in levels of poverty, living standards, and individual access to resources will have to occur before there can be sustainable changes in levels of neglect in Indigenous communities in the Northern Territory (Scott & Higgins, 2011).

It is difficult to separate the effects of neglect from those of poverty and other associated risk factors. For instance, does a neglected child do poorly in school because of neglect, or because books and computers are a luxury, their community doesn't have a public library, and they come from a poor household with few resources to pay for rent and food?

Family structure

Single-parent families, particularly those headed by a single mother have been found to be more vulnerable to neglect than intact, two-parent families (Dufour et al., 2008). Families of single parents, particularly mothers, are also more likely to have a low socio-economic status and to suffer from the effects of poverty and lack of access to services - any consideration of single parenthood must also take into account these factors. A high proportion of neglectful families are two-parent households (38%), and the neglect was evident even in homes where the father was no longer resident but he continued to maintain contact with the children (Dufour et al., 2008), suggesting that paternal involvement is not enough to protect children from neglect.

The role of fathers

Neglect is often seen as being the fault of mothers and the role and responsibility of fathers is seldom taken into account (Dubowitz, 1999). Most research focuses on maternal characteristics with few studies investigating the role of fathers in neglectful parenting. Further, much of the professional focus is on mothers while fathers' behaviour is largely ignored (Dubowitz et al., 2000). This may be because single parent households are more likely to be associated with neglect and mothers are often the parent responsible for the care of the children in those households; however the lack of research on the role of fathers in child neglect is a limitation of the research (Dubowitz, 1999).

Child characteristics

Although child characteristics may influence the exposure to neglect (e.g., difficult temperament) it is important to consider the home environment and context of child characteristics and not view the child characteristics in isolation.

Younger children are more likely to be exposed to neglectful parenting behaviours and suffer worse consequences. Children under 3 are very vulnerable and those under the age of 1 are most vulnerable (Connell-Carrick, 2003). Children aged between 6-8 years comprise the largest proportion of those who are reported to child protection authorities - but this may be a result of teachers having contact with children and therefore be due to improved recognition, rather than higher rates of neglect in this age group (Dubowitz, 1999).

Some research has shown that mothers who neglect their children are also more likely to rate their child as difficult than mothers who are not neglectful (Brayden et al., 1992) and children with a disability are associated with higher levels of neglect, especially boys (Connell-Carrick, 2003).

Parental history and wellbeing

A number of factors play a role in parenting ability and its effect on children and risk indicators associated with neglect. One Canadian study found that 40% of mothers of neglected children had experienced ongoing domestic violence. The same study found mothers were more likely to have had a history of been maltreated in childhood than fathers. Fathers in the same study were more likely than mothers to have been charged with violent crimes and crimes against property (Dufour et al., 2008).

Neglect has been associated with young maternal age, low socio-economic status, and low levels of educational achievement - each of which are also associated with poverty. Early research into neglect found neglectful mothers had poor problem solving skills and low self esteem, were socially isolated, and felt their supports provided less tangible and emotional support (Alink et al., 2013).

Some research has suggested that neglectful parents were more likely to perceive the child's behaviour as problematic and to have high levels of stress, hyper-reactivity or anger associated with their response to that behaviour than non-neglectful parents (Alink et al., 2013). Families where neglect occurs are likely to have decreased capability to deal with the complex issues they face. This compounds the issues and leads to parental feelings of being overwhelmed. Where neglect is related to a failure to provide guidance and discipline this generates further feelings of inability, which spirals into a sense of hopelessness, thereby further exacerbating the already complex and difficult situation in the family.

Neglectful parenting is also associated with a maternal history of domestic violence, alcohol and/or substance misuse, and mental illness, particularly depression (Connell-Carrick, 2003; Dubowitz, 1999). Mothers may be intensely focused on coping with their own issues, so are less aware and/or available to tend to the needs of their children than non-neglectful mothers (Higgins & McCabe, 2001).