Children of Neglect

When No One Cares

Margaret Smith, Rowena Fong

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135940119
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoterapia

This book contains a comprehensive review of the current state of child neglect. Included are statistics regarding incidence and lethality, definitional issues, etiological theory, history of and current policy, and current interventions. As child neglect is often linked with structural issues, the book also examines the relationship of child neglect to poverty, substance abuse and culture.

Chapter One
The Children of Neglect
AN OVERVIEW OF THE ISSUES

INTRODUCTION

Child neglect is an overlooked area of child welfare practice. The consequences of neglect to children are at least as serious as the consequences of abuse. Nevertheless, the focus of those working in the field of child maltreatment has been on abuse, to the neglect of neglected children and their families. The strong association between neglect and poverty and the lack of societal will to address issues associated with poverty create difficulties in terms of effective policy and practice in regard to families who neglect their children. It is as if “no one cares,” neither the parents of neglected children, nor the society in which they live. It is time to refocus on the issues of child neglect in families, both to assist in healing these families and as a vehicle for implementing structural changes that will benefit all families. This book will examine research, social policy, and practice with respect to neglectful families. It presents and critically analyzes major definitional, theoretical, policy, and treatment issues associated with families who neglect their children. Research, policy, and practice implications associated with these issues are included. Separate chapters regarding the relationship between neglectful families and culture, substance abuse, and poverty are also included; as is a final chapter stating conclusions and future directions.

ISSUES ASSOCIATED WITH CHILD NEGLECT

When one addresses the problem of families who neglect their children, two issues are immediately apparent. The first concerns its epidemic proportions in terms both of numbers and severity, including fatal consequences to children. The second is the lack of attention paid to the problem in terms of neglect-specific research, policy, and intervention. Thus, two primary issues related to the problem of child neglect are (a) its epidemiology, including incidence, prevalence, and consequences to children; and (b) the child welfare field’s focus on child abuse, not child neglect.

Epidemiology

Fatal child neglect. Children are seriously injured and die at the hands of their parents or caretakers at least as frequently from neglect as from abuse (DiLeonardi, 1993; Erickson & Egeland, 2002; Margolin, 1990; United States Department of Health and Human Services ([USDHHS], 1999b, 2002; Wolock & Horowitz, 1984). Most child deaths resulting from identifiable events involve some type of neglect (Block, 2002). The following statistics reveal just how deadly child neglect can be.

• In 1983 the American Humane Association (AHA) reported that of all the children who died from maltreatment in 1981, 56% died as the result of neglect.
• In 1986 the percentages for fatalities indicated that 44.3% involved neglect, while 62% involved abuse (AHA, 1988).
• Lung and Daro, as cited in Bonner, Crow, and Logue (1999), estimated that between 1993 and 1995, 37% of the children who died as the result of maltreatment died of neglect. An additional 15% died of a combination of abuse and neglect, indicating that 52% of the deaths during that time period involved child neglect.
• In 1994, 42% of the fatalities were due to neglect (Erickson & Egeland, 2002).
• Over one child per 1,000 children in the United States, or a total of 977 children, died as a result of maltreatment in 1995 (Petit & Curtis, 1997). Of these deaths, 50% were due to neglect and 22% were due to physical abuse.
• Petit et al. (1999) reported that in 1996, 478 infants (children under twelve months old) died as a result of abuse and/or neglect. The total number of children who died as a result of maltreatment that year was 930, of which 47% involved neglect and 21% involved physical abuse.
• In 1998, the Child Welfare League of America (CWLA, 2002a) found that 421 children died of physical abuse and 406 deaths involved neglect. The total deaths from child maltreatment for that year were 1,039.
• The USDHHS (1999b) reported that child maltreatment deaths are most often associated with child neglect, as opposed to child abuse. The rate for that year was 38.2% for neglect only.
• In 2000, 1,200 children died of abuse or neglect. Again, these deaths were most often (34.9%) the result of neglect only. When including children who died as a result of abuse and neglect, 57.1% (approximately 685) of children’s deaths due to maltreatment involved child neglect as compared to 50% that involved abuse (i.e., abuse only [27.8%] and abuse and neglect [22.2%]) (USDHHS, 2002).

To put these numbers in perspective, during 1996 fifty-five law enforcement officers and twenty-one military personnel were killed in the line of duty (Petit et al., 1999).

This long list of statistics is included to substantiate the conclusion that child neglect is consistently (over time and various methods of data collection) at least as fatal as child abuse, and is usually more so. This information is, for the most part, not considered or, worse, ignored when researchers, policymakers, practitioners, or the public in general focus on child maltreatment issues.

Child neglect. In terms of overall reports of child maltreatment, not just fatalities, neglect is the most prevalent type of child maltreatment. A study of the effects of the Child Abuse Prevention and Treatment Act of 1974 indicated that the majority of reports made as a result of this legislation have been reports of child neglect (Stein, 1984). Studies have shown that the ratio of neglect to abuse reports ranges from 3:1 to 10:1 (Wolock & Horowitz, 1984).

• In 1986 the American Association for Protecting Children found a 2.5:1 ratio of neglect to abuse for the year 1984.
• More recently, Rose and Meezan (1993) reported that child neglect constituted 55% of all reported child maltreatment.
• Sedlak and Broadhurst (1996) in The Third National Incidence Study of Child Abuse and Neglect (NIS–3) reported that of the 2.8 million children substantiated as endangered or harmed due to maltreatment in 1993, 70% suffered from neglect and 43% from abuse.
• In 1995, 47% of substantiated reports were for neglect and 22% were for physical abuse (Petit & Curtis, 1997).
• Smith (1998) found similar results (47.1% neglect to 23.1% abuse) in a study of Child Protective Services (CPS) in Hawai’i.
• In 1998, Emery and Laumann-Billings reported that 54% of child maltreatment cases were child neglect.
• The CWLA (2002b) reported that neglect comprised 42%, physical abuse 17%, and sexual abuse 9% of substantiated/indicated cases of child maltreatment for the year 1999. The total number of substantiated cases of child maltreatment for that year was reported to be 991,355.
• Again for 1999, the USDSSH (1999b) reported that 826,000 children were maltreated–58.4% were neglected, 21.3% were abused and 11.3% were sexually abused.
• A total of 879,000 children were victims of abuse and neglect in the year 2000. Of these 62.8% were neglected, 19.3% were physically abused, and 10. 1% were sexually abused (USDSSH, 2002).

Once more a list of statistics, which is evidence that, in spite of discrepancies in data collection and methodologies (which could account for dissimilar results), the approximate 2:1 ratio of neglected to abused children persists over time.

Child neglect and poverty. Presented here is a brief overview of this complex issue. A more complete and comprehensive portrayal is given in Chapter Ten. In regard to socioeconomic status (SES), child maltreatment is correlated with low-income families. Looking at SES, a Canadian study of cases referred to Ontario’s Children’s Aid Society (CAS), which is the Canadian equivalent of Child Protective Services (CPS), found that 50% of those whose income was known were supported by social assistance, as compared to 23% of the total population in Ontario (Trocme, McPhee, & Tam, 1995).

There appears to be an inverse relationship between a family’s economic status and child maltreatment in the family; and the poorer the family, the harsher the outcomes for the children. When considering the various types of child maltreatment, the relationship with poverty is stronger for child neglect than it is for child abuse. It is clear that child neglect is unquestionably linked with poverty (Emery & Laumann-Billings, 1998; Erickson & Egeland, 2002; Pelton, 1994; Sedlak & Broadhurst, 1996; Thomlison, 1997).

In support of this conclusion, Pelton (1994) and Thomlison (1997) reported that in 1986 the risk of neglect in families whose income was less than $15,000 per year was nine times greater than in families whose income was more than $15,000. The NIS–3 (Sedlak & Broadhurst, 1996) found this rate had grown significantly over the next seven years. In 1993 families who earned less than $15,000 per year were 44 more times likely to neglect their children than similar families who earned greater than $30,000 per year.

Sedlak and Broadhurst (1996), Petit and Curtis (1997), and Petit et al. (1999) reported similar ratios of neglect to family income.

• For families whose income was less than $15,000, 27.2 children per 1,000 in the population were harmed as the result of child neglect.

The figures for families whose incomes exceeded $15,000 were significantly lower.

• Children were harmed due to neglect at a rate of 11.3/1,000 for families whose income was between $15,000 and $30,000.
• For families whose income was above $30,000 the ratio was 0.6/1,000.

Using an endangerment standard (i.e., the number of children endangered or harmed by child neglect) the NIS–3 (Sedlak & Broadhurst, 1996) found the ratios and discrepancies to be even greater:

• 72.3/1,000 for the lowest income group and
• 1.6/1,000 for those with incomes over $30,000.

These figures were significantly higher than for physical or sexual abuse. Thus, the relationship between poverty and neglect is clear. However, as minorities are overrepresented in the welfare, as well as the child welfare, system, the relationship between child neglect and culture is not so clear.

Child neglect and culture. Generally, when analyzing statistics to determine the incidence of child maltreatment related to culture, as opposed to SES, culture and social class overlap and are difficult to separate (e.g., is neglect in a family associated with poverty and/or with ethnicity?). Minorities tend to be overrepresented in both the CPS case loads and the lower SES groups, making it difficult to pull out the effects of race from the effects of class on child maltreatment (Korbin & Spilsbury, 1999). In addition, ethnicity usually operationalizes as Whites, Blacks, and others (Garbarino & Ebata, 1983), which does not yield useful information regarding differences among various other cultural groups.

Some incidence studies have been done in regard to the Native-American community with the following results.

• Fischler (1985) indicated that the neglect to abuse ratio for off-reservation Native Americans in 1978 was 2.5:1.
• For Native Americans living on a reservation it was 6:1 for Navajos and 2:1 for Cheyenne River tribes.
• In Canada, 47% of First Nations Peoples families referred to CAS were referred for child neglect as compared to 26% of White families, indicating a higher incidence of neglect among the First Nations Peoples in Canada (Trocme et al., 1995).

In the United States minorities, as well as low-income families, were consistently overrepresented in the studies reported by Garbarino and Ebata (1983). These results could be attributed to the facts, as mentioned above, that most studies use only White, Black, and sometimes Hispanic subcultures; and minorities are consistently overrepresented in low-income categories.

When Spearly and Lauderdale (1983) took income out of the equation, they found increases in child neglect rates among the Black population as opposed to White and Hispanic.

• In this study Whites had a maltreatment rate of 12.3 reports per 1,000 White families and
• Blacks had 23.3 per 1,000 Black families.
• Hispanics were in the middle with 18.2 reports per 1,000 Hispanic families.

This study indicates there may be an association of ethnicity, as well as class, with child neglect. However, most studies found no differences in child maltreatment rates among the various ethnic groups studied (Nelson, Landsman, Cross, Tyler, & Twohig, 1994; Paget, Philp, & Abramczyk, 1993; Pelton, 1994; Sedlak & Broadhurst, 1996). An in-depth look at the relationship between neglectful families and culture is presented in Chapter Eight.

One problem that is made abundantly clear as one looks at the statistics concerning the prevalence of child neglect, and the association of neglect with economic status and race, is the need for better definitions and methodologies in collecting child incidence data regarding child maltreatment in general, and child neglect in particular. Most of the data regarding child neglect are estimates at best. Zuravin (1999) reported findings that indicated underestimation of the prevalence and severity of child maltreatment, including neglect. We really do not know with any degree of certainty how many children are neglected each year; nor, indeed, how many are neglected to death (Block, 2002; Bonner et al., 1999; Federal Interagency Forum on Child and Family Statistics, 1998). However, the best information that we do have indicates that children are neglected more frequently than they are abused; and severe damage, including death, is a consequence of neglect just as often as child abuse.

Effects of child neglect. “In the past, the consequences of child neglect were not considered to be as severe as the consequences of other forms of maltreatment… Indeed, neglect in early stages of life may lead to severe, chronic and irreversible damage” (Perry, Colwell, & Schick, 2002, p. 193). Empirical research has shown substantial negative effects of child neglect on children over and above fatalities. Thornberry, Ireland, and Smith (2001) reported that neglect experienced in childhood has a more negative impact on early adolescent outcomes than physical abuse. Trocme et al. (1995) found the effects of neglect were primarily psychological or emotional. The findings of Ney, Fung, and Wickett (1994) indicated that the most severe psychological conflicts resulted from being neglected as opposed to being abused. Neglected children also experience more problems with academic achievement and discipline in school than their nonneglected peers (Kendall-Tackett & Eckenrode, 1996). In addition, neglected children suffer more physical health problems including malnutrition, failure to thrive, handicaps and impaired visual and motor skills (Fischler, 1985; Helfer, 1987a; Martin & Walters, 1982; Nelson, Saunders, & Landsman, 1990; Polansky, Chalmers, Williams, & Buttonwieser, 1981; Polansky, DeSaix, & Sharlin, 1972; Sweet & Resick, 1979; Tower, 1993; Zuravin & Greif, 1989). Erickson and Egeland (2002) arrived at the conclusion that “the impact of neglect on children’s development was at least as damaging as other more overt types of abuse” (p.).

Neglect, when combined with other forms of maltreatment, increases a child’s vulnerability even more; for example, when neglect precedes abuse, the effect of neglect is significantly increased (Ney et al., 1994). Neglect when combined with abuse has a stronger effect than abuse alone on the number of disciplinary referrals and grade repetitions for school-aged children, especially for children in the middle grades (Kendall-Tackett & Eckenrode, 1996). Watters, White, Parry, Caplan, and Bates (1986) found that the most serious injuries to children, more serious than abuse alone, occurred in families where abuse and neglect coexisted. These studies indicate that both the most serious physical and psychological harm to children occur in the presence of child neglect.

Jonson-Reid, Drake, Chung, and Way (in press) and Marshall and English (1999) found that neglect was the most likely reason for recidivism in families reported to CPS on more than one occasion. Neglect was the most common reason for second complaints, regardless of the type of the initial report (Jonson- Reid et al., in press). In addition, the USDHHS (2002) reported that neglected children were 27% more likely to experience recurrence of maltreatment than were physically abused children. Given previous research indicating the presence of more severe outcomes for children when neglect is involved, these findings suggest that more children are at higher risk than is commonly believed. When this information is combined with the statistics regarding fatalities, it is clear that neglect has an effect that is at least as devastating as abuse on more children than is generally kno...