Quiz #1

Chapter 3: Child Neglect and Child Psychological Maltreatment

Lecture Outline

I. Child Neglect

a. Scope of the Problem of Neglect

i. It is the most frequently reported form of child maltreatment

ii. Neglect of children’s basic needs was acknowledged or defined as a social problem in early 20th century

iii. It is the “most forgotten” form of maltreatment

iv. It is the most difficult type of child maltreatments to define

1. deficits in meeting a child’s basic needs constitute neglect

2. three fundamental needs of children

a. perceived support from mothers

b. nonexposure to family conflict

c. early affection from mothers

3. definitions fail to distinguish between parental failure to provide when options are available and when options are not available

v. Measurement of Child Neglect via the National Incidence Studies (NIS0

1. The previous standard of neglect was based on the Harm Standard. To be counted as an incident of neglect, the incident had to reflect demonstrable harm to the child.

2. Now the National Incidence Studies include an endangerment standard (i.e. risk of harm). For example, leaving an infant in a hot locked car alone while a mother runs a quick errand in a grocery store endangers the infant even if no harm occurs

vi. Other measurement variables that affect the interpretation of neglect

1. The frequency and duration of the neglect (e.g., leaving the infant outside the grocery store for 5 minutes or 5 hours)

2. The chronicity of neglect (e.g., mom leaves the baby unattended outside the grocery store every day or once in 8 months)

vii. Two Types of Families

1. Chronically neglectful—experienced multiple problems and deficits, including lack of knowledge, skills, and tangible resources

a. need multiple treatment interventions of long duration

2. Nonchronically neglectful—had experienced recent significant crises that appeared to overwhelm their normally sufficient coping abilities

a. need short-term crisis, stress management, and support group interventions

b. Typologies

i. Prenatal neglect (Box 3.1)

1. actions of a pregnant woman that can potentially harm her unborn child

a. drug exposure (e.g., alcohol-fetal alcohol syndrome)

b. stress (e.g., effects of poverty)

c. domestic violence (e.g., injury, prematurity)

2. need special prevention programs rather than criminalization

ii. Physical neglect— failure to provide a child with basic necessities of life, such as food, clothing, and shelter, and refusal to seek or a delay in seeking health care, desertion or abandonment, refusing custody responsibilities, and inadequate supervision

iii. Educational neglect—failure to provide a child with the experiences necessary for growth and development, such as intellectual and educational opportunities

iv. Emotional neglect—failure to provide a child with emotional support, security, and encouragement

v. Medical neglect—failure to provide the child with basic health care needs

1. refusal to allow medical treatment

2. refusal to allow vaccination

c. Cross-cultural neglect—physical neglect, abandonment, child prostitution, children living on the street, physical beatings, forcing a child to beg, and infanticide.

i. Three events elicited nonagreement about classification the behavior as neglectful: medical neglect, parental substance abuse, and physical discipline

ii. Globally (in US also) children often experience polyvictimization: neglect, physical abuse, and so forth (e.g., see the Dutch study)

iii. Romanian infants: Although not physically neglected, they were severely emotionally neglected – Often induced psychiatric symptoms

d. Prevalence of neglect

i. Multiplicity of official estimates: NIS, DHHS (data from child protective services), NCANDS

ii. Official estimates have increased and then decreased (Table 3.2 NIS studies). Rate per 1,000 was 10.5 for 2010 and 13.1 for 1993

iii. Kaiser-Permanente study of adult recollections indicated that females experienced more emotional neglect while males experienced more physical neglect

iv. Self-report surveys

1. 27% reported some form of child neglect at least once during the past year

2. most common form was leaving a child alone even when the parent thought an adult should be present

3. 11% reported they were unable to ensure their children obtained the food they needed

4. 2% reported an inability to care for their children adequately because of problem drinking

v. Effects of neglect on children

1. child neglect in the first two years of life may be a more important precursor of childhood aggression than later neglect or physical abuse at any age

2. neurobiological research has also established that early neglect has the potential to modify the body’s stress response

3. Attachment difficulties

a. relationship between neglect and disturbed patterns of infant-caretaker attachment

b. potential for lifetime problem and passage on to next (i.e. intergenerational transmission)

c. prevalence of comorbidity (i.e. dual diagnosis)

d. parents lack sensitivity, are inconsistent and chronically unresponsive to the baby’s needs

e. 30% develop insecure (anxious) attachment that manifests in avoidant or ambiguous type of attachment

f. behavior problems such as aggression, bullying, or social withdrawal, extreme dependence on others, low self-esteem, and unpopularity

g. disorganized attachment when parent-infant interactions are so chaotic and the infant shows a number of symptoms, such as approach-avoidance behavior. These children are likely to develop some form of psychopathology

4. Cognitive and academic difficulties

a. deficits in language abilities, academic skills, intelligence, and problem-solving skills

b. significantly poorer overall school performance and poorer math skills and language and reading skills

c. poorer performance patterns were generally stable over time

d. cognitive deficits generally more severe for neglected children than for physically abused children

5. Emotional and behavioral problems

a. more emotionally abused children met criteria for at least one clinical diagnosis (e.g., anxiety, cognitive, or impulse-control disorders)

b. more treated for psychiatric conditions

c. specific personality disorders (paranoid, borderline, avoidant, dependent, obsessive-compulsive) occurred significantly more often among emotionally abused children

6. Physical consequences

a. most serious physical consequence is death; neglect is the form of maltreatment most often associated with death (31.9% of child deaths attributed to neglect)

b. research on whether neglect is a risk factor for either obesity or underweight has produced mixed results

c. failure to thrive (FTT) (Box 3.2)

i. marked retardation or cessation of growth during the first 3 years of life

ii. height and weight gain below standardized growth patterns

iii. initially coined to describe infants and young children hospitalized or living in institutions in the early 1900s who exhibited marked deficits in growth as well as abnormal behaviors such as withdrawal, apathy, excessive sleep, unhappy facial expressions, and self-stimulatory behaviors, including body rocking or head banging

iv. can stem from both organic (e.g., physical problem – e.g., kidney disease) and nonorganic causes (e.g., physical and emotional neglect)

v. strongest correlate of nonorganic FTT is poverty

II. Characteristics of Neglected Children and Their Families

a. Characteristics of Neglected Children

i. 71.1% of maltreated children were neglected

ii. Most child neglect occurs in children under 5, and neglect decreases with age

iii. educational neglect (47%) was highest for children 9–11 years of age and then declined somewhat

iv. emotional neglect (25%) was highest for adolescents 15–17 years of age; rose steadily from birth through the late teens

v. physical neglect occurred at a rate of 38%

vi. 2.2% were medically neglected

vii. 48% male, 51% female

viii. 58% of children physically neglected by a biological parent were White

ix. 53% of children physically neglected by a nonbiological parent (or parent’s partner) were Black

x. There are significant numbers of neglected disabled children in Eastern Europe

b. Characteristics of Neglectful Parents

i. Statistics

1. 92% of neglect perpetrators were the biological parents

2. 86% of neglect perpetrators were female, a finding that may reflect the general social attitude that mothers are responsible for meeting the needs of their children

3. 12.1 per 1,000 parental neglect perpetrators were unemployed; 4.1 per 1,000 parental neglect perpetrators were employed

4. 16.1 per 1,000 neglected children were in low socioeconomic status (SES) families; 2.2 per 1,000 neglected children were not in low SES families

5. 26.9% substance abuse problem in the household

6. 19.4% mental illness problem in the household

7. 23.3% parental divorce/separation

8. 4.7% incarcerated household member

ii. Risk Factors for Neglect of Children

1. caregiver’s substance use/abuse

2. prior referrals for neglect to social agencies

3. more than one type of maltreatment during initial incident

4. caregiver absence

iii. Parent-Child Interactions of Neglectful Parents

1. generally interact less with their children, and when they do interact, the interactions are less positive

2. engage in less verbal instruction and play behavior with their children, show their children less nonverbal affection, and exhibit less warmth in discussions

3. are more negative, including issuing commands and engaging in verbal aggression

III. Child Psychological Maltreatment

a. Varying Viewpoints

i. It is a side-effect of other forms of abuse and neglect

ii. co-occurs with all other forms of abuse

iii. It is a unique form of child maltreatment

iv. It is a basic element of all forms of child abuse together

v. It is the most pervasive and destructive form of child maltreatment

vi. It has negative consequences that are very elusive

vii. a single act of psychological maltreatment is unlikely to result in significant and immediate harm, but the cumulative effects of this form of abuse are insidious

viii. negative consequences for victims are just as serious, if not more so, than those related to physical and sexual abuse

b. Scope of the Problem of Child Emotional Maltreatment

i. Definition—repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs

ii. dilemma in defining psychological maltreatment is determining what the focus should be:

1. child outcomes— mental injury or impaired psychological functioning and development

a. challenge: requires demonstration of harm; harm associated with psychological maltreatment may not be evident immediately

2. parental behavior—spurning, terrorizing, isolating, exploiting/corrupting, and denying emotional responsiveness

3. parent-child interactions—violation or failure to respect the elements of a child’s psychosocial being

iii. Prevalence of Psychological Maltreatment

1. Psychological maltreatment is the least common form of reported and substantiated child maltreatment because

a. Of definitional ambiguity

b. adults may not have recognized their childhood treatment as psychologically abusive

2. polyvictimization—multiple forms of abuse

3. 86% reported using psychological aggression toward their children (e.g., yelling, screaming or shouting, using threats, and swearing) at least once (average of 22 times) a year; most common form used was verbal (shouting, yelling, or screaming)

iv. Effects of Psychological Maltreatment on Children

1. psychological maltreatment is the strongest predictor of long-term impacts on psychological functioning

2. associated with negative feelings and long-term mental health risks in adulthood

3. individuals perceive themselves as others see them; children come to believe the negative things they are called are true and may begin to act as though they are worthless, stupid, unlovable, or ugly

4. specific effects

a. parental terrorizing predicted anxiety and somatic concerns

b. parental ignoring predicted depression and Borderline Personality Disorder

c. parental degradation predicted Borderline Personality Disorder

5. mediators of effects—maladaptive schemas adopted in childhood to cope

a. overly accommodating behavior

b. social isolation

c. domineering/controlling behavior

6. neurodevelopmental effects

a. likely to result in significant and enduring alterations in the neurobiology of stress response systems

b. significantly more vulnerable to stress, anxiety, depression, and other problems of adaptation

IV. Children Exposed to Interparental Violence

a. Scope of the Problem of Children Exposed to Interparental Violence

i. children suffer psychological maltreatment not only directly, but also indirectly, from exposure to violence between others

1. directly observe violent acts

2. overhear violent behaviors

3. see the results of assaults

ii. interparental violence and child abuse co-occur in families at a significantly high rate

iii. if classified as an act of omission, exposure to interparental violence is child neglect

iv. if classified as an act of commission, exposure to interparental violence is a form of psychological maltreatment

v. the definition influences societal responses; is a mother who does not leave her abusive husband guilty of exposing her child to interparental violence

vi. 3.3 million to nearly 10 million children witness interparental violence (Straus, 1991)

vii. 9.8% of children surveyed (Finkelhor et al., 2009) had been exposed to interparental violence

viii. The Kaiser-Permanente study of adult recall data revealed a 13.7% rate for females and an 11.5% for males

b. Effects of Exposure to Interparental Violence

i. suffer problems in five general areas (Table 3.8)

1. emotional functioning

2. behavior problems

3. social competence

4. cognitive ability

5. physical health

ii. depression, trauma-related symptoms (e.g., anxiety and sleep disturbance), low self-esteem, alcohol and drug use, poor social adjustment, general psychological distress, and ineffective conflict resolution skills

iii. verbal and physical violence against one’s own spouse, dating partner, or peers; verbal and physical abuse of one’s own children; and participation in violence outside the family

iv. father-initiated violence was associated with greater risk for psychological problems

v. the forgotten, unacknowledged, hidden, unintended, and silent victims of family violence

V. Characteristics of Maltreated Children and Their Families

a. Characteristics of Maltreated Children

i. Age and gender (please align)

1. findings from NIS-4 indicated that psychological maltreatment increases with children’s age and that boys are more likely than girls to experience psychological maltreatment

2. findings from DHHS showed the peak of psychological abuse was between 4 and 11 years of age

3. other researchers have failed to find any gender differences associated with psychological maltreatment

ii. Resiliency (ability to cope with abuse)

1. resilience does not extend uniformly across every sphere; children exposed to maltreatment may be resilient in only one domain, such as competency

2. resilience is dependent upon age, gender, ethnicity, the quality of mothering, social support, the child’s exposure to other forms of violence (i.e., polyvictimization), and child characteristics such as temperament and self-esteem

3. three crucial elements contributing to children’s resilience

a. better parenting performance

b. fewer maternal mental health problems

c. less severe exposure to violence

b. Characteristics of Maltreating Parents

i. meta-analysis (integration of many studies’ findings) identified parental risk factors

ii. Socioeconomic Status Risk Factors

1. higher in families with very low income, unemployment, and dependence on social assistance

2. SES is a stronger predictor of child neglect than of any other form of child maltreatment

3. income level has also been associated with severity of neglect, with higher-income families generally associated with less severe forms of neglect

iii. Family Structure/Functioning Risk Factors

1. mothers who have a greater number of children during their teen years or who are younger at the birth of their first child

2. teenage mothers whose first children were premature or had a low birth weight

3. mothers who left a coresidential relationship with a biological father or entered a coresidential relationship with a nonbiological father, especially for women with less education

iv. Intergenerational Transmission of Maltreatment

1. neglectful parents reported childhood histories of both neglect and abuse

2. witnessing intimate partner violence (IPV) was independently related to engaging in IPV in one’s own adult relationships

3. intergenerational transmission of (e.g., inadequate) parenting styles

4. mothers’ anxious attachment style predicted children’s insecure attachment to both mother and father

VI. Parenting Problems in Neglectful and Psychologically Maltreating Families

a. Stressful Circumstances

i. single parenting

1. often extremely stressful

2. fathers who make a positive difference in their children’s lives are not just those who are present in the house, but those who are involved with their children

3. substance-abusing fathers place their children at much higher risk when they live with their children

4. married father in the home was beneficial

5. marriage was not uniformly associated with better outcomes

6. cohabitation may be associated with negative outcomes, especially for Hispanic families

ii. being disabled

1. some members of society may criticize a disabled woman for having children; others try to offer the support she needs to care for an infant

2. has to struggle to maintain control over her parenting

iii. living in a home where marital violence is occurring

1. risks children’s emotional and behavioral adjustment

2. custody and visitation issues usually force the mother to safeguard her child while arranging visitation with her abusive spouse

3. most perpetrators did not realize their children had been negatively impacted by their violence

4. mothers living with violent fathers have serious problems coping with their own fear while trying to protect their children

5. custody problems for mothers

a. Abusive husbands may gain custody

b. Reporting father’s child neglect/abuse

c. Parental alienation syndrome—non-empirically-based syndrome in which one parent forms an alliance with a child in order to denigrate the other parent

d. Financial inequities

e. Hostile court settings

6. law guardians and custody disputes (guardian ad litum—court appoints a law guardian to oversee the process and report back to the court)

a. lacked expertise

b. unprofessional

c. sometimes supported abusers’ custody petitions despite known child abuse by the father

d. displayed biases and inequality

e. committed mother bashing

iv. coping with other stresses (risk factors for parental psychological maltreatment of children)

1. being a stepparent

2. being a homosexual parent

3. managing without a spouse/parent who is deployed in the military

b. Challenges to the research on psychological maltreatment

i. Lack of a standard definition

ii. Inadequate sampling

iii. Polyvictimization effects

iv. Sources of reports

v. Research designs

vi. Correlational data

vii. Lack of theoretical underpinnings

viii. Non-comparability of comparison groups

VII. Policy, Practice, and Prevention

a. Practice

i. Types of treatments

1. interventions with adults to enhance parenting skills

2. interventions with children to reduce effects associated with maltreatment

3. economic assistance to the family

4. multiservice interventions—combination of interventions simultaneously

a. individual, family, and group counseling; social support services; behavioral skills training to eliminate problematic behavior; and parenting education (e.g. Healthy Families New York)

ii. Factors that enhance effectiveness of treatment for psychological maltreatment

1. implementation by highly trained staff, professionals rather than paraprofessionals

2. relatively high dosage (i.e., high levels/numbers) and intensity of treatment

3. comprehensiveness of scope (i.e., multiservice)

4. increase the focus on economic well-being

5. comprehensive two-generation model

iii. Services

1. Goals of home visitation programs

a. connect at-risk parents with mentors who come to their homes and provide social support, parenting suggestions, and help with life decisions

b. increase parents’ knowledge about general child development

c. improve parents’ overall child-rearing skills

d. increase parents’ empathy for and awareness of others’ needs

e. improve parents’ ability to provide sensitive, responsive responding

f. improve family and parent-child communication

g. change parents’ beliefs about the value of abusive parenting

h. increase parents’ ability to handle stress

i. increase parents’ use of nonviolent approaches to child discipline

j. identify high-risk parents in a community (and intervene during pregnancy

2. Social support programs

a. emotional support groups are the most common type of service

b. provide mothers with social support, parent training (including child management and nurturing skills), and training in problem-solving and decision-making skills

c. included social support for the children with a child mentor who served as a “big brother” or “big sister”, engaging the child in interesting activities and providing positive attention and affection

3. Successful Early Intervention Programs

a. Healthy Families New York

b. Nurse-Family Partnership

c. U. S. Triple-P—Positive Parenting Program

4. Interventions for children exposed to interparental violence

a. Needed because of increased risks of PTSD, self-blaming behaviors, functional impairments, and depression

b. IPV screenings by practitioners, medical professionals, researchers are needed

c. individual treatment

d. group therapy goals

i. labeling feelings

ii. dealing with anger

iii. developing safety skills

iv. obtaining social support

v. developing social competence and a good self-concept

vi. recognizing one’s lack of responsibility for a parent or for the violence

vii. understanding family violence

viii. specifying personal wishes about family relationships

ix. safety planning

e. home visitation programs

f. shelter programs, but hampered by the lack of adequate staff

5. Safe Start Initiative programs

a. increase awareness about exposure to violence and identify affected children

b. intervene with parents in order to help them ensure the safety and well-being of their children at all times

c. need to assure that practices of programs are developmentally appropriate

iv. Common Problems in Interventions

1. therapy drop-outs

2. lack of correct implementation by workers

3. interactions with difficult children

v. Elements for Successful Programs; a meta-analysis of content and delivery found three program components were less effective than others

1. teaching parents how to problem solve about child problems

2. teaching parents how to promote children’s academic and cognitive skills

3. including ancillary services as part of the parenting program

b. Policy

i. Legal issues concerning parental behaviors

1. legislators must determine when parental mistakes cross the line and require a legal response

2. need to clarify some terms that are overly vague

3. should rethink the requirement that a child’s injuries be substantial and observable is problematic, because the

effects of psychological maltreatment may not be readily identifiable

4. need to recognize that some of the most damaging neglect occurs during the first two years of life before a child can verbally communicate distress

ii. Neglect and maltreatment investigations

1. best practices recommend conducting most investigations with a multidisciplinary team

a. advantages include sparing the child from repeated questioning, sharing expertise, and joint decision-making, better equipped to address issues relevant to the nonoffending parent

2. even severe cases of psychological abuse are difficult to prove in court

a. prosecutors usually find a “tag-along” charge consisting of some other type of abuse, such as physical abuse

3. successful investigations

a. gather relevant information about the incident, what is observed and what is suspected

b. question multiple sources, such as family members, neighbors, and school personnel

c. use valid and reliable assessment instruments and procedures

d. confer with other experts as necessary

iii. Laws

1. Safe Families Act— mandates that various agencies make decisions in the best interests of the child

a. Challenge: current law instructs caseworkers to remove children from the home only when absolutely necessary for their safety and to provide a rationale for their decision-making

2. Safe Haven laws—allows biological mothers to give up their newborn infants anonymously in specific safe locations (e.g. Texas’s Baby Moses abandoned baby law)

3. The Child Abuse and Treatment Act—specifies that maltreated children must have access to early intervention under Part C of the Individuals with Disabilities Education Act

iv. Shortcomings in agency policies, dependency court rulings, and Child Protection Services (CPS) workers’ actions

1. jurisdictions enact significantly different policies

2. counties within the same jurisdiction adopt dissimilar policies

3. personnel fail to document maltreatment

4. some courts do not articulate a ruling, but simply state a return date

5. CPS workers may not state why they removed a child from his home

6. CPS workers may not state the rationale for their out-of-home placements

7. CPS workers had offered referral services to 53% of parents before removing a child

8. CPS workers did believe exposure to domestic violence was harmful to children

9. Personnel did not uniformly document findings about the identity of the abuser

10. Workers who reported found that the mother was the victim in 65% of the cases, but 19% of the victims were incorrectly classified as co-batterers

11. CPS sometimes unknowingly placed the child in a different abusive home because of an insufficient investigation

12. No one specified child visitation guidelines for the offending parent

13. 82% of parents voluntarily agreed to their child’s removal without court adjudication

c. Prevention

i. no prevention programs have yet been established with the explicit purpose of preventing only child psychological maltreatment

ii. state and federal funding has not been available to support intervention and prevention research or program implementation

iii. there is a need for further government intervention

iv. researchers suggest a two-tier approach

1. first tier: education and support strategies

a. parent education classes

i. effective parenting skills

ii. knowledge of child development

iii. stress management techniques

iv. conflict resolution

b. sensitization campaigns—educate the general public regarding the harmful nature of parent-child verbal aggression (e.g. “Words Can Hurt”)

2. second tier: prevention efforts (e.g. home visitation programs)