REP 4

Child Abuse & Neglect 31 (2007) 607–614

Commentary

Understanding and addressing the “neglect of neglect”: Why are we making a mole-hill out of a mountain?

Dominic McSherry

Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen’s University, 6 College Park, Belfast BT7 1LP, Ireland

Received 20 March 2006; received in revised form 7 August 2006; accepted 7 August 2006 Available online 28 June 2007

Keywords: Child neglect; Child abuse

Introduction

Current knowledge relating to child neglect points to the existence of a rather absurd paradox. On the one hand, child neglect has consistently been shown to have a markedly higher incidence rate than abuse (Childhood Matters, 1996; Sedlak & Broadhurst, 1996), and to result in more profound devel- opmental deficits (see Eckenrode, Laird, & Doris, 1993; Egeland, Sroufe, & Erickson, 1983; Gauthier, Stollak, Messe, & Aronoff, 1996; Kurtz, Gaudin, Wodarski, & Howing, 1993; Ney, Fung, & Wickett, 1994). On the other hand, child neglect is the most understudied and consequently the least understood type of maltreatment. This is commonly referred to as the “neglect of neglect” (Wolock & Horowitz, 1984).

Although the phrase “child abuse and neglect” is ubiquitous in the field of child maltreatment, research, theory and practice tend to be focused on abuse, at the expense of neglect. For example, Kaplan, Pelcovitz, and Labruna (1999) carried out a review of the child maltreatment literature between 1988 and 1998 and found that studies have infrequently examined neglect. Why has child neglect received so little attention compared with abuse? The key aims of this commentary are first, to examine why child neglect is so poorly understood and attended to and second, to make suggestions as to how this situation can be improved upon. The vast majority of work that specifies child neglect has been conducted in the United States and the United Kingdom. Consequently, this commentary focuses primarily upon these two jurisdictions.

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Definitional difficulties

Because child neglect can take many forms and occurs in a wide range of contexts, it has proven very difficult to define in a way that generalizes across all cases. Speaking from a United States perspective, Zuravin (1999) noted that the lack of a standard definition of child neglect had been recognized as a fundamental hurdle to developing understanding of this type of maltreatment more than a decade earlier (National Centre on Child Abuse and Neglect, 1987), but that the development of a standard definition remained outstanding. Dubowitz et al. (2005, p. 494) commented that “a long history of imprecise defini- tions of neglect has hampered researchers’ ability to make inferences about the nature and consequences of neglect.” Currently, the issue as to how child neglect might be defined has yet to be resolved, however, major advances are being made in this regard (Dubowitz et al., 2005; English, Thompson, Graham, & Briggs, 2005). In the United States, definitions of child neglect continue to vary from one state to the next and reflect the diverse notions held by professionals and non-professionals as to what constitutes child neglect. This variation contributes to the difficulty in developing general or global definitions and assessing national incidence rates.

Not only do definitions differ between states, but there is no general consensus within society as to what constitutes neglect. Rose and Meezan (1996) pointed out that operational definitions of neglect differ in three ways: first, between the professionals that use them (for example, social workers, caseworkers, protective service investigators, police officers, and juvenile court judges); second, between these profes- sionals and the lay community; and third, between different cultural groups. This lack of consistency in definition and approach contributes to a context of confusion when attempting to target and tackle neglect.

A major obstacle to the establishment of a general definition of child neglect is the problem of threshold, that is establishing what may be considered minimally adequate levels of care. There is general agreement about what constitutes inadequate care, such as a lack of food, clothing, shelter, affection, and attention or supervision. However, disagreement continues between professionals and ethnic groups on how to establish thresholds of minimal care and how these may vary depending upon the child’s age or the values that a particular community holds. Korbin and Spilsbury (1999) argued that, as child neglect encompasses so many gray areas, what constitutes neglect in practice is often highly contested across cultures, and basic needs are not always as clear-cut as food and water. For example, at what age is it acceptable to leave a child unattended? They noted that for Laotian and Cambodian refugees in the United States, it is unremarkable to assign care giving responsibility of younger siblings to children as young as eight years old in the absence of an adult caregiver. Should this behavior be considered neglectful? Could the fact that some children mature more quickly than others be taken into consideration when assessing neglect in this particular case? What might be deemed an acceptable period of time to leave children unsupervised? Would the area that the child lives in, that is urban or rural, be considered an important factor in determining whether leaving the child alone constituted neglect?

Definitions of neglect in the United Kingdom address the same basic issues as those in the United States and consequently suffer the same ambiguities. For example, the Department of Health (1999, p. 6) defined neglect as, “the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. It may involve a parent or carer failing to provide adequate food, shelter and clothing, failing to protect a child from physical harm or danger, or the failure to ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.” However, what is not so clear is how the terms “persistent,” “basic,” or “serious” used above, ought to be interpreted.

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Stone (1998) argued that neglect appears to be poorly understood in terms of theory, which is reflected in the paucity of literature and empirical studies that deal specifically with neglect and in the lack of neglect- specific professional training for practitioners. Parton (1995) pointed out that in the United Kingdom, neglect is primarily viewed as an issue of child protection, and is framed in narrow legal terms that specify high-risk or significant harm, which results in lower than expected incidence rates. It was also noted that the emphasis upon child protection in the UK has not always been the case. In the 1960s and 1970s neglect was regarded as a child welfare issue. However, with the emergence of right-wing political thinking in the early 1980s, which was opposed to the use of wide-ranging state welfare programs to address social problems and coupled with the emergence of a number of high-profile scandals, legalism began to take center stage and provided a new framework for dealing with relationships between individuals and between the individual and the state.

Parton (1995) also commented that legalism also conveniently allowed the state to retract from a position of responsibility to large swathes of the population by establishing very narrow definitions of child abuse and neglect, thus allowing limited financial resources to be directed only at the very needy and legally legitimizing abdication of responsibility to those that were simply needy. Moore (1989) suggested that neglect of neglect occurs because these cases do not contain enough drama to spark the child protection system into action. This is an important point because cases of neglect rarely contain enough visual impact for social services to consider these children as being in serious harm or to be very needy.

Neglect is difficult to substantiate

Although the most frequently occurring type of child maltreatment, Urquiza and Winn (1992) pointed out that child neglect is the least understood, because of the difficulty in substantiating anything but severe neglect. Gelles (1999, p. 279) pointed out that “the unique feature of neglect is locus of responsibility. It is often unclear whether neglect is due to a parent’s omissions or due to absence of social, economic, or psychological resources.” Similarly, Stone (1998) argued that in cases of child neglect it is often quite difficult to know where to attribute blame, that is with the parent, the environment, or a mixture of both.

More recently, English et al. (2005, p. 191) commented that one of the main difficulties with substan- tiating child neglect is that “neglect is the absence of a desired set of conditions or behaviors, as opposed to the presence of an undesirable set of behaviors,” as is the case with abuse. Essentially, it is a far simpler task to identify something that is present, as opposed to something that is not present. Furthermore, Minty and Pattinson (1994) noted that one of the reasons neglect seems to have become a simple add-on to child abuse is that, in order to establish neglect, evidence has to be gathered in a systematic way over a period of time, rather than in response to a specific incident. Similarly, Stone (1998) argued that one of the reasons neglect has a low public profile relative to abuse may be because neglect tends to be a long-term developmental issue rather than an event-specific crisis.

Neglect is associated with poverty

Almost 30 years ago, Wolock and Horowitz (1979) carried out a comparison of the demographic and social characteristics of 380 abusive and neglectful families and 143 non-abusive families that were in

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receipt of Aid to Families with Dependent Children (AFDC). They discovered that the less well off families were increasingly likely to maltreat their children, particularly in the form of neglect or neglect along with physical abuse. More recently, Sedlak and Broadhurst (1996) found that children in families with an income under $15,000 per annum are 22 times more likely to be victims of neglect than those living in families with annual incomes over $30,000. These findings suggest that child neglect may be a manifestation of families having to live in poverty.

Hay and Jones (1994) argued that there is some evidence that neglect is not only higher among the poor but particularly amongst the poorest of the poor (see also Wolock & Horowitz, 1984). However, they cautioned that observed relationships between poverty and maltreatment might result from selection bias. Similarly, O’Toole, Turbett, and Nalpeka (1983) argued that poorer families are more visible and hence more likely to be both officially and clinically judged to be neglecting their children than wealthier families.

At face value, there does appear to be a clear relationship between child neglect and poverty. However, what is not so apparent is the nature of this relationship. Crittenden (1999) argued that although many policy makers claim that alleviating poverty at both the national and international level is essential to tackling child neglect, three decades of efforts to improve the economic status of poor families in the United States have been generally ineffective at preventing child neglect. Crittenden (1999) suggested that it is not poverty but the parental characteristics that result in those parents and families living in poverty that hold the key to understanding child neglect. It was argued that both poverty and child neglect may be the effects of learning to process information in distorted and limiting ways. Essentially, child neglect is more to do with deficits in parenting behavior that operate independently of economics, rather than flawed parenting judgments that result from economic hardship (Crittenden, 1999; Stevenson, 1998).

More recently, McSherry (2004, p. 730) developed a less polarized perspective on this relationship, and argued that poverty and neglect need to be understood as reciprocal, circular and interdependent, “cyclical neglect may have more to do with cyclical modes of thought and behavior rather than cyclical experiences of poverty. However, the presence of these modes of thought and behavior would tend to be self-reinforcing in the context of financial hardship. Therefore, addressing poverty in its wider context would narrow the scope for this self-defeating mindset.” The key point for policy and practice was that, although the eradication of poverty is to be desired, it ought not to be seen as a necessary pre-requisite for effectively targeting and reducing the incidence of child neglect.

Neglect is not prioritized

English (1998) pointed out that in the United States, the increasing volume of reported child mal- treatment allegations has led to many child protection agencies adopting a policy of prioritization, that is making judgments about the cases that ought to receive service priority. One problem with this approach is that physical abuse tends to be prioritized to the detriment of neglect. Yet as English (1998, p. 57) noted, “the harm these [neglected] children may suffer from years of chronic neglect can be more damaging and pervasive than bruising or broken bones”. Commenting from a United Kingdom perspective, Stone (1998) noted that neglect cases appear to be given a low priority within Child Pro- tection Services (CPS), with social workers ignoring cases of neglect until a specific incident of abuse arises.

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Negative impact of neglect is underestimated

Social policy in the United States continually under-states the consequences of neglect when construct- ing legal and social interventions for neglected children. Instead, policy is driven by the more emotionally charged problems of child abuse (Gelles, 1999). Rose and Meezan (1996) found that foster care workers viewed neglect less seriously than Child Protection Service workers, and that both of these groups rated neglecting behaviors as being less serious compared with laypersons from the community at large. It was argued that this difference may be explained by the perceived seriousness of child abuse compared with the less obvious harm of neglect.

Even in situations where neglect cases have been screened, there are various system factors that have a bearing on the likelihood of investigation and substantiation. English (1997) found that referrals for physical neglect were less likely to be responded to by CPS on an emergency basis, were assessed as lower risk than any other form of child maltreatment at intake, and were subsequently less likely to be investigated. English (1999) pointed out that allegations of neglect are the least likely type of maltreatment report to meet the threshold for CPS investigation. It was suggested that one of the reasons for this is that a system under pressure is a system that can only respond to crisis.

Social services in the United Kingdom face similar pressures to those in the United States, particularly in terms of the availability of adequate funding and staffing levels to meet the increasing volume of mal- treatment referrals (McSherry, Iwaniec, & Larkin, 2004). It is not surprising, therefore, that only the most visible cases of child maltreatment are being attended to. Several United Kingdom commentators (Minty & Pattinson, 1994; Stevenson, 1996; Stone, 1998) have argued that social workers often underestimate the seriousness of neglect, in spite of the large body of evidence that suggests that neglect may lead to major developmental deficits and may increase the risk of the child being injured or killed. Minty and Pattinson (1994) pointed out that a significant number of child fatalities have been attributed to parental/caregiver neglect, and that professionals had failed to recognize the risk posed to these children, even in cases of severe neglect (see Department of Health, 1991).

The balancing act

A key problem for social service agencies coming to an agreement about how to respond to instances of child neglect is that perceived negatives in one aspect of a child’s life may be thought to be balanced out by positives in another. For example, if a child’s physical appearance, hygiene, and health care are a cause of concern but school attendance and performance is good, agencies may see the positive effect of school as balancing out some of the negatives of other concerns. Similarly, if there are concerns about physical neglect and school attendance but the family are very willing to work with social services, then the positive acceptance of intervention may be thought to balance out the negative of neglect. Furthermore, these balancing acts are more likely to favor positive aspects over those that are negative in the context of a highly pressurized system.

Iwaniec and Hill (2000) noted that the problem of when and how to intervene in cases of child neglect was grossly overlooked prior to the Children Act 1989, and has continued to be marginal- ized in post-Act policy and practice. They argued that neglected children do not get the attention they need (although they do come under the category of children in need) and even when they do, they tend to be dealt with briefly as a response to referrals by health visitors, teachers or neighbors.

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These children tend to be simply patched up and left without appropriate assessment and long-term action.

Addressing the “Neglect of neglect”

There are a number of steps that could be taken to help raise awareness and understanding of child neglect and to ensure that it is dealt with in a timely manner. First, child neglect needs to be defined in clear and concise terms. This would allow social workers, health workers and so forth, to develop a clear picture of the particular types of neglect scenario they would be dealing with and also help them to verify and substantiate allegations of neglect. However, it needs to be borne in mind that it may be impossible to define neglect in narrow or concrete terms and that fluid definitions which are context, time and culturally specific, may be required. Clearly, defining child neglect at any given time or context will depend heavily upon current political and moral ideals regarding what is considered adequate care for children and the strength of policy or political will to ensure that these ideals are met. One useful technique or guide to help social workers gain a better understanding of child neglect might be to develop a database of neglect case studies, in either single case or composite form, that typify good practice. These would allow for better informed decision-making processes and would facilitate a deeper understanding of the complexity of neglect.

Second, all social services agencies should provide intensive training specifically tailored for staff dealing with neglect cases. The available evidence suggests that neglect can lead to profound develop- mental deficits for the child, but that this is often underestimated by staff. Increased understanding of the detrimental impact of neglect would help ensure that, when tough decisions have to be made in relation to directing limited resources at the most needy, cases of child neglect will no longer be placed at the bottom of the list.

Finally, it would appear that a critical time scale for cases of child neglect may need to be established. This would prevent the continual cycle of assessment and periodic rehabilitation with the birth parents (with the child drifting in and out of foster care), often over several years, which is commonplace in cases of neglect. It needs to be recognized that the damage neglect inflicts upon the child is related to the length of time that it occurs. Setting a critical time, whereby persistent neglect after a certain point in time would result in the child being taken permanently from the custody of the parents, would help to prevent serious damage to the child. Additionally, it might focus the mind of the parents on the need to demonstrate that they are capable of providing adequate care for their child. This could be facilitated by drawing up contracts between parents and practitioners that specified time scales and mutual obligations (Iwaniec, 1995; McSherry, 2006).

Summary

Over the last number of decades, despite the best intentions of many to ensure otherwise, there has been a tendency to make a mole-hill out of a mountain as far as child neglect is concerned. This commentary has identified a number of inter-related reasons for this neglect of neglect. As the research does appear to indicate that neglect can result in profound developmental deficits for children, it is clear that this imbalance needs to be rectified as a matter of urgency. To tackle neglect effectively it needs to be addressed

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as soon as it is identified. This requires that practitioners both recognize the initial signs of neglect and, perhaps more importantly, feel compelled to do something about it. Whether or not practitioners act in this way is dependent upon child neglect attaining a priority position within the arenas of research, policy and training. If not, professionals working within these arenas could be accused of having something in common with those creatures better known for making mole-hills, short-sightedness.

Acknowledgements

The author would like to thank Christine McSherry and Emma Larkin for helpful comments on an earlier draft of this commentary. The author would also like to acknowledge the support of the Research and Development Office in Northern Ireland who provide core funding for the Institute of Child Care Research.

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