March 01, 2013

Understanding Neglect's Toll on Child Development

Claire Chiamulera

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

Child neglect accounted for 78% of all maltreatment cases nationwide in 2010. That’s more than half a million documented cases of neglect in the United States. The rate is far greater than other maltreatment forms for that year: physical abuse (17.6%), sexual abuse (9.2%), and psychological abuse (8.1%). Yet why does neglect get less attention?

A new report by the National Scientific Council on the Developing Child at Harvard University explains the types of neglect that significantly impact young children’s development. The report, The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain, synthesizes research on child neglect in the early years, drawing on studies of young children who experienced severe neglect and extreme deprivation in institutional and family settings.

Despite data showing neglect is the most common form of child maltreatment, neglect receives less public attention than physical abuse. The report distills neglect research and provides a framework for developing strategies to protect children from these harmful forms of neglect. Read on for highlights.

Two Misconceptions

Two common misconceptions about neglect are:

#1 Physical abuse does greater harm to children’s health and development than severe neglect.

Research clearly shows that young children who experience long periods of severe neglect or deprivation have more severe cognitive impairments, language deficits, academic problems, withdrawn behavior, and problems interacting with peers when compared to child victims of physical maltreatment. This suggests that severe neglect may do more damage to the brain architecture than physical abuse.

#2 Removing a child from a neglectful setting will produce positive outcomes.

Most neglected children need therapy and supportive care to support their recoveries. Removal from neglectful caregivers alone does not address the impact the neglect has had on the child. Without targeted interventions and services, severely neglected children face a greater risk of continued problems.

How Neglect Affects Young Children’s Development

Severe neglect can harm young children’s development in the following ways:

Abnormalities in the structure and functioning of the developing brain.

Children who experience high levels of social neglect early in life show lower electrical activity in the brain, comparable to nonneglected children who have trouble with attention and learning. These children also show decreased brain metabolism and poorer connections among different parts of the brain essential for cognitive, emotional, and social competence.

Altered development of biological stress-response systems, making it hard for children to cope with adversity.

Significant deprivation disrupts the two main stress response systems in humans: sympathetic-adrenal-medulary system (produces adrenaline and affects heart and respiration rates), and the hypothalamic-pituitary-adrenal axis (elevates the stress hormone cortisol). Severely neglected children show abnormal cortisol levels that can cause structural weakness in the developing brain architecture; the resulting adverse effects could be lifelong.

Abnormal physical development and impaired immune systems.

Severe neglect is linked to delayed growth in head circumference in the early years. Extreme deprivation (e.g., institutional settings where children are “warehoused”) is linked to pervasive growth problems (smaller body size, impaired gross motor skills and coordination), compromised physical health, and heightened risk for infection and stress-related diseases during life.

Emotional, behavioral, and interpersonal relationship difficulties during life.

Chronic neglect can lead to insecure or disorganized attachment to primary caregivers that affect interactions with others as children mature. Weakened social skills and fewer peer interactions often result. Chronically neglected infants and toddlers often show increased negative emotions, including poor impulse control; lowered enthusiasm, confidence and assertiveness when problem-solving; and an inability to discriminate emotions. As they age, emotional problems may emerge, including low self-esteem, poor self-confidence, and lack of assertiveness. Personality disorders, anxiety, and depression are also risks.

Cognitive problems, academic delays, poor executive function skills, and difficulty regulating attention.

Cognitive impairments and academic delays are common among severely neglected children. These children also have more problems in school and referrals to special education than nonneglected children. Problems that continue into adulthood include low IQ scores, reduced high school graduation rates, and poor reading skills. Executive function skills, which are key to operating effectively and independently in life, often suffer. Serious neglect also affects children’s ability to regulate attention, causing them to be unfocused and unable to pay attention at school.

Promoting Children’s Recoveries

Children who experience severe neglect can recover with certain supports.

Appropriate, timely interventions can reduce and reverse severe neglect’s harms.

Removal from severely neglectful environments to nurturing settings is known to enhance children’s recoveries. Removal alone is not enough, however. Systematic, evidence-based, long-term interventions are also key to healing. For example, systematic interventions targeting the social-emotional needs of young children in foster care can improve their ability to regulate stress response at the same level as nonneglected children.

Promising Interventions:

The report identifies the following three interventions as effective for children who have experienced significant neglect:

  • Attachment and Bio-Behavioral Catch-Up (ABC) Intervention: Short-term intervention designed to improve attachment regulation and bio-behavioral regulation in children who have been abused or neglected.

    Targets: Infants and toddlers in foster care, relative care, or living with birth parents.

    Strategy: Strengthen parents’/caregivers’ sensitivity and responsiveness to infants’ cues and help them provide setting that helps them improve their regulatory abilities.

    Evidence: Children receiving ABC developed more secure attachments to caregivers than a control group and were better able to regulate their stress response and behavior.
  • Child-Parent Psychotherapy (CPP)
    Treatment model aimed at improving social-emotional, behavioral, and cognitive functioning in children exposed to interpersonal violence and other traumatic events.

    Targets: Children 0-5 who experience mental health, attachment, and/or behavioral problems resulting from trauma.

    Strategy:
    Repair trust in parent-child relationship by building parent’s capacity to protect and help child regain sense of safety.

    Evidence: Five randomized studies document CPP’s effectiveness in anxiously attached toddlers, children who witnessed domestic violence, maltreated infants, maltreated preschoolers, and toddlers of depressed mothers.
  • Multidimensional Treatment Foster Care Preschool Program (MFTC-P) Early intervention program aimed at promoting healthy self-regulation, positive relationships with caregivers and peers, and enhanced school readiness in vulnerable children.

    Targets: 3-6 year-old children in foster care with neglect histories.

    Strategy: Help caregivers provide positive, responsive, and consistent environments for young children by reinforcing positive behaviors and setting limits to address problem behaviors. Behavioral therapy and playgroups offer added support.

    Evidence: Preschoolers receiving MFTC-P showed improved attachment-related behaviors, fewer behavior problems, and improved stress responses.

Children’s recoveries from neglect are influenced by the severity, duration, and timing of the neglect, and the timing and type of intervention.

Children who experience more chronic neglect during early childhood tend to withdraw and show more anxiety and mood changes when stressed than those who experienced less severe neglect. The longer the neglect occurred, the more likely the child will have deficits in attention, academic achievement, brain activity, and the ability to regulate stress response.

Timing of interventions is critical; ideally, the earlier the intervention, the better. Removal from neglectful settings by 6, 12, or 24 months is known to boost children’s cognitive, attention, memory and executive functions.

Wrap-Up

The report finds that the toll of severe neglect on young children is underestimated. Research shows severe neglect disrupts young children’s cognitive and executive functions, stress response systems, and brain architectures. Without intervention, these disruptions can lead to learning problems, social adjustment difficulties, mental health problems, and physical disease and other challenges. Advocacy for these children and families is critical. Assuring nurturing caregivers, combined with tailored services, can help these children overcome these challenges if implemented early and in a quality way.

—Claire Chiamulera, CLP Editor

*Source: Center on the Developing Child at Harvard University. The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain, 2012.