Experience of neglect at different ages
Horwath also notes that children and young people experience the impact of neglect differently at different ages.
Infancy (birth to two years)
Babies’ growth and development is linked to their interaction with the world and their caregivers.
Emotional and cognitive development can come through play. For example, games like ‘peek-a-boo’, where actions are repeated for social and emotional reinforcement from the reactions of caregivers, and neural connections are ‘fixed’ through stimulation. Disinterest or indifference to such actions and/or failing to offer stimulation will limit the child’s development and growth, and damage infant attachments.
Pre-school (two to four years)
Most children of this age are mobile and curious, but do not understand danger. They need close supervision for their physical protection, which neglected children may not experience.
Children may not be appropriately toilet trained if they are in neglectful families, as this process requires patient and persistent interaction and encouragement.
Children’s language development may be delayed if their caregivers are not interacting with them sufficiently, and physical care may be inadequate, for example dental decay.
Primary age (five to eleven)
For some neglected children, school can be a place of sanctuary. However, if their cognitive development has been delayed and they are behind their peers at school, it can also be a source of frustration and distress.
Signs of neglect, for example dirty or ill-fitting clothing, will be obvious to peers, teachers, and to the children themselves, and may cause embarrassment and difficulties in their social interactions.
Children without clear and consistent boundaries at home can struggle to follow school rules and get into trouble.
Educational neglect can include failing to ensure that children attend school, and high levels of absence can further impair their academic progress.
Adolescence (twelve to eighteen)
Neglect is likely to have an impact on the young person’s ability to form and maintain friendships and pro-social relationships. However, they may be reluctant to talk about their situation if they’re scared of becoming looked after or being split up from their siblings.
Although adolescents can find sufficient food for themselves, they are likely to be drawn to high-fat, high-sugar convenience foods if they’ve never learned to prepare meals.
Risk-taking behaviour may be associated with, attributed to, or worsened by, a lack of parental supervision. This can expose neglected young people to the risk of harm through, for example, alcohol and substance misuse, risky sexual behaviour, or criminal activity.
Resilience to neglectful situations does not increase with age, and can have significant consequences for young people’s emotional wellbeing. In a study of Serious Case Reviews, Brandon et al (2012) noted that ‘past neglect was a factor in eleven out of fourteen reviews conducted after a young person was believed to have committed suicide’.
It’s important to remember that neglect should be seen in the context of each individual’s experiences.
A number of factors (social determinants) increase the likelihood of neglect in some families. Vulnerable families may have a combination of the following risk factors:
Child risk factors
- behavioural problems
- chronic ill health
Parental risk factors
- poor mental health, especially maternal mental health difficulties
- drugs and alcohol (substance misuse)
- domestic abuse
- parents’ own exposure to maltreatment and lack of experience of positive parenting in childhood
Wider determinants of health
- poor social support
Adverse childhood experiences (ACEs)
A growing body of research is showing the long-term impacts that experiences and events during childhood have on individuals’ life chances.
Adverse Childhood Experiences (ACEs) such as abuse, neglect, and dysfunctional home environments have been shown to be associated with the development of a wide range of harmful behaviours including:
- harmful alcohol use
- drug use
- risky sexual behaviour
ACEs are also linked to conditions like diabetes, mental illness, cancer, and cardiovascular disease, and ultimately to premature death. As the number of ACEs increases, so does the risk of these negative outcomes.
Types of ACEs
- sexual abuse by parent or caregiver
- emotional abuse by parent or caregiver
- physical abuse by parent or caregiver
- emotional neglect by parent or caregiver
- physical neglect by parent or caregiver
- parent or caregiver addicted to alcohol or other drugs
- witnessed abuse in the household
- family member in prison
- family member with a mental illness
- parent or caregiver disappeared through abandoning the family or divorce
Stable, nurturing environments and adult-child relationships help children to develop strong cognitive and emotional skills, and the resilience needed to flourish as adults. Encouraging such relationships can prevent ACEs, even in difficult circumstances. It’s crucial to support and nurture children and young people as they develop and grow.
Being ACE aware in Middlesbrough will help us to understand the characteristics of children and young people and their families. It will provide agencies with a shared language and understanding, and has the potential to transform systems. It will improve pathways by making sure referrals are made to the most appropriate service, which will prevent people ‘falling through the net’. An ACE-informed service will place greater emphasis on restorative services.
Being ACE-aware is not about routine enquiries or screening, it takes organisational planning, and for staff to be trained and supported in their practice.
Working to address the neglect of children and young people is complex, and needs consideration of six key areas (identified by Jane Wiffin):
Persistence and change
Neglect which constitutes ‘significant harm’ is:
- chronic or acute
- resistant to intervention
The behaviour of seriously neglectful parents often includes care which lacks consistency and continuity. There may be brief periods when care is marginally improved. At these times, it’s important not to be over-optimistic. Keep a balanced approach and beware of over-emphasising the positives, especially when standards of care are known to change.
Child’s developmental needs
Gain an understanding the impact of neglect on the child’s biological, psychological, and emotional development. This will include physical care, emotional care, medical needs, supervision and guidance, and stimulation and education.
Impact of neglect on the child and their lived experience
Understand the child’s world through direct, first-hand observation of their everyday life, which includes the child’s lived experience of neglect and any other forms of abuse, and the views of others who may know the child well.
‘Causal factors’ are additional factors which may impact on a parent’s ability to care for a child. These may include
- parental mental ill-health
- domestic abuse
- substance misuse
Parental domestic abuse, mental ill-health, and drug and alcohol misuse are key issues which contribute to neglect. Unless the parents’ issues are identified and supported, the outcomes for their children will be poorer than for their peers.
Acts of omission or commission
Acts of commission are deliberate and intentional. Acts of omission are the failure to provide for a child’s basic physical, emotional, or educational needs, or to protect a child from harm or potential harm, including carer ignorance of neglect.