Risk factors and signs of neglect

Acting with urgency: responding to child neglect


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Risk factors are “measureable characteristic[s] of an individual [or the community and society within which they reside] that heightens the probability of a worse outcome in the future

Although child neglect occurs across all genders, ages, cultural groups and socioeconomic groups, there are many differences in how and why it occurs. As such, risk factors help to identify potentially vulnerable children and families and may provide information as to why the neglect is occurring. 

However, it is important to note that the presence of risk factors doesn’t mean that these factors have necessarily caused the child neglect to occur. Risk factors do not have to be present for child neglect to occur, and if risk factors are present child neglect may or may not occur. It is important to take into consideration the factors that build resilience and protect children from being neglected. 

When a child experiences risk factors alongside limited protective factors, the probability of experiencing child maltreatment increases. 

Protective factors are “a correlate of resilience that may reflect preventative or ameliorative influences: a positive moderator of risk or adversity”.

When assessing risk of neglect it is important to think about how risk may change once you have considered the probability or possibility of a parent's capacity to change. To do this think about the range of risk and protective factors present, how they operate to hinder or promote a child's development and the availability and effectiveness of any services or programs parents are asked to participate in. 

Risk factors

Child and young person level risk factors

It is important to acknowledge the characteristics of children that are associated with increased risk of neglect as this helps identify children who are most vulnerable. It is also important to remember that a child’s behaviour may also be caused by or considered an outcome of neglect. 

Disability and behaviour problems

Overall, having a disability or behaviour problem may be a risk factor for neglect. However this depends on the types of behaviour exhibited, and the support needs required for different types of disability. 

In terms of disability, children with psychological and emotional problems, learning difficulties and physical disability may be at higher risk. 

In terms of behavioural problems, children who have conduct disorder symptoms, socialised aggression, attention problems and physical aggression towards their mother, internalising or externalising behaviours and poor social competence may be at higher risk. Interestingly, parent perceptions of their child’s behaviour were more strongly associated with increased risk than other indicators of child behaviour.

Children with… 

Conduct disorders are

Speech / language disorders are

Learning difficulties are

Cerebral Palsy are

Non-conduct psychological disorders are

8.2 x

3.8 x

5.3 x

2.7 x

2.7 x

more likely to experience neglect

Age and gender

Child age or gender does not appear to influence the risk of neglect. However, the impacts of neglect will be different across developmental stages, with increased harm potential in the early years of a child’s life.Parent and caregiver level risk factors

A range of parental stressors have been found to be associated with an increased risk of neglect, as was social isolation, adverse childhood experiences and lack of parenting knowledge and skills. In addition criminal justice system involvement may also have a relationship to child neglect.  

 

Younger parent age

  • Being a younger parent may be a risk factor
  • Its impact is likely to be small
 

General stressors

  • Parent stress (including daily and personal stress)
  • Poor self-esteem and affect regulation ability (including impulsivity and hyperactivity)
  • Unemployment 
  • Lack of social support.
 

Mental health and wellbeing

  • Poor parental mental health/wellbeing is a risk factor for neglect 
  • The impact varies by psychiatric disorder.
 

Substance use

  • Parent substance use is consistently related to higher rates of referrals and re-referrals to the Child Protection System and higher substantiation rates.
 

Adverse childhood experiences

  • Parent adverse childhood experiences such as the childhood abuse and poor relationships with their own parents.
 

Parenting knowledge & behaviours

  • Less or less positive interactions with their child 
  • Unrealistic expectations of child
  • Insensitivity to child needs, and 
  • Preoccupation with own needs.
 

Criminal Justice System involvement

  • Parent’s prior involvement with criminal justice system 
  • This association may be influenced by other factors related to the incarceration such as increased stress on the non-incarcerated parent or visibility to mandatory reporters.

Family level risk factors

The family level risk factors that have been identified for child neglect include; 

 

Domestic violence (DV)

  • Domestic Violence may be a risk factor for child abuse and neglect 
 

Parent-child relationships and parent behaviours

  • Poor parent-child relationships and a parent perceiving the child to be a problem may increase the risk of neglect 
  • Parenting behaviours and parenting related stress 
 

Family structure

  • Family structure may influence risk of child neglect although findings are mixed 
 

Family / household size

  • A larger family size may increase the risk of neglect occurring
 

Low socio-economic status

  • Low socio-economic status has consistently been associated with increased risk of neglect, however this association is complex.

Community level risk factors

The community level risk factors that have been identified for child neglect include; 

 

Income

  • Child neglect has been consistently linked with indicators of low socio-economic status at the neighbourhood level, including low neighbourhood income, low property values and high unemployment rates
 

Property values

 

Unemployment rates

 

Poverty rate

  • Greater neighbourhood poverty is related to increased levels of child neglect
 

Housing

  • Inadequate or overcrowded housing within a neighbourhood is associated with child neglect
 

Community resources & social supports

  • Neighbourhoods at high risk of child abuse and neglect have fewer social supports and neighbourhood resources than those at low risk of child abuse and neglect.
 

Greater alcohol availability

  • Neighbourhoods with a high density of bars in the area have an increased risk of neglect.

Protective factors

The factors which have been identified as protective against the occurrence of neglect, or which moderate against its impacts are: 

 

Social cohesion & trust

  • Higher levels of social cohesion and trust amongst youth may moderate the impacts of neglect.
 

Social support

  • Maternal access to frequent social support and perceptions of social support can be protective against neglectful parenting but these relationships are complex.
 

Self-efficacy

  • Higher levels of caregiver self-efficacy can be protective against the occurrence of neglect
 

Maternal self-care

  • The risk of intergenerational child abuse (including neglect) can be moderated by mothers taking care of their own needs.
 

Neighbourhood quality

  • For impoverished children, living in a higher quality neighbourhood with access to neighbourhood resources may be protective against neglect.  

The signs of neglect

There is consensus on the following observable child features;

  • Child is dirty, including their body, nails and clothes, has matted or thin hair, poor body odour, dental problems and chronic infestation for example head lice
  • Chronic nappy rash, infected sores, thin limbs and cold injury for example red, swollen limbs and stunted growth 
  • Delayed motor skills, unimaginative play, clumsiness, delayed language and social skills (eating with utensils, toileting, dressing and nose-blowing etc.), inattention and lack of persistence, perseverance and enthusiasm
  • Failure or refusal to get immunisation and developmental checks, poor attendance at appointments, poor compliance with therapy and prescribed health care
  • Abandonment, expulsion from home, inadequate supervision, chronic truancy 
  • More aggression with peers among older children and adolescents. 

One way of conceptualising the causes of neglect has been proposed by Crittenden (1999) as follows: 

Disorganised neglect

Families who have ongoing crises and chaos

Indicators

  • Families have multiple problems
  • Caregivers are keen for help, e.g. phone bill, child suspended at school, though attempts to help may be sabotaged
  • Motivated by emotional responses, feelings and affect
  • The more intensity, the more immediate response
  • Unpredictable parental responses for the child – which teaches child to exaggerate their emotions to emphasise the drama
  • Chaotic environment 

Responses

Initially, a response should provide comfort and reassurance to the parent, then create a structured predictable environment with accurate information about behaviours and outcomes.

Maintaining support as change occurs is critical to support them to move to independence when ready.

Teach parents to use cognitive information to respond then use emotions to regulate that response.

Practitioner Caution

Practitioners can become easily absorbed into the family, resulting in over-optimism and feeling positive about minimal change when in fact the needs of the child remain unchanged.

Emotional neglect

Families who provide practically but not emotionally for their child

Indicators

Priority is given to cognitive responses rather than emotion/affect.

Parents provide materially but not emotionally. They focus on predictable outcomes, leading to an emphasis on education, performance and learning rules for behaviour.

Parents may provide material objects to demonstrate love.

May be less likely to be identified as neglectful.

Children likely to be mature, independent, neater, diligent

  • Punished for expression of negative emotions
  • Falsely cheerful
  • If parent is depressed, the child may learn to ‘parent’.

Often high functioning/financial advantage.

Responses

For families that are superficially successful, more work is required to discover underlying issues.

The role reversal is more serious. If possible the child should be kept at home. Parents should be taught to seek help elsewhere while remaining emotionally engaged with children.

Practitioner Caution

Practitioners find this type of family difficult to work with because of the lack of understanding of emotional warmth by the parent. Removal of the child will reinforce their feelings of rejection. As families may appear successful, there is less likely to be professional involvement.

Depressive neglect

Families who are withdrawn and unresponsive

Indicators

This is the more typical picture of neglectful families.

Families appear withdrawn and dull, and often don’t have interest in or understand the need for intervention.

Struggle to engage/cooperate/change as they don’t understand child needs even following careful explanation. 

Doubt that anything will change the current situation.

Child development inhibited because parent does not respond to their cues.

  • Infrequent contact, lacks affection play or soothing so child begins to withdraw.
  • Most serious for infants. 
  • Children shut off feelings – depression not associated with hurt, anger or abandonment.

Responses

Focus on learning behaviours that cause predictable and meaningful outcomes.

Parents have to be taught how to engage with their children with appropriate expressions of affect.

Practitioner Caution

Often linked to substance misuse or mental health problems. Practitioners need to be realistic about the level of change. Easy for practitioners to get caught up in the sense of ‘hopelessness’.

There are also a number of useful models that can provide guidance to child protection workers for identifying the signs of neglect. 

One model is the Graded Care Profile measure, which supports practitioners to assess whether the care being provided is adequate or potentially placing a child or young person at risk. It covers four domains: physical care, safety, affection and love and esteem. This tool can be used to have a more objective and transparent picture of the care that a child is receiving and the areas of concern. The information gathered can also support more targeted planning and interventions. 

There are four categories by which to grade the situation as outlined below. 

 

Grade 1: Thriving family

Grade 2: Coping family

Grade 3: Barely coping family

Grade 4: Family in crisis

  1. Level of care

Essential needs met

Some essential needs met

Most essential needs unmet

Essential needs entirely unmet/ hostile

  1. Commitment to care

Child is not priority most of the time

Child and carer equal

Child second

Child not considered

  1. Action

Universal services

Targeted services & early intervention

Specialist services

Crisis intervention

Implications for practice 

  • Practitioners must be aware of the risk factors for child neglect in order to identify potentially vulnerable children and families. 
  • Risk factors are not necessarily the reason that the neglect has occurred or is occurring. It is critical that practitioners identify what the underlying causes of the child neglect are for each family in order to determine appropriate interventions.
  • All risk factors must be interpreted cautiously, in relation to each unique family situation. Practitioners must determine whether risk factors are directly contributing to neglect or whether the risk factor is related to other problems that are directly contributing to the neglect.
  • When considering all risk factors, practitioners must also consider the protective factors that exist for the family and how they interact with the risks. 
  • Practitioners need to be alert to the presence of child/youth behavioural difficulties and disability, particularly psychological and emotional problems, learning difficulties, speech/language disorders, physical disability such as cerebral palsy, conduct disorder, social aggression and/or aggression towards their mother, attention problems, internalising and externalising behaviours and poor social competence. Practitioners must be aware of the associated support needs for these behaviours, and assess whether this puts the child/young person at greater risk of experiencing neglect. 
  • Practitioners should be aware that younger parent age may be a risk factor for child neglect. They should consider the role of general stressors on a parent’s ability to care for their child, including ongoing daily and personal stress, poor self-esteem and self-regulation, unemployment and lack of social support. Practitioners should also identify whether parental mental illness and substance use is increasing the risk of child neglect occurring. If these factors are also underlying causes, this will provide information as to the most appropriate interventions for each family. 
  • When working with parents, it is critical that the parent’s own childhood experiences are taken into account, given that they may have experienced childhood maltreatment and had poor relationships with their parents, which may increase the risk that they neglect their own child(ren). 
  • Practitioners should be attuned to parent-child relationships, and in particular consider whether the following factors are increasing the risk of neglect: 
    • less or less positive interactions
    • unrealistic expectations
    • insensitivity to child needs, and 
    • preoccupation with own needs. 
  • If there is domestic violence in a home, practitioners should assess whether neglect may also be occurring in order to provide appropriate support. Practitioners should acknowledge the ways in which a woman is already resisting the violence, support the woman to reflect on her parenting strengths but also where care may be compromised, and put appropriate supports in place. 
  • It is important in practice for practitioners to unpack if and how a family’s socio-economic status is contributing to the parent’s failure to provide adequate care to their child. Families may need to be linked in with services to provide concrete support, for example housing or employment services.
  • It is important that the role of the neighbourhood is taken into account. Practitioners may be able to advocate for broader community level changes in order to reduce the risk of neglect. 
  • Drawing on protective factors can assist parents to locate and use a range of resources, supports and coping strategies that they need to parent effectively, even when they are dealing with other difficult circumstances. Strength based practice approaches which recognise and draw upon protective factors are also likely to lead to the development of better relationships between child protection practitioners and families.

Parts of this paper are based on a literature review conducted by the Australian Centre for Child protection: 

Parkinson, S., Bromfield, L., McDougall, S. & Slaveron, M. (2017). Child neglect: Key concepts and risk factors. A report to the NSW Department of Family and Community Services Office of the Senior Practitioner. 


References 

Bracknell Forest Council. (ND). Really useful guide to recognising neglect. Retrieved from www.bflscb.org.uk/sites/default/files/useful-guide-to-neglect.pdf 

Govindshenoy, M., & Spencer, N. (2007). Abuse of the disabled child: a systematic review of population-based studies. Child: Care, Health & Development, 33(5), 552-558.

Masten, A. S., & Wright, M. O. (1998). Cumulative risk and protection models of child maltreatment. Journal of Aggression, Maltreatment & Trauma, 2, 7-30.