Neglect describes mistreatment and relates specifically to a caregiver’s failure to meet the basic needs of the person they provide care for. Though most often associated with children, neglect can also refer to the mistreatment of adults, especially when it comes to elder care.
People who have been through neglect may be more likely to experience attachment issues, feelings of isolation, anxiety, and depression. Individuals who wish to overcome challenges associated with these issues may find it helpful to speak with a qualified mental health professional.
United States federal and state law requires caregivers to provide a child’s food, shelter, clothing, health care, and supervision to the degree that it keeps them safe. When a caregiver does not meet these needs, it is considered neglect. Some states also include educational neglect, medical neglect, and child abandonment in this category.
According to the 2015 Child Maltreatment Report conducted by the National Child Abuse and Neglect Data System (NCANDS), Child Protective Services (CPS) received approximately 2.2 million reports of alleged child maltreatment in the United States in 2015. Subsequent investigations by CPS revealed that 683,000 children were confirmed as victims of maltreatment, and of those, 75.3% experienced neglect. Additionally, the vast majority of maltreatment victims were young children, with over a quarter of the victims under the age of 3.
When it comes to the care and well-being of children, neglect continues to be an issue. However, children are not the only population at risk for becoming victims of neglect. According to the National Council on Aging (NCOA), approximately 1 in 10 adults age 60 and over have experienced some form of abuse or neglect, and in about 60% of those cases, the perpetrator was a spouse, adult child, or family member.
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In many ways, abuse and neglect are similar; both involve the care and treatment of dependent individuals, harmful behaviors from caregivers, and lasting negative effects for their victims. However, there are some distinct differences between the two that impact how each is addressed.
The Child Protective Services Law (CPSL) defines child abuse as intentionally, knowingly, or recklessly causing physical, sexual, or emotional harm to a child, either by acting or failing to act. Abuse includes bodily harm, sexual exploitation, or mental injury. Neglect, on the other hand, may not always be intentional. For example, the declining physical health of a caregiver could cause them to unintentionally neglect their children. Or, in the case of elder neglect, an individual’s deteriorating mental state brought on by aging may lead them to neglect self-care without realizing it.
Neglect can be defined further by examining its types and how they can differ based on the age of the victim. When it comes to neglect of a child, there are four main types of neglect:
- Physical: Failure to provide necessities like food, shelter, clothing, standard medical care, supervision, and safety
- Educational: Failure to ensure school age children are enrolled in school, home schooled, or provided specialized educational training where appropriate
- Emotional: Failure to attend to psychological care and emotional needs
- Medical: Failure to allow for necessary medical treatment recommended by medical professionals; depending on the state, this may also include mental health treatment.
The National Adult Protective Services Association (NAPSA) outlines the following types of adult or elderly neglect:
- Physical: Failure to meet the medical, hygienic, or dietary needs necessary to an individual’s physical health
- Emotional: Failure to accommodate or account for an individual’s emotional well-being by belittling, ignoring, or preventing them from seeing family or friends
- Abandonment: Failure to fulfill caregiver duties by forsaking expected responsibilities or failing to arrange for care in the case of caregiver absence
- Financial: Failing to fulfill financial obligations, like paying utilities and rent, to ensure the stability and safety of an individual
- Self-neglect: Failure of seniors and adults to meet their own physical, psychological, emotional, and financial needs to the point that their safety and well-being are threatened
To recognize neglect, it can help to know where to look. Certain factors can put people at greater risk for becoming perpetrators or victims of neglect. For example, parents with substance abuse issues may be more likely to neglect their children, and children living in poor or violent areas may be at greater risk for neglect.
Risk factors for child neglect include:
- Domestic violence
- Chronic medical or mental health issues
- Drug and alcohol issues
- Lack of social supports
- Grief and loss
- Stressful life events
- Caregivers with disabilities or cognitive impairment
- Having young children
Risk factors for elder neglect include:
- Dementia or other cognitive issues
- Lack of spouse, partner, or social supports
- Functional impairment
- Chronic physical health issues
- Financial stressors or poverty
In addition to risk factors, there are numerous warning signs to consider when identifying potential victims of neglect. The following list is divided by age, with some overlap.
Warning signs for child neglect include:
- Increased mental health concerns
- Weight loss or signs of malnourishment
- Changes in school performance or attendance
- Learning difficulties
- Stealing or begging for food
- Poor hygiene, dirty clothing, insufficient clothing for weather
- Untreated injuries or illnesses
- Frequent drug or alcohol use by caregiver or child
- Inconsistent supervision
Warning signs for elder neglect include:
- Sudden functional impairment
- Isolation from friends and family
- Weight loss or signs of malnourishment
- Decreased attention to hygiene
- Feelings of hopelessness, fearfulness, or depression
- Disorientation or cognitive problems
- Difficulty managing finances
Regardless of age, victims of neglect can be negatively affected by it. How long those effects last depends on the severity of the neglect, its duration, the victim’s age when it occurred, and the type of care provided in response.
Young children, especially under ages 3 and 4, require attentive caregivers to meet their physical, emotional, psychological, and cognitive needs. This type of care promotes security and healthy development. Research indicates that the absence of regular care can cause children to exhibit trauma responses. During neglect, the brain does not receive the positive stimulation it requires for growth; instead, it is flooded with stress hormones. Constant under-stimulation coupled with ongoing fear and anxiety can negatively impact a child’s physical and mental development, possibly resulting in issues as the child grows.
These problems may include the following:
- Impaired brain development: Portions of the brain may not develop properly, resulting in mental health issues, cognitive and academic problems, and speech and language issues.
- Poor physical health: Studies indicate that neglected children may be at risk for diabetes, adolescent obesity, or poor lung function.
- Poor emotional or mental health: Neglect puts children at risk for trauma-related mental health issues, including posttraumatic stress, borderline personality, depression, and anxiety. Research shows there is a greater likelihood for suicidal ideation and depressive episodes among those who have experienced abuse and neglect.
- Poor attachment and social skills: Some infants and toddlers who experience the loss of their primary caregiver at a young age have trouble forming attachments later in life.
- Behavioral issues: Children who experience neglect may have poor boundaries and present with indiscriminate friendliness.
- Addiction: Studies show that children who experience abuse or neglect can have an increased likelihood to misuse drugs and alcohol.
Adult and elderly victims of neglect can face negative effects as well. Ranging from mild to severe, these effects could include the following:
- Physical issues: Elder neglect can result in problems like unchecked or untreated injuries, bed sores, malnourishment, and aggravation of preexisting health problems.
- Psychological issues: Elderly individuals who are neglected may experience mental health issues like depression, anxiety, or posttraumatic stress.
- Social issues: Elderly individuals may face isolation, loss of social supports, and loss of healthy social outlets.
- Financial consequences: Lack of financial management can result in loss of vital utilities like heat or electricity, resources, or a place to live.
It is important to note that neglect can have serious implications, and in some cases, may result in death. Elders who have been abused or neglected have a 300% higher risk of death. Additionally, of the 683,000 child victims of maltreatment in 2015, 1,670 of them were fatalities.
These numbers can be overwhelming, but the good news is that neglect can be prevented, and help is readily available.
In the United States, there are several organizations that provide support to those who have experienced neglect. Government entities, social service agencies, and mental health professionals across the country offer countless supportive services for those in need.
Child Protective Services and Adult Protective Services are often the first line of defense when it comes to the response, management, and prevention of neglect in the United States. Both have access to resources that can positively impact the lives of both victims and perpetrators of neglect. Social service agencies, especially those who offer foster care and adoption services, are well-equipped to provide children with secure living environments and responsive caregivers. Social service agencies can also provide support to birth parents and caregivers who need help improving their parenting skills. Lastly, mental health professionals are vital in helping victims and their families work on building and repairing relationships, learning specialized parenting techniques, increasing resilience, and addressing mental health concerns.
There are several therapeutic models that can effectively address issues associated with neglect. These include group therapy, trauma-informed care, structural family therapy, parent-child interactional therapy (PCIT), and art therapy. No matter which method of support is chosen, therapy should be delivered by trained professionals who focus on improving attachment, consistent and nurturing caregiving, clear boundaries, safe and secure relationships, and healthy development.
For those uncertain where to turn, immediate help is available. If you suspect a child is being abused or neglected, contact your local Child Protective Services agency, your state child abuse reporting hotline, or call the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1.800.422.4453). If you know an elderly individual you suspect is being abused or neglected, contact your local Adult Protective Services agency, the local police, or your state's long-term care ombudsman. You can also call the Eldercare Locator hotline at 1-800-677-1116 for more information.
- Neglect in children of parents with mental health issues: Kento, 10, is the son of a single mother with severe depression. As a result of her depression, Kento's mother often sleeps during the day and is not always able to make sure he is fed or that he gets to school on time. Kento becomes withdrawn, as he often ends up staying home by himself for long periods of time while his mother sleeps in her room, and his grades suffer due to his abscences from school. When his aunt notices how many days of school he has missed, she makes an arrangement with his mother so that he can live with his aunt while his mother receives the care she needs for her depression. Since then, Kento has been able to go to school and eat regular meals. His grades start improving. However, due to the neglect Kento received from his mother, he finds it difficult to socialize with his peers and begins dealing with mental health issues of his own. His aunt connects him with a therapist who helps him work through the effects of neglect.
- Elder neglect after death of spouse: Edna, 87, has recently experienced the death of her husband. Now without the support she had lived with for so long, she finds it increasingly difficult to practice daily self-care as she grieves. Edna becomes fixated on anxious thoughts and forgets to cook and clean for herself regularly; she also begins leaving her house less and less frequently. Her children do not visit her often or check to make sure she is taking care of herself, so it is months until she finds help. Eventually, a neighbor notices that Edna has lost a significant amount of weight, and helps her locate the resourcs she needs to improve her health and situation.
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