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Child Abuse & Neglect 26 (2002) 679 – 695

Child neglect: developmental issues and outcomes夞
Kathryn L. Hildyard, David A. Wolfe*
Department of Psychology, The University of Western Ontario, London, Ontario, N6A 5C2, Canada

Objective: This article highlights the manner in which child neglect, the most common form of
maltreatment, affects children’s development.
Method: The review is organized according to three developmental periods (i.e., infancy/preschool,
school-aged and younger adolescents, and older adolescents and adults) and major developmental
processes (cognitive, social-emotional, and behavioral). Although the focus is on specific and unique
effects of various forms of child neglect, particular attention is paid to studies that allow comparisons
of neglect and abuse that clarify their similarities and differences.
Results: Past as well as very recent findings converge on the conclusion that child neglect can have
severe, deleterious short- and long-term effects on children’s cognitive, socio-emotional, and behav-
ioral development. Consistent with attachment and related theories, neglect occurring early in life is
particularly detrimental to subsequent development. Moreover, neglect is associated with effects that
are, in many areas, unique from physical abuse, especially throughout childhood and early adoles-
cence. Relative to physically abused children, neglected children have more severe cognitive and
academic deficits, social withdrawal and limited peer interactions, and internalizing (as opposed to
externalizing) problems.
Conclusions: The current review offers further support for the long-standing conclusion that child
neglect poses a significant challenge to children’s development and well-being. Limitations with
regard to the state of the knowledge are discussed and directions for future research are outlined.
© 2002 Elsevier Science Ltd. All rights reserved.

Keywords: Child neglect; Child abuse; Development; Consequences

夞 Support for this article was provided by a doctoral fellowship from the Social Sciences and Humanities
Research Council of Canada (KH) and a Senior Research Fellowship from the Ontario Mental Health Foundation
* Corresponding author.

0145-2134/02/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved.
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It is self-evident that neglected children face a multitude of risk factors known to impair normal development (Schumacher. McCall & Groark. permitting criminal behavior. 2000. D. 1996). with emotional neglect showing the greatest increase (which is likely because of increased recognition and identification of child witnesses to domestic violence). and emotional abuse affects another 18 children per 1000. In North American incidence studies. sexual abuse. and failure to provide necessary treatment for a child being less common. affecting almost 30 children out of every 1000 in the US. failure to meet adequately the physical needs of children). Child neglect continues to be the most commonly reported form of child maltreatment. 2000]. based on the limited findings available (Hart. Physical. given that a lack of parental care and nurturance— hallmarks of neglect—poses one of the greatest threats to children’s healthy growth and well-being (Rutter & Sroufe. Sameroff. homelessness. & Heyman. and witnessing domestic violence. with medical neglect. respectively) was found in reported emotional neglect between the second and third National Incidence Studies in the US. and poor prenatal and postnatal care are all associated with neglect (Pelton. 1984). 2001. parental psychopathology. Trickett & McBride-Chang. sexual. 2001). especially in the absence of compensatory strengths and resources (Brooks-Gunn & Duncan. or 43% of the total [these percentages exceed 100% because of overlap. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 Introduction The “neglect of neglect” has been acknowledged for over two decades (Wolock & Horowitz.680 K. 1998. including those working in related fields of childcare.e. 2000). 1995). Binggeli. serious care- giving deficits.L. emotional. and educational neglect account for the majority of other cases. Emotional neglect (i. Slep. The significance of child neglect. & Brassard. or mental disorders) and exposure to family violence are difficult forms of maltreatment to define because of their lack of visible injuries and often delayed impact on development. family breakup. 2000). are often surprised to learn that the consequences of child neglect are as severe as those associated with physical abuse.A. and child development. failure to supervise leading to sexual abuse. should come as no surprise. US Department of Health and Human Services (US- DHHS). 1997. reflecting a growing awareness of these forms of maltreatment and their insidious impact on . a two. however. family. and each of these risk factors has been shown independently to increase children’s vulnerability to psychopathology.e. 1994). Incidence studies also indicate that the rate of child neglect increased by nearly 100% from 1986 through 1993.. Nonetheless. abandonment. leading to physical harm (Trocmé & Wolfe. yet child neglect remains the poor cousin of child maltreatment research. Many individuals. substance abuse. USDHHS. acts or omissions by the caregiver that could cause the child to develop behavioral. the most common form of child neglect (accounting for about half of investigated cases) involves failure to supervise the child properly. Hildyard. and accounting for 70% of all reported maltreatment in that country (Sedlak & Broadhurst. Physical neglect (i. Unlike physical or sexual abuse. Chronic three-fold increase (based on either the harm or endangerment standard. which is usually incident-specific. 2000). cognitive. neglect often involves chronic situations that are not as easily identified as specific incidents.

the neglected children showed poor impulse control and demonstrated less flexibility and creativity in problem-solving than control and other maltreated children (Egeland. 1981). because of space limitations. Compared to other maltreatment groups. Therefore.A. Child neglect most typically begins at an early age and has an accumulating effect on subsequent developmental abilities and limitations. Whereas the mothers in the “neglectful” group failed to provide adequate physical care or protection for their children. a prospective longitudinal study designed to follow the development of 267 children born to first-time mothers identified as being at risk for parenting problems. emotionally neglected children participating in the Minnesota Mother-Child Project had the most dramatic decline in scores on the Bayley Scales of Infant Development from 9 months to 24 months of age (at 9 months the average developmental quotient [DQ] of infants of psychologically unavailable mothers was 118. Hildyard. At 24 months of age. 1999). and behavioral). 2001. we pay particular attention to studies that allow comparisons of neglect and abuse that clarify their similarities and differences. D. In this study. We begin with re- search involving infants and preschoolers and identify noteworthy “themes” that have been identified among this age group and might be continuous over development.L. This article highlights the manner in which the principal forms of child neglect exert their influence on development. Infants and preschoolers Cognitive and moral development Observations of maltreated children participating in the Minnesota Mother-Child Project. which cannot be unconfounded at this stage of research development. & Labruna. The experience of the children of these mothers would be consistent with what is typically considered emotional neglect. social-emotional. the mothers in the “psychologically unavailable” group were characterized by emotional detachment and unresponsiveness to their children’s bids for attention and care. Although our focus is on specific and unique effects of various forms of child neglect. K. the current discussion is restricted primarily to physical and emotional neglect. & Thayer.. Kaplan. Sroufe. more frustrated. & . the following review is organized according to three developmental periods (i. We caution that it is quite likely that some neglected children in these studies would also have been abused. At 42 months. provide some of the strongest evidence for the negative impact of neglect on early cognitive and academic development. school-aged and younger adolescents. and angrier in problem-solving tasks than nonmaltreated and other maltreated children. children with a history of physical neglect were less enthusiastic. McCarroll. and older adolescents and adults) and major developmental processes (cognitive. infancy/ preschool. two groups of neglectful mothers were identified: “neglectful” mothers and “psychologically unavailable” mothers. Furthermore. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 681 the course of development (Jellen.e. Pelcovitz. at 24 months the average DQ had dropped to 87) (Egeland & Sroufe. children’s exposure to family violence and other forms of emotional maltreatment and abuse are therefore not reflected in the conclusions. when confronted with an obstacle box where a toy was visible but inaccessible.

At ages 12.A. 1989). 1993). whereas neglected children considered the unfair distribution of resources to be more universally wrong for themselves (but not for others). Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 Erickson. Gowen. and generalizability of hypothetical familiar moral and social-conventional nursery school transgressions. Hildyard. to observe their compliance to the less-desired tasks and spontaneous displays of . rule contingency (the permissibility of actions in the absence of rules). Both groups judged moral transgressions relating to physical and psychological harm and unfair resource distri- bution to be more serious. When they examined children’s judgments of emotional responses to the transgressions. 24. and generally wrong. found that the adequacy of received psychological care predicted young children’s IQ scores and ability to engage in age-appropriate play. Moral development.682 K. for instance. however. & Pianta. Few differences were found between maltreated and nonmaltreated children’s moral and social judgments. Cicchetti. Smetana. 1983). Recent observational studies of maltreated youngsters have shed additional light on the development and expression of moral development. Culp et al. and wrong than social-conventional transgressions. neglected. In an early study of moral development. between the two groups of abused and neglected children. A recent study by Smetana et al. and 36 months. Abused. 1982. children who received inadequate psychological care scored lower on IQ measures than those with adequate psychological care. Other studies have also linked neglect with lags in early cognitive development. and control preschoolers were compared in their judg- ments regarding the seriousness. as shown during mother-child compli- ance tasks. and Twenty- man (1984) examined maltreated children’s judgments regarding different types of moral transgressions. neglected. 18. 1991. By kindergarten. Koenig. (1999) similarly found that physically abused. punishable. and Rogosch (2000) observed maltreated and nonmaltreated preschoolers interacting with their mothers during a clean-up session following a free-play period. physically neglected children’s performance on standard- ized tests of intellectual functioning and academic achievement were the lowest of all the maltreatment groups. They also reported that perpetrators would feel less sadness than did nonmaltreated children. Egeland. and these problems were more severe than those associated with physical abuse (Allen & Oliver.. Smetana et al. Allen and Oliver (1982) found that neglect occurring alone is more problematic for language development than abuse and neglect together. Gowen (1993). Differences were found. and nonmaltreated children did not differ in their evaluations of moral transgressions. however. and that they all judged them as very serious. deserved punishment. neglected children reported more fear when judging how victims would feel in hypothetical instances of unfair resource distribution than did physically abused or nonmaltreated chil- dren. (1984) concluded from this early study that abused and neglected children differ in moral and social-conventional judgments that are related to their experi- ences of maltreatment. Kelly. Abused children considered transgressions entailing psychological distress to be more universally wrong for others (but not for themselves). A history of neglect has also been shown to be predictive of problems in expressive and receptive language among preschool children. including the emotionally neglected children (Erickson. punishable. Interestingly.L. D.

1999). Barnett. and 18% combined abuse and neglect. and neglected children display.L. 1989. The likelihood that child neglect is significantly associated with disorganized attachment is evident from a closer look at Carlson et al. The sample was comprised of many neglect cases: 59% physical neglect. that neglected children expressed significantly more negative affect in the clean-up paradigm than comparison children (the physically abused children did not differ significantly from comparisons).’s (1989) sample. Ganiban. 1996). Cicchetti. 1981). 2000). Lyons-Ruth. Whereas physically abused preschoolers showed less moral internalization (i. 1988). & Braunwald. neglected children did not differ from the nonmaltreated group. K. & Botein. rather than inhibit.. Hesse & Main. 2000. neglected children are more likely to have anxious (i. Connell. & Cicchetti. Many maltreated children lack an organized attachment strategy. abused preschoolers engage in “compulsive compliance” in which negative behaviors are suppressed and the child imme- diately complies with maternal demands.e. which has found that when interacting with their mothers. (2000) did find. these infants are caught in an irresolv- able conflict (George. 2000). less of a shift from reliance on external controls to internal mechanisms) than nonmal- treated children. Social. of which 82% of maltreated children were classified as disorganized. Abused and neglected preschoolers often have nega- tive mental representations (i. Koenig et al. Because neglect cases were well represented in this sample.e. 27% emotional maltreatment (including emotional neglect). Attachment theorists have pro- posed that for disorganized infants.. internal working models) of the self and others (Toth. Taken together.. however. insecure) attachments to their caregivers than nonmaltreated children (Crittenden & Ainsworth. conclusions regarding disorganized attachment would correspondingly apply to this popu- lation. the parent (who should be a main source of safety and protection) is at the same time the source of danger or harm itself (Hesse & Main. this research suggests that neglected children may have difficulties with emotion regulation in compliance situa- tions. and behavioral development Attachment. Egeland & Sroufe. which is referred to as disorganized attachment (Carlson. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 683 negative affect. lending further support to the conclusion that neglected children are equally as likely as abused children to show a disorganized attachment strategy (Barnett. emotional. Furthermore. . whereas 57% of the emotionally neglected children participating in the Minnesota Mother-Child Project were securely attached at 12 months of age. the researchers deter- mined that abused and neglected children could not be reliably distinguished on the basis of attachment classifications. These findings are consistent with other research. D. As a result of this “irresolvable paradox. 1990).e. at 18 months of age the classifications of these children had changed to anxious attachment (Egeland & Sroufe. whereas physically abused children may be likely to comply out of fear. When the attachment behavioral system is activated.A. 1981). expressions of anger (Crittenden & DiLalla. Representations of self and others. 1989.” breakdowns in the infant’s attachment strategy for enlisting caregiver protection occur and disorganized attach- ment behaviors are expressed (Hesse & Main. Similar to studies of abused children. in subsequent analyses with the same sample. Children who experience early emotional neglect seem to be particularly at risk for attachment problems. Grunebaum. Hildyard.

Conversely. these two groups of maltreated children differ in the positive versus negative valence of their self-views. and nonmaltreated children. were also found to represent others as hurt. 1989. that whereas the physically abused children had high levels of negative self-representations. Social and behavioral problems. 1981). although confronted with parenting dysfunction. and were more socially isolated than abused and nonmaltreated children (Cam- ras & Rappaport. and nonmaltreated preschoolers into the laboratory to ob- serve peer interactions.L. abused. physically abused children.. abused-and-ne- glected. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 Cicchetti. For example. Toth et al. The early social development of neglected children is also compromised in a manner suggestive of poor social adaptation. Erickson et al. 1984). 2001). it may well be that physically abused children are more likely to develop some sense of the self as positive. The fact that the neglected children have the restricted positive self- representations is consistent with the reality of these children’s lives. Neglected preschoolers are also more uncooperative and noncompli- ant than nonmaltreated children but. Emotionally neglected infants’ participation in feeding and play situations declines considerably between 3 and 6 months of age (Egeland & Sroufe. & Gerber. Macfie. Waldinger.. 1991. Toth. Hoffman-Plotkin & Twentyman. 2000. 2001). they are typically less so than physically abused . again. Cicchetti. sad. the neglected children had low levels of positive self-representation. neglected children engaged in fewer social interactions with other children. or traumatizing care that they have experienced often leaves them with models of themselves as unworthy of love and others as unavailable or rejecting. D. in particular. Although neglected preschoolers tend to be more aggressive than nonmaltreated children (Bousha & Twentyman. 192–193). 1984). Maughan. however. The unresponsive. in which they most likely receive minimal attention to their basis needs. Thus. whereas neglected children have far fewer opportunities to do so” (pp. 1993. (1997) remark: “. by their physically abusive parents. may experience periods during which they are responded to. the neglect that they experience may impede their overall development of self. insensitive. 1984. Hildyard. Toth. Neglected children seem to have particularly restricted positive views of the self. 1997. . . Hoffman-Plotkin & Twentyman. possibly even positively. the narratives of maltreated children contained more negative maternal representations and more negative self-representations than the nonmaltreated children. Macfie. They also found. Neglected children tended to be more isolated during free play with their siblings and more passive and withdrawn with their mothers than children in the other groups.684 K. As Toth et al. Neglected children. a recent investigation found that physically abused and neglected preschoolers tend to represent the self as angry and opposing others more often than nonmaltreated children (Waldinger et al. Crittenden (1992) brought neglected. & Vanmeenen. & Emde. Erickson et al. neglected children tend to be socially withdrawn. Haskett & Kistner. In essence. In the preschool years. as characterized by social withdrawal and few positive interactions with peers. 1992. as expected. sexually abused.. For example. marginally maltreated. were more avoidant in their interactions. In a related study involving preschool and daycare settings. 1989). or anxious more often than physically abused.A. (1997) used narrative story stems to examine the maternal and self-representations of maltreated preschoolers and found that. they are less aggressive than their physically abused counterparts (Crittenden.

emotionally neglected infants show major declines in performance on the Bayley Scales of Infant Development. They also appear to have particularly poor coping abilities. Erickson et al. Such findings underscore the importance of emotional nurturance in the beginning stages of . The most striking feature about these children. & Toth. 1981). Only physical abuse. personality development. in particular.g. In a problem-solving task at 24 months of age. Hornung. D. clinginess. displaying the most negative affect and the least positive affect. in contrast.. Egeland et al. self-punishing behaviors. including cognitive and language problems. Cicchetti. Macfie. have more externalizing problems. 1983). They also did not demonstrate a sense of humor (Erickson et al.. 1983).. K. 1989. Other studies have failed to find an association between neglect and dissociation. 1992). Cicchetti. was the large number of pathological behaviors they exhibited (examples of behaviors included in the “pathology score” included tics. Neglected preschoolers are generally confused by the emotional displays of others and are less able to discriminate emotions than nonmaltreated and abused children (Pollack. and their attachment problems worsen dramatically.. was signifi- cantly associated with clinical levels of dissociation. and emotion regulation. When they find themselves in stressful situations. soiling accidents. Over the course of several months. neglected preschoolers tend to be more hopeless than physically abused children. sexually abused. and neglected children each demonstrated more dissociation than nonmaltreated children. 1983. Hildyard. phys- ically and emotionally neglected preschoolers often demonstrate notable problems in coping. neglected infants and preschoolers are distinguishable from abused children in several areas. Compared to their nonmaltreated and abused counterparts. Summary This review reaffirms and expands previous conclusions that child neglect has a pervasive. Moreover. Cicchetti. however. & Reed. who in turn tend to be more angry (Crittenden 1985. however. however (e.. Shields & Cicchetti. In the preschool setting. Emotional development. Macfie. stealing. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 685 children (Bousha & Twentyman. The emotionally neglected children.. They also received the lowest ratings on agency (i.e. 2000). and present as dependent and unhappy. and fewer positive social inter- actions.. were also very dependent and negativistic (Egeland et al..L. 2001). The neglected children also received the lowest ratings on self-esteem and were observed to be the most unhappy group of children. 1989). and so forth). frequent physical complaints. Physically abused youngsters. including increased noncompliance and aggression towards adults and other children. the physically neglected children were observed to be the most dependent and to demonstrate the lowest ego control (Egeland et al. 1998).A. tantrums. Emotional neglect appears to be particularly detrimental in infancy. 1984. 1983). and Toth (in press) studied dissociation in a sample of maltreated and nonmaltreated preschoolers and found that physically abused. confidence and assertiveness in dealing with the environment) at 42 months of age (Egeland et al. physically neglected children participating in the Minnesota Mother-Child Project were found to have the poorest coping abilities of all the maltreatment groups (Egeland & Sroufe. negative impact on children’s early competence across major developmental dimensions. Neglected preschoolers may also show symptoms of dissociation.

e. Hildyard. researchers have surmised that physical contact occurring in the form of abuse may be less harmful than no contact at all (i. wherein mothers of these infants dismiss the importance of relationships. 1996).L. neglect) because such parents may be less emotionally detached and disinterested in their infants and may be somewhat more likely to respond to their children’s important signals than neglectful parents (Egeland & Sroufe. School-aged children and younger adolescents Cognitive development Not surprisingly. 1996). 1991). Similarly. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 life on subsequent psychological development. there is some evidence to suggest that neglect occurring in the absence of other major forms of child maltreatment is associated with worse outcomes than neglect that occurs in conjunction with physical abuse.A. 1997). In addition. 1995. 1991. comparable to the significance of food and safety on physical development (Scarr. the aforementioned problems in cognitive development continue un- abated into middle and late childhood. Eckenrode. In middle childhood. McCrone. Wodarski. although both physically abused and physically neglected children perform poorly on measures of academic performance. including the early attachment relationship and related emotional needs (Attie & Brooks- Gunn.. and 6 (Erickson & Egeland. Children who experienced emotional neglect in the first 2 years of life were found to perform significantly worse than their nonmaltreated counterparts on the Peabody Individual Achievement Test when tested in grades 1. 1992). Social. maltreated children continue to have negative mental representations of themselves and others (Lynch & Cicchetti. 1981. Toth at al. Zeanah. and by the second grade all of them had been referred for special educational services (Egeland. Benoit. neglect occurring alone is associated with more severe language problems than neglect occurring alongside abuse. scored significantly lower on tests of achievement. Kurtz. For example. emotional. was associated with the lowest academic achievement levels. They also tended to be inattentive and unin- volved in learning (Erickson & Egeland. the academic deficits of neglected children are more severe than those of abused children. regardless of whether it occurred by itself or in conjunction with other forms of maltreatment. . both neglected and abused children differed from comparison children on standardized tests in math. For example. Thus. They had considerable difficulty coping with the demands of school. 2. but neglected children also performed significantly worse in language and reading. D. and behavioral adjustment Representations of self and others. Although counter-intuitive. 1989). Laird. & Barton. and Howring (1990) found that.686 K. Gaudin. This conclusion is consistent with the failure to thrive literature. 3. and Doris (1993) found that neglect. Physically neglected children in Minnesota Mother- Child Project demonstrated a significant decline in functioning during the early school years. Egeland and Sroufe (1981) observed that emotional neglect alone was associated with worse consequences than when it was accompanied by physical abuse..

2001. Wolfe & Mosk. one that was characterized by negative interpersonal expectations and difficulty solving problems within relationships. McCrone et al. physically abused. Patterson. Emotional development. 1984. (1994) assessed maltreated children’s mental represen- tations of relationships among school-aged children using a projective storytelling task. emotional neglect. Kaplan. and sexual abuse. are not limited to the caregiving relationship. No significant differences were found between the stories of neglected and abused children. More specifically. 1998). Whereas neglected. 1977). Reidy. Toedter. Severe neglect. Erickson et al. & Cic- chetti. Ryan. (2001) inves- tigated the outcomes associated with physical neglect. they are significantly less so than their physically abused peers (Erickson & Egeland. was particularly detrimental on school-aged children’s emotional well-being.. & Kupersmidt. They are predominantly avoidant in their peer interactions (Kaufman & Cicchetti. and problem-solving. 1989). Hildyard. including hitting. Lahey. Stovall & Craig. Com- pared to the stories of the nonmaltreated children. only the physically neglected group and the group that had experienced neglect in conjunction with emotional abuse demonstrated greater internalizing symptomatology than the nonmal- treated group. D.A. 1984). less socially mature. Though neglected children also have elevated behavior problems. physical abuse. they are more likely to present with a general lack of social skill and emotional problems (see following discussion). 1984. Kim. & Yanushefski. 1996.. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 687 Egeland. Rogosch. K. Shields. Herrenkohl. & Carlson. and less capable of developing trust with others (Herrenkohl. 1989). and destructiveness (Bousha & Twentyman. teachers and parents describe physically abused children as being more difficult to manage. These perceptions are consistent with behavioral observations that reveal that abused chil- dren behave more aggressively during interactions with parents or siblings. Erickson et al. Pelcovitz. The negative self and other representations of maltreated children. neglected school-aged children. Although neglected children are also more likely to be aggressive. 1990. In a recent investigation. 1984. are unpopular with peers (Erickson & Egeland. Consistent across studies. In contrast to the aggressive tendencies of abused children. are more isolated and withdrawn in their social interactions. se- . and sexually abused children were all rated higher in externalizing problems than nonmaltreated children. Manly et al. therefore. however. 1989). & Cicchetti. Furthermore. & Kreiger. Ki- nard. Samit. disruptive. Social and behavioral problems. neglected school- aged children tend to have social difficulties and continue to be characterized as socially withdrawn. like their younger counterparts. 1996. 1994. abused children stand out in terms of their behavior problems. Manly. 1983). suggesting that the mental representations of neglected and abused school-aged children are more similar than different. the stories of the maltreated children suggested that they had a much more negative view of the social world. Atkeson. the maltreated children’s stories tended to be preoccupied with negative relational dynamics. 2001). & Treiber. As with their younger counterparts.L. differences that set them apart from both abused and nonmaltreated youngsters (Erickson & Egeland. particularly when it occurred during the preschool years. and have fewer reciprocated playmates than other children (Bolger. peer acceptance. one of the most distinc- tive features of the neglected group was the elevation in internalizing problems. 1980. Kalkoske. Not surprisingly. and noncooperative in comparison to nonmaltreated children. In fact. Salzinger. 1996. Conger. yelling. to the exclusion of positive relational dynamics such as empathy.

and lower ego resil- ience in middle childhood.. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 verity of neglect and/or emotional maltreatment experienced in infancy or toddlerhood was found to predict externalizing symptoms. Much of the research relies on the longitudinal investigation of Cathy Widom and her colleagues.L. The physically neglected children were found to display the most varied and most severe socioemotional problems. Although findings to date make it . This was true even when the severity of all other co-occurring forms of maltreatment were considered. Children were assessed in kindergarten. neglected children seem to exhibit fewer externalizing problems than physically abused children. depression (Toth.688 K. and many of these problems tended to be of an internalizing nature (Erickson et al. although peers and adults see them as being disruptive and uncooperative. & Cicchetti.’s (2001) findings provide additional support for the idea that neglect occurring early in life is particularly detrimental on children’s development. 2001). Two well conducted longitudinal projects also suggest that neglected children experience significant internalizing problems and that they may have more emotional problems than physically abused children. Older adolescents and adults We begin this final section on a cautionary note because research on the long-term consequences of child neglect is greatly lacking. we see that neglect is associated with severe cognitive problems. D. this is because of the fact that subsequent developmental tasks build on previous milestones and competencies. it should be noted that others have not found such differences on socio-emotional development (Wodarski et al. follow-up data from a sample (N ⫽ 15) of officially identified neglect cases derived from a larger 1975 community cohort has provided valuable information on developmental changes among maltreated and nonmal- treated children (Cohen. 1996). often more so than abused children. or suicidality (Finzi et al.A. Manly. Whereas the above studies report significant internalizing problems among neglected children. and at all grades they were rated as exhibiting more internalizing type problems than nonmaltreated children (Erickson & Egeland. Summary The picture that emerges of the school-aged neglected child is quite similar to the picture of the neglected preschooler. aggressiveness. 1990). 2001). Findings from the Minnesota project similarly suggest that school-aged children with a history of neglect exhibit emotional problems. who are following a large sample of maltreated children into adulthood.. In addition. Finally.. 1992). The emotionally neglected group of children also received low teacher rankings on overall emotional health. Presumably. and follow-up assessments were done throughout the elementary school years. they continue to be challenged by normal developmental tasks. Again. 1989). ego control. Because neglected children fail to achieve important milestones. The theme of social withdrawal also persists. Hildyard. which led the researchers to conclude that this form of early maltreatment represents extreme risk for later successful adaptation. as with the younger group. Manly et al. & Smailes. problems that are often worse than those associated with abuse. Brown.

both neglect and physical abuse have been linked with dissociation in adulthood (Ogawa. childhood emotional. adult criminal behavior. and alcohol problems. & Bernstein. Brown. Summary. Finally. Persons with histories of neglect are also at-risk for delinquency. 1999). Smailes. 2000). 1994). childhood maltreatment was found to have little direct impact on mental health once the presence of stressful life events was controlled. & Bernstein. Widom’s group found that sexual abuse and neglect were both significant predictors of prostitution for females. Hildyard. Child physical abuse and neglect both continue to be associated with significant negative outcomes into late adolescence and adulthood. Weinfield. Widom. In a related study. D. antisocial personality disorder. Brown. Cohen. 1997). 1995). A history of abuse or neglect in childhood is also associated with an increased likelihood of running away from home (Kaufman & Widom. Cohen. and about half could be classified as “thrownaways” (Greene. 1996. 1999). whereas those with physical abuse backgrounds showed increasing antisocial and problem behaviors (Cohen et al. research points to neglect being associated with significant negative outcomes in late adolescence and adulthood. individuals who had experienced childhood abuse or neglect were four times more likely to be diagnosed with personality disorders than those without such a history (Johnson. 2001). 2001). with few differences in outcomes . Smailes. Widom. In a large follow-up study. Similarly. Such individuals are very similar to those with physical abuse histories in terms of arrests for violent crimes as a juvenile or an adult (20% for neglect vs. Egolf. however. 1998). and supervision neglect were also associated with increased risk of personality disorders and with elevated symptoms of anxiety and depres- sion. K. however. & Egeland. & Russo. and violent criminal behavior (Maxfield & Widom. occurring alone or in combination with neglect. 1996). physical. Herrenkohl. In this latter study. a related study did find that preschool and school-aged physical abuse. Sroufe.. commensurate with the developmental impact noted in early and middle childhood. was associated with teenage parenthood (Herrenkohl. Rivera & Widom. Both abuse and neglect appear to have long-term effects on cognitive abilities. whereas physical abuse was only margin- ally associated with prostitution (Widom & Kuhns. A US nationwide study of 587 runaway and homeless adolescents revealed that just under half had experienced physical abuse in the home. 1990. & Kelly. By adulthood. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 689 difficult to distinguish the long-term effects of neglect and their relative comparison to other forms of maltreatment. especially during early adolescence.L. 21% for physical abuse) (Maxfield & Widom. and White (2001) also investigated the relationship between childhood maltreatment and adult mental health. McLaughlin. Ringwalt. 1996).A. Although they found relationships among childhood abuse and neglect and adulthood dysthymia. Carlson. 28-year-old individuals with a history of abuse or neglect were found to have lower scores on tests of intelligence and reading ability than individuals without a history of maltreatment (Perez & Widom. abuse and neglect were not associated with increased risk for promiscuity or teenage parenthood. In an investigation of the relationship between childhood maltreatment and risk for personality disorders in early adulthood. Horowitz. even after childhood physical or sexual abuse were controlled statistically (Johnson. these problems were in remission among the adults with known neglect back- grounds.

instead. In this regard. neglected children are distinguishable from their physically abused counterparts in terms of more severe cognitive and academic deficits.. substance abuse. social withdrawal. timing) and the severity and chronicity of the events themselves. both forms of maltreatment are associated with subsequent criminal behavior. Patterson. It is important to acknowledge the limitations in this state of knowledge. adolescent adjustment was significantly related to the developmental period in which maltreatment had occurred. if experiences of neglect or psychological abuse increased during mid- . In a study of the relationship between different forms of child maltreatment and subsequent adolescent adjustment. For boys. and stressful life events. Manly et al. More research examining the long-term consequences of neglect is clearly needed. That is.690 K. conclusions regarding the carry-over of themes that characterized younger neglected individuals (i. as well as the interaction of neglect and witnessing spouse assault. Wolfe / Child Abuse & Neglect 26 (2002) 679 – 695 noted between the two forms of maltreatment over time (with the exception of recent follow-up results from Cohen et al. the current review offers further support for the long-standing conclusion that child neglect poses a significant challenge to children’s development and well-being. and nurturing (American Psychological Association. internalizing problems) cannot be drawn on the basis of limited knowledge. Notably. neglect is associated with effects that are. For girls. Conclusions Child abuse and neglect have considerable psychological importance because they occur within ongoing relationships that are expected to be protective. Finally. adolescent adjustment was accounted for in large part by the interaction of physical and psychological abuse.e. there has been little attention paid to how boys and girls may differ in their response and adaptation to abuse and neglect experiences. 2001)... of maltreatment best predicts negative outcomes (Bolger & Patterson. in many areas. 1998). Furthermore. Other recent research has suggested that chronicity. Additional studies taking a prospective approach and studies investigating the long-term effects are needed. 1991).A. In general.’s (2001) study serves as a good example in this regard. such as the developmental period in which maltreatment begins (i. supportive. Children from abusive and neglectful families grow up in environments that fail to provide consistent and appropriate opportunities that guide development. Hildyard. we might expect that children who experience neglect will be at particular risk for maladaptive outcomes. cognitive deficits. & Kupersmidt. researchers need to take into account important developmental con- texts and processes. 2001. personality disorders. and internalizing (as opposed to externalizing) problems. Given that neglect tends to be more chronic than all other forms of maltreatment. during early childhood. Wolfe and McGee (1994) found important interactions between the child’s sex and the timing and nature of maltreatment experiences. 1996). social withdrawal and limited peer acceptance. especially throughout childhood and early adolescence.e. However. they are placed in jeopardy of physical and emotional harm (Wolfe & Jaffe. Bolger. D. rather than type and/or severity.L. unique from physical abuse. In particular. They found that severe neglect occurring in the early childhood years is particularly detrimental to successful adaptation.

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