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ACEs Risk Factor #5: Neglect

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Hate is often used as an opposite for the word love; meaning to feel intense or passionate dislike for (someone). I would like to think a better word is indifference: meaning to have no interest or sympathy; unconcerned.

  • I do not care if you bathe or not
  • I do not care if you eat or not
  • I do not care if you are safe or not

Child physical and sexual abuse receive the greatest professional attention and research. Neglect, a type of maltreatment, is more common, less known, and it is the deadliest Horner (2014). The World Health Organization (WHO) defines neglect as the failure to provide for the development of the child in:

  • Health
  • Education
  • Emotional Development
  • Nutrition
  • Shelter
  • Safe Living Conditions

It is difficult to base neglect on one instance and usually requires a pattern to form before a closer look is required, except in the case of gross negligence, such as: when a child is left home alone and wanders into the street, possibly being hit by traveling cars. Neglected children are at a higher risk to also experience physical, sexual, or emotional abuse.

Types of Neglect include:

  • Medical - Failure to seek medical care or continue a care plan
  • Safety/Supervision - Use of car seats/seat belts, ingestion, weapons, violence
  • Education - Truancy and failure to complete assignments
  • Dental - Failure to seek dental care, may result in caries and infections
  • Nutrition - Obesity, failure to thrive or continue a care plan
  • Shelter - Homelessness, safe, clean, hygiene/clothing
  • Abandonment - Nurture, Affection, Love
  • Prenatal drug exposure

The Adverse Childhood Experiences Study found that children who experienced neglect were more likely to experience liver disease as adults, ischemic health disease, asthma, migraines, comorbid pain conditions, and lung cancer.

Neglect can be a physical/psychological harm and can cause short/long term effects, such as:

  • Depressive Disorders
  • Anxiety Disorders
  • Suicidal Ideation/Attempts
  • Drug Use
  • Sexually Transmitted Infections
  • Risky Sexual Behavior

Medical/Mental Ill Parent(s)

Some parents/caregivers may have physical health, cognitive, or mental health concerns that limit their ability to provide safe and adequate care for their children Horner (2014).

Physical health problems can obviously impair caregiver ability to provide basic physical care, such as: bathing, preparing food, and laundering clothes. Caregiver cognitive or mental health concerns may affect the caregiver's ability to understand the importance of providing nearly every aspect of adequate care, from health care to love and nurture. Parents with these concerns may honestly not know how to meet even the most basic needs of their children or may be so impaired that they are oblivious to the needs of their children.

Ill parents and their spouses get the most attention from health care professionals, often leaving out the feelings of the child; even though many children become lifetime caregivers Sieh (2010).

Children react to the stress by:

  • Self-Isolating
  • Guilt/Worry about changes in parent health
  • Fearing higher negative outcomes of the illness for themselves
  • Psychosomatic Complaints - headaches, cramps, weak immune system
  • Developing symptoms of depression, anxiety, physical complaints
ACE Risk Factor #5: Neglect

Parental illness can impact family life, including:

  • Emotional
  • Financial/Work
  • Relationships
  • Sleep
  • Altered food options
  • Education
  • Leisure Time
  • Social Activities
  • Feel obligated to care
  • Worry of death

For example, a married mother of two sons has a medical condition that causes her to have seizures. She would not be able to work and may need someone to look after her who could complete errands, like driving to the store. The husband cannot look after her because he must works. The oldest son cannot care for her because he is leaving for college soon. The son of 7 years old will be responsible for his mother's care - check on her frequently, contact first responders in the event of a seizure, and his father.

Her medical bills soon outweigh the father's paycheck and causes the family to have unstable housing, something the child worries about while at school during the day. He wonders if today will be the day he steps off the bus and yet again finds the family's belongings on the curb because of another eviction. He loses sleep worrying.

Drug/Alcohol Problem (Substance Abuse)

Substance abuse in the home can severely impact many areas of the family dynamic and limit the ability to provide safe, adequate care for children.

Some of the affects include:

  • Unmet developmental needs
  • Impaired attachment
  • Economic hardship
  • Legal problems
  • Emotional distress
  • Violence against the child

1 in 10 children under the age of 18 live with at least one adult who is a substance abuser Lander (2013). At the time of birth, the primary relationship, (many times with the mother) serves as the framework for all relationships throughout the remaining life cycle. This prelanguage relationship is how the infant learns to communicate and relate to their environment, by crying, cooing, rooting, and clinging.

Eye contact, tone, soothing touch, reading the infant's needs, and volume/rhythm of voice are the important building blocks of a healthy attachment. A secure attachment forms when the primary caretaker is responsive and nurturing. An inconsistent or unresponsive caretaker forms an insecure attachment that results in anxiety, depression, trauma, and failure to thrive.

Negative consequences of one or both parents' substance abuse include:

  • Difficulty establishing trusting relationships
  • Overly responsible in future relationships
  • Taking on adult responsibilities before developmentally appropriate

In utero, maternal substance abuse could cause:

  • Damage to the growing fetus
  • Birth defects
  • Fetal alcohol syndrome

A parent with a substance abuse problem is three times more likely to  abuse their child physically or sexually. Incest has a very high association with parental substance abuse as do all types of sexual abuse. About two thirds of incest perpetrators report using alcohol directly before the offending incident Sedlak (2001).

The parent and the child may become separated because of the parental substance abuse, such as:

  • The parent going to prison
  • Long-term treatment for the parent
  • Child protective services removes the child from the home

Substance-related death, such as:

  • Overdose
  • Motor vehicle accident
  • Medical complications

These children are more likely to have poor physical, intellectual, social, and emotional outcomes. They are also at a higher risk of developing their own substance abuse problems.

When the caretaker is unable to meet the developmental needs of the child, the child begins to parent themselves, their younger siblings, and the parent in a phenomenon called "reversal of dependence needs". When this happens, the parents needs are placed before the child's, which results in the inability of the child to set healthy boundaries in relationships later in life or make important connections between their feelings, thoughts, and actions.


Parents play a critical role in brain development. Long-term mental and emotional problems can result if a child does not have a reliable source of attention, affection, and stimulation. Studies of children who spent time in Romanian orphanages during the 1980s-1990s are key to what scientist know about parental bonding and how it affects the brain.

Children entered orphanages for different reasons, such as:

  • Parents could not care for them financially/physically
  • They were born the wrong gender
  • They became ill
  • Both parents died
  • Unwanted

Beatings, neglect, and boredom were the norm as many children had serious disabilities or were labeled "irrecoverable". The orphanage did not function under established rules, there was one rule - Listen to me or I will beat you. Brains of children who experienced neglect showed a 60% reduction in size compared to a child who had not experienced neglect Hamilton (2014).

This was not due to malnutrition, but due to the lack of a parent or other loving caregiver; some orphans did not even have a person to take them out of their cribs. One child was adopted at the age of 11 and moved to his forever home in San Diego, but soon after began experiencing conflict with his adoptive parents. He shared that he responded better when he was beat or smacked around-showing love, compassion, and kindness made him even more angry.

The amygdala response (a brain region that plays an important role in emotional reactions) of a child who spent time in an orphanage or other institution did not have discriminating signals when the child was shown a photo of an unfamiliar woman and their adoptive mother. Scientist now know that the brain can rewire itself and fill in the gaps caused by missing development, called neuroplasticity.

Exhausted Parent(s)

Until recently, parents of sick children were the exclusive concern of research conducted on parental exhaustion. Situations where exhaustion occurs because of being physically and emotionally overwhelmed by one’s parental role is called parental burnout. Professional burnout, in comparison, is exhaustion related to working conditions. Extremely vulnerable parents often feel a sense of guilt, shame, and loneliness Hubert (2018).

It is characterized by three aspects:

  • Physical /Emotional Exhaustion
  • Emotional distancing from one's children
  • Sense of incompetency in one's parenting role

Burnout has been shown to increase alcohol use (by up to 80%) as a means of diffusing tension accumulated during the day and develops when demands are high/resources are limited. Often, those affected looked forward to parenting, being needed, and being the "Super Mom". The difference between job and parental burnout is that you can resign from the company and even change careers, but there is no equivalent "Escape Route" for parents Mikolajczak (2018). Parental burnout increases the risk of neglect and verbal/physical violence towards child(ren).

Two physical escape ideations reported are suicide and flight (or to leave without leaving an address). There are also psychological ways to escape an unbearable situation that distract from and regulate unpleasant moods, such as:

  • Smoking
  • Drinking Alcohol
  • Binge Eating
  • Working
  • Gambling
  • Shopping
  • Exercising
  • Telephoning
  • Social Media/Internet
  • Substance Abuse (Pills/Drugs)


Hamilton, J. (2014, February 24). Orphans' Lonely Beginnings Reveal How Parents Shape A Child's Brain. NPR.

Horner, G. (2014). Child Neglect: Assessment and Intervention. Journal of Pediatric Health Care. 28(2), 186-192.

Hubert, S., & Aujoulat, I. (2018). Parental Burnout: When Exhausted Mothers Open Up. Frontiers in psychology, 9, 1021.

Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: from theory to practice. Social work in public health, 28(3-4), 194–205.

Mikolajczak, M. et al. (2018). Consequences of parental burnout: Its specific effect on child neglect and violence. Child Abuse & Neglect, 80, 134-145.

Sedlak, A. J. (2001). A History of the National Incidence Study of Child Abuse and Neglect. Special Studies and Strategic Planning:National Incidence Study of Child Abuse and Neglect.

Sieh, D. S., Meijer, A. M., Oort, F. J., Visser-Meily, J. M., & Van der Leij, D. A. (2010). Problem behavior in children of chronically ill parents: a meta-analysis. Clinical child and family psychology review, 13(4), 384–397.

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