Joining Forces

Joining Families

Volume 13, Issue 1 • Spring 2013

R e a l W o r l d R e s e a r c h f o r F a m i l y  A d v o c a c y P r o g r a m s

F e at u r e d I n t e r v i e w

Child Emotional Neglect — The Failure to Nurture
An Interview with Howard Dubowitz, M.D.
Howard Dubowitz, M.D.
Howard Dubowitz, MD, is a Professor of
Pediatrics and the Director of the Center for
Families and Children at the University of
Maryland His medical training includes the
University of Cape Town, South Africa; aninternship in Israel at the Tel Hashomer Hospital, Ram Gan, Chaim Sheba Medical School;a pediatric residency at Boston City Hospital;
and a fellowship in child abuse and neglectat the Children’s Hospital, Boston. He also
worked as a general practitioner in London
and has a Master of Science degree in epidemiology from the Harvard School of Public
Health. Dr. Dubowitz serves in a wide variety

In This Issue

This issue of Joining Forces Joining Families (JFJF) focuses on child emotional neglect, the least understood form of child neglect. Our interview is with Howard
Dubowitz, MD, an internationally recognized expert on child neglect who has appeared previously in JFJF (Volume 10, No. 1, March 2007) in which he discussed
child neglect prevention and intervention.
Our statistics article presents estimates of the community prevalence ofchild maltreatment from the most recent national sample survey. These data arecompared to the Army and U.S. national child maltreatment statistics on founded
incidents with emphasis on the prevalence of child neglect.
Websites of interest gives links to major sources of child neglect statistics,
Child Maltreatment 2011 and the National Incidence Study-4 (NIS-4). We alsopresent the CDC website that features child maltreatment prevention information.
Finally, there is a link to the video of a recent conference on child neglect.

Contents

Child Emotional Neglect — The Failure to Nurture ...................................1
Building Bridges to Research: National Statistics on Child Emotional
Neglect......................................................................................................3
A Brief Review of Child Emotional Neglect as Child Maltreatment.............4
Websites of Interest..................................................................................8of professional capacities in teaching, research,
and administration, and has received numerous
professional honors and awards including, mostrecently, the American Academy of Pediatrics’
Special Achievement Award. Widely publishedin scientific journals and books, Dr. Dubowitz is one of the principal investigators on the
LONGSCAN study, a prospective research
project involving five independent centers in
the U.S. that examines the antecedents andconsequences of maltreatment of children (seeRunyon et al., 1998).
Reference
Runyon DK, Curtis PA, Hunter WM, BlackMM, Kotch JB, Bangdiwala S, Dubowitz H,
English D, Everson MD, & Lansdverk J. (1998).
Longscan: A consortium for longitudinalstudies of maltreatment and the life course ofchildren. Aggression and Violence Behavior,
3:275–285.


Dr. McCarroll: Is child emotional neglect
getting more attention in the academic andprofessional communities?
Dr. Dubowitz: There is quite a bit of awareness and interest. Many would probably agree
that this is an especially damaging form of
maltreatment. It is not that there is a lack ofinterest. It has been around for a long time.
Spitz (1945) and others did their work many
decades ago and more recently there has been
the research on the Romanian orphans (Colvert, Rutter, Beckett, et al., 2008). One of the
big challenges is that it has been tricky to define
and operationalize. For example, pediatriciansmight encounter many situations in which
Continued on page 2

One of the importantelements of parenting
is to be nurturing andemotionally supportiveof their children.

parents are not as nurturing as you would like.
Maybe there are real deficits, but it is not easy
to discern at what point to label it as neglect
and the threshold for referring or reportingto CPS is generally very high. The response ishindered by some of the practice and practical issues rather than by disinterest or lack ofawareness of how very damaging this can be tochildren.

attending to the kid’s physical needs. For example, I am thinking of a kid who, say, is severely
depressed, possibly suicidal and if the parent
did not respond you might think that might begrounds for emotional neglect. However, by andlarge, even under such gross and relatively severe
circumstances, it is unusual for CPS to respond.
It’s a problem that is really not well dealt with bychild protection systems.

Dr. McCarroll: How familiar is the childprotection community with the issue ofemotional neglect?
Dr. Dubowitz: Good question. I thinkthey are pretty familiar with it, but in termsof the practice it gets hugely shortchanged. I
remember a few years ago in talking with theperson who runs a state CPS, who explainedthat “they really don’t do” emotional neglect. I
would say there are two circumstances where
typically CPS does get involved. First, andmore typically, they are more concerned withother types of abuse and neglect. Emotional
neglect might be part of the mix and it getsnoted and, hopefully, addressed, but by itself it
is unlikely to get a CPS response. The second is
if it is really severe, but even there it is typically
mixed up with other circumstances such as not

Dr. McCarroll: How do you speak about childemotional neglect when you teach?
Dr. Dubowitz: We use a lot of case material
in training pediatric residents. In the case of a
12-year old boy whose father was killed, the boy
was severely depressed and his school performance plummeted. Part of what I am trying toconvey is that we be mindful not only of children’s physical needs, but also the emotional.
We discuss with the residents and other students
how they can or should approach situations likethat.
Understandably, physicians and others often
have a high threshold for labeling circumstances
as neglectful — given the implication of having
to report or thinking they have to report to CPS.
The way that I teach about this is that they aregoing to encounter many situations where a situation might not cross that threshold, dependingon the state legal requirements, where they label
it as neglect. Nevertheless, we can recognize howthese circumstances jeopardize the kid’s healthand development and they could or should stillintervene. One focus in prevention work is to try
to identify parents who are depressed (Dubowitz, Feigelman, Lane et al., 2009; Dubowitz, Lane,
Semiatin, et al., 2011). If a mom or a dad is depressed that can impede their parenting abilities.
Responding to the depressed parent can help
both the parent and then the kid.

Joining Forces
Joining Families
Editor-in-Chief
James E. McCarroll, PhD
Email:
Editorial Advisor
James.McCarroll.CTR@usuhs.mil COL Nancy D. Ruffin, LCSW, MSC, USA
Family Advocacy Program Manager
Headquarters, Department of the Army
Joining Forces Joining Families
is a publication of the U. S.
Army Installation Management Command and theFamily Violence and Trauma
Project of the Center for the
Study of Traumatic Stress(CSTS), Bethesda, Maryland
20814-4799, tel. 301-2952470. CSTS is part of the
Department of Psychiatry of
Uniformed Services University of the Health Sciences,which is our nation’s federal
medical school.

2 • Joining Forces/Joining Families

Editorial Consultants
David M. Benedek, MD, COL, MC, USA
Professor and Scientist
Center for the Study of Traumatic Stress
Uniformed Services University of the
Health Sciences
dbenedek@usuhs.mil
Nancy T. Vineburgh, MA
Director, Office of Public Education
and Preparedness
Center for the Study of Traumatic Stress
Email: nvineburgh@usuhs.mil

Dr. McCarroll: In your writing and your teaching
you emphasize children’s needs. A research
instrument that is based on child needs isthe Multidimensional Neglect Behavior Scale(Kantor & Straus, 2003; Dubowitz, Villodas,
Litrownik, et al., 2011). Many of the items
measure parent-child interactions. Examples
are “Do you watch your child play?”, “Do you
play games with your child?”, “Do you talk to
your child?” Many of these interactions could
be recommended to parents to remind them todo such activities or to increase them.
Dr. Dubowitz: I think you are really talking
about one of the important elements of parentContinued on p. 5
Spring 2013

Building Bridges to Research: 				National Statistics on Child Emotional Neglect
By James E. McCarroll, Ph.D., and Robert J. Ursano, M.D.
The estimatednumber ofemotionally neglectedchildren under theEndangerment
Standard more thandoubled in the interval
between 1993 and2005–2006.

Child neglect occurs in many forms,
from what may appear to be mild and simple
omissions in the daily lives of children to theextreme cases of child death. In this article, wewill explore child emotional neglect, a subtype
that has received less attention than other typesof neglect. However, as described in other articles in this newsletter, child emotional neglect
is a recognizable and an important type ofchild maltreatment.

Child Neglect in the Army

Child neglect has the highest percentage and rate per thousand children of childmaltreatments. Over the past 10 years, from2001 to 2011, child neglect has accounted for
between 50% in 2001 to 64% in 2011 of allchild maltreatments.
Subtypes of child neglect are not identified
in the incidents reported to the Army (ArmyRegulation 608-18 The Family Advocacy
Program), but the following are the types ofacts that can be considered: abandonment, lackof supervision, exposure to physical hazards,
educational neglect, health care neglect, anddeprivation of necessities. None of these categories recognizes emotional neglect.

National Statistics on Child Neglect

The latest national statistics on foundedcases of child maltreatment are reported inChild Maltreatment 2011, published by the Administration on Children and Families (http://archive.acf.hhs.gov/programs/cb/ pubs/cm10/
cm10.pdf). About 78% of victims were reported
for neglect and an additional 2.4% for medical neglect. No additional subtypes of neglect
were reported. The CDC repeats many of thesestatistics from the same source, Child Maltreatment, as it is the only national annual report ofchild maltreatment incidents.

National Estimates of Child Neglect

Another source of data on child neglect
in the U.S. population is the Fourth National
Incidence Study (the NIS-4) (see http://www.
acf.hhs.gov/programs/opre/ abuse_neglect/natl_incid/index.html). The NIS estimates thenational prevalence of child maltreatment. It isa congressionally mandated, periodic research

http://www.CSTSonline.org

project of the United States Department of
Health and Human Services. NIS-4 data werecollected in 2005 and 2006. Earlier NIS studies
used data from 1993 (NIS-3) and 1986 (NIS2). The NIS differs from Child Maltreatment
2011 in that it uses founded Child Protective
Services (CPS) cases of abused and neglectedchildren and an additional source of estimates,
those children who have not come to the attention of CPS, but have come to the attentionof professionals (these professionals are called
sentinels) who encountered them during thenormal course of their work in a wide range ofagencies in U. S. representative communities.
The NIS reports three subtypes of neglect: physical, educational, and emotional.
Emotional neglect is defined as inadequate
nurturance or affection, chronic or extreme
domestic violence in the child’s presence,knowingly permitting drug or alcohol abuse orother maladaptive behavior, failure or refusal
to seek needed treatment for an emotional or
behavioral problem, overprotective treatment,
inadequate structure, inappropriately advanced
expectations, exposure to maladaptive behaviors and environments, and other inattention to
the child’s developmental or emotional needs.

NIS Harm Standard and Endangerment
Standard

The NIS applies two definitional standards
in parallel: the Harm Standard and the Endangerment Standard. The Harm Standard is relatively stringent in that it generally requires thatan act or omission result in demonstrable harmin order to be classified as abuse or neglect. In
order for the child to be counted as emotionallyneglected, the maltreatment had to cause serious harm to the child.
The Endangerment Standard includes all
children who meet the Harm Standard, but
adds those children if a CPS investigation
substantiated or indicated their maltreatment
and those that the sentinel thought were indanger of maltreatment. Thus, the Endangerment Standard is slightly more lenient than theHarm Standard.
Under the Harm Standard, almost one-halfContinued on page 7

Joining Forces/Joining Families • 3

A Brief Review of Child Emotional Neglect as 		Child Maltreatment
By James E. McCarroll, Ph.D., and David M. Benedek, M.D.
The emotionally

What is Child Emotional Neglect?

unavailable parent (orChild emotional neglect (also called psychological neglect) is a form of child emotional
maltreatment, which includes child emotional
abuse and emotional neglect. Child emotional
maltreatment refers to the emotional unavailability of the parent or caretaker (Glaser, 2002).
Glaser describes parental insensitivity as asituation in which caretakers are preoccupied
with their own difficulties such as mental ill
health, substance abuse, or overwhelming workcommitments, and are unable to respond totheir child’s emotional needs. Child emotional
neglect was once called hospitalism (Spitz,1945). This term was used to describe the causeof high morbidity and mortality in infants
institutionalized at an early age and for a longtime: the severe and lasting deprivation ofmaternal care. These infants showed developmental deterioration, relational or affective expression reduced to silence, motor andbehavioral deficiencies, and increased morbidity and mortality rates. This behavioral patternoccurred generations later with Romanianorphans who were later adopted by British
families (Colvert, Rutter, Beckett et al., 2008).
Less severe child emotional neglect occurs
when there is a lack of parental (or caregiver)warmth, physical affection and nurturance orwhen signs of needed comfort or attention are
ignored (Strathearn, 2011). Thus parents may
be withdrawn, unresponsive, unmotivated andunable or unwilling to respond to their children’s needs for emotional connection.

caregiver) is preoccupied
with their own needs andunable to respond to achild’s emotional needs.

Definitions of Child Emotional Neglect
There are two conceptual approaches tothe definition of child emotional neglect:(1) by the intentions of the parents and (2) by
the child’s needs. Child protection professionals and state statutes typically focus on parent
or caregiver behavior such as in feeding, clothing, and providing the necessities of daily living for the child (Trocme, 1996). The focus onchild needs is based on the needs for emotional
support and nurturance of children.
Conceptualizing emotional neglect interms of children’s unmet needs is challenging(Straus & Kantor, 2005). First is the difficultyof specifying the unmet needs, which is very
4 • Joining Forces/Joining Families

different from specifying abusive actions. Second is whether the purpose of the definition isfor statutory reasons, for research, for interventions or for educational purposes. Straus andKantor stress that the definition of neglect must
not confound the behavior (omission) withpossible causes. They also note that neglectful behavior and harm must also be measured
separately. Most state statutes and instruments
do not do this. Categories often include whether the child has suffered harm. If only harm isfound, it is impossible to evaluate the effects ofneglect separate from harm. If neglect is measured only by harm, the prevalence of neglectful
behavior will be vastly underestimated.

How is child emotional neglect measured?
The Ontario Child Neglect Index (Trocme,
1996) evaluates the caregiver’s behavior in supervision, physical care, and provision of healthcare. Omission of psychological care is given
under the subset of Mental Health Care. The
standards include anticipating and responding to the child’s emotional needs, inconsistent
response to emotional distress, and not providing services for emotional distress. One ofthe problems of all standards is establishing athreshold (Dubowitz, 1994). Milder forms ofchild emotional abuse may not be brought tothe attention of the authorities since they are
difficult to prove. More common and less severe
privation can appear when parents or caregivers
do not ignore their children, but may think they
are doing the right thing by providing only theminimal nurturance. This is more often seen
with boys. Military families may be more prone
to this as they want their sons to be “masculine”
and not “needy”.There are research instrumentsthat also measure failure to respond to childneeds such as the Multidimensional Neglectful
Behavior Scale (MNBS) (Kantor, Holt, Mebert,
et al., 2004). The MNBS measures four domainsof child neglect: cognitive, emotional, physicaland supervisory. It assesses exposure to violence, alcohol-related neglect, abandonment,
and children’s appraisal of parenting. The emotional subscale includes eight items that evaluate the affection, support, and companionshipwithin the parent-child relationship. In addition to the emotional neglect subscale, the other
Spring 2013

Child emotional neglect
is more likely when there
is a lack of parental(or caregiver) warmth,
physical affection andnurturance or ignoringsigns of needed comfort
or attention.

subscales have many items that require parentchild interaction. For example, “The child’s
parent does not talk to him or her a lot.” There
are versions of the MNBS. One is for adultrecall of their own experiences and another for
adults to rate their own behavior toward theirown children. These items can also be clinicallyuseful for parents and professionals (counselors or home visitors) for increasing parentchild interaction and for possible prevention ofchild emotional neglect.

What are the consequences of emotional
neglect?
A longitudinal study of children at three
years of age found that emotional neglect was
the only type of child neglect (other possible
types of neglect were emotional, physical, or
environmental) associated with externalizing
or internalizing behavior problems at age 3(Dubowitz, Papas, Black et al., 2002). They
concluded that it is important to identify psychological neglect as early as possible.
In a study of 1,700 children ages 11-15,
a small group (3%) perceived their parents
as almost always emotionally neglectful andcontrolling. When these children were later
examined, they had over twice the odds of a
psychiatric disorder at age 15 (Young, Lennie &Minnie, 2011).

Can The Effects of Child Emotional Neglect
Be Reversed?
Severely neglected Romanian orphans who
were later adopted by well-functioning families
in the U. S. and Great Britain suffered pervasive emotional neglect in that they received
adequate nutrition and physical care, but little
dependable social interaction with an adultcaregiver. When examined some years later, theadopted Romanian orphans showed considerable heterogeneity compared to non-deprived
children who were also adopted (Rutter,
Kreppner & O’Conner, 2001). While many of
the Romanian orphans showed considerable
catch-up, many still had attachment problems,
inattention and over-activity, quasi-autistic features and cognitive impairment. The greater theduration of deprivation, the more disturbancesin attachment behavior (O’Conner, Marvin,
Rutter, et al., 2003). However, one-fifth of thechildren who had spent the longest time in institutions showed normal functioning, perhaps
reflecting resilience to this particular stressor.
Children who spent less than six months in the
Romanian orphanages showed almost complete
recovery.

Recommendations
It is important that parents and othercaregivers who work with children be awareof (1) the harmful effects of child emotional
Continued on p. 7

Featured Interview, 		From page 2

Reading to children canbe an emotionally intimate
time that promotes
closeness and bonding.

http://www.CSTSonline.org

ing — 101 —the many different ways that parents can be more nurturing and emotionally
supportive of their children. One interesting
program in pediatrics has been to encourage
parents to read to infants. Aside from the advantages that it has shown in terms of cognitive
stimulation is that reading, looking at pictures,
talking with one’s child can be and should be arather emotionally intimate time. More important than hearing the words, the bonding andthe closeness that this experience can foster isperhaps even more valuable.
Most of my first-hand experience has beenwith very high risk families in which some of
the most basic aspects that one would think ofin parenting are often not appreciated. I will
give you one example. It is pretty common ofparents of 6–7 month old babies that we seehere to worry that if the baby is crying, picking up and comforting him or her will spoil

the child. I do not mean to blame, but there isenormous ignorance of child development inrecognizing that at six months of age, the baby
needs to feel securely attached and know there
is a responsive adult who is going to take care of
him or her. Many parents do not recognize that.
Stepping away from the child abuse andneglect area, to a broader concern, how can
we really better equip parents with some very
important fundamental knowledge that ought
to help them be better parents? Parenting takes
massive patience. It’s a tough job, there is no
instruction manual, the extended family isoften not available, everyone’s busy, and a lotof people struggle with really poor judgment.
They need better support and guidance.
Dr. McCarroll: The concept of attachment isa basic tenet of child development. How doyou explain this to high risk families? Are
Continued on p. 6
Joining Forces/Joining Families • 5

Featured Interview, from page 5

The child who isemotionally abused byhumiliating or belittlingis probably emotionallyneglected as well.

there terms that you have found that are more
applicable and understandable and practicalto use than attachment?
Dr. Dubowitz: I would say that attachment
is not on their radar screen I think that there
is, hopefully, some recognition of the need forbonding with their baby, but there is a lot ofvariation. Some parents are better equipped
to recognize that. For example, there is theimportance of consistency in responding, but
often there is not a cognitive awareness or
mindfulness of what it takes to foster secureattachment.
Dr. McCarroll: The scientific literature on
emotional neglect also includes a lot of
papers on emotional abuse. How different arethose, in your view? Are they separable or are
they two aspects of the same phenomenon?
Dr. Dubowitz: I think they are prettyintertwined, but there are some differences.
Humiliating a child is different from ignoring and not being responsive. What they shareis that neither of them provides the essential
emotional support that kids — and all of us— need. They often hang together. The child
who is emotionally abused is very likely to beneglected as well, but I would think that there
would well be some added harm to the child
who is also emotionally abused, like being
frequently belittled. I have not seen researchon this, but clinically I have heard kids indicatethat abuse feels like it is worse, yet I have also
heard that getting nothing can actually feelworse than getting negative attention.We knowa fair amount of what the emotional needs ofchildren are. We need to find a variety of strategies to help parents respond to those needs
and this is something that can and should
happen in different settings. It is really at theheart of parenting. Some basic knowledge ofchild development will help parents to bond in
healthy ways.
Dr. McCarroll: Seeing children develop isa source of pleasure and pride for parents.
There are many positive effects on adultdevelopment from nurturing a child.
Dr. Dubowitz: Sure. Absolutely right. Beinga terrific parent and, hopefully, seeing the fruitsof one’s efforts should be deeply enriching. In
my work with dads, we discuss the enormous
gifts of being an involved dad — what theygive and what they get.

6 • Joining Forces/Joining Families

Dr. McCarroll: How do you help parents work
toward being a terrific parent?
Dr. Dubowitz: I am, after all these years, stubbornly holding on to the idea that most parents
want to be terrific parents. Something gets in theway that impedes their ability. I think they needguidance and support in learning how to parent.
Dr. McCarroll: There have to be many avenues
to working on this.
Dr. Dubowitz: This is something that ideally should be pervasive, in many settings —throughout the culture, the media, in Head Start,
with pediatricians, neighbors, and child carecenters. This is the big broad goal: a society thatreally values kids, that really understands andrecognizes the importance of raising them well,and takes advantage of different opportunities tohelp achieve the goal.
Dr. McCarroll: Thank you for your work and yourthoughts
Dr. Dubowitz: You are welcome.
References
Colvert E, Rutter M, Beckett C, Castle J, Groothues C, Hawkins A, Kreppner J, O’Connor TG,
Stevens S & Sonuga-Barke EJS. (2008). Emotional difficulties in early adolescence following
severe early deprivation: Findings from the English and Romanian adoptees study. Development
and Psychopathology; 20: 547–567.
Dubowitz HD, Feigelman S , Lane WG, & Kim
J. (2009). Pediatric primary care to help preventchild maltreatment: The Safe Environment for
Every Kid (SEEK) model. Pediatrics; 123:858–864.
Dubowitz HD, Lane WG, Semiatin JN, Magder
LS, Venepally M, & Jans M. (2011). The Safe
Environment for Every Kid Model: Impact onpediatric primary care professionals. Pediatrics;
127:e962-e970. DOI: 10.1542/peds.2010–1845.
Dubowitz HD, Villodas MT, Litrownik AJ, Pitts
SC, Hussey JM, Thompson R, Black MM &Runyan D. (2011). Psychometric properties of ayouth self-report measure of neglectful behavior
by parents. Child Abuse & Neglect; 35:414–424.
Kantor GK & Straus MA. (2003). The parent
report Multidimensional Neglectful Behavior
Scale. Family Research Laboratory, University of
New Hampshire, Durham, NH 03824.
Spitz RA. (1945). Hospitalism: An inquiry into
the genesis of psychiatric conditions in earlychildhood. Psychoanalytic Study of the Child;
1:113–118.
Spring 2013

Building Bridges to Research, from page 3

The NIS applies two
definitional standards
in parallel: the Harm
Standard and theEndangerment
Standard.

of the neglected children experienced educational neglect (47% of neglected children), 38%
third were physically neglected and 25% were
emotionally neglected. The rate of emotional
neglect under this standard was 2.6/1,000
children. (The rate of overall child neglect was
10.5/1,000).
The difference in rates of emotional neglect
between the NIS-4 (2.6/1,000) and NIS-3(3.2/1,000) were not significantly different, butwere significantly different from the NIS-2 rate
(0.8/1,000).
Under the Endangerment Standard, morethan one-half of the neglected children were
physically neglected (53%, of neglected children), 52% were emotionally neglected and
16% were educationally neglected. The rateof emotional neglect was 15.9/1,000 children. (The rate of overall child neglect was
30.6/1,000).
The rates of emotional neglect significantly
increased from the NIS-2 (3.2/1,000) to the
NIS-3 (8.7/1,000) to the NIS-4 (15.9/1,000).
The estimated number of emotionally neglected children under the Endangerment Standard
more than doubled in the interval between the
NIS-3 and NIS-4 studies, rising from 584,100
in 1993 to 1,173,800 in 2005–2006 (a 101%
increase in number, an 83% increase in therate). The increase in the rate of emotional
neglect since 1993 could, in part, signify a realincrease in the occurrence of maltreatment, but
it is fairly clear that it also reflects some change
in policy and focus. Since the NIS–3, a numberof CPS systems have undertaken initiatives toincrease collaboration between CPS and agencies that serve domestic violence and alcoholand drug problems.

Summary and Conclusions

Child abuse statistics reported above represent cases from the Army specifically and for
the U. S. population on the whole, Child Maltreatment 2011 and the NIS-4. The NIS-4 statistics estimate the prevalence (overall counts
and rates) for an earlier time period (2005–6),
but it is unlikely that there has been a dramaticchange since then. Overall, these reports show
the high prevalence of child neglect. Unfortunately, case reports (Army and Child Maltreatment 2011) do not reflect subtypes with the
exception of medical neglect in Child Maltreatment 2011. However, the NIS-4 data do present
subtypes and show both the high prevalence
http://www.CSTSonline.org

and increasing rate of emotional neglect. Particularly striking is the vastly increased percentageof emotional neglect (15.9%) of all neglect cases
reported in the Endangerment Standard compared to the Harm Standard (2.6%). This is not
surprising as it is likely that most emotionallyneglected children, especially young children,
will not be seen as harmed by observers who
might more easily qualify the same observation
as endangering. What is important, however, isthat these emotionally neglected children are
noticed by sentinel reporters, reflecting many
possible relationships with parents and othercaretakers who are likely to be detrimental tothe children’s welfare. These reports from the
NIS-4 indicate the need for child protection
workers and other sentinels to be increasingly
aware of child emotional neglect as a harmful
type of child maltreatment.
Child Emotional Neglect, from page 5neglect, and (2) work to see that the behaviors
of parents and caregivers enrich children’s lives
by providing them with emotionally supportive
contacts. Parenting programs can help parents
recognize the variety of interactions they canhave with their children to improve mutual
attachment and the emotional quality of children’s lives.

References
Colvert E, Rutter M, Beckett C, Castle J, Groothues C, Hawkins A, Kreppner J, O’Connor
TG, Stevens S & Sonuga-Barke EJS. (2008).
Emotional difficulties in early adolescence following severe early deprivation: Findings fromthe English and Romanian adoptees study. Development and Psychopathology; 20: 547–567.
Dubowitz H. (1994). Commentary: Neglecting
the neglect of neglect. Journal of Interpersonal
Violence; 9: 556–560.
Dubowitz H, Papas MA, Black MM, & Starr
RH. (2002). Child neglect: Outcomes in highrisk preschoolers. Pediatrics; 109:1100–1107.
Glaser D. (2002). Emotional abuse and neglect(psychological maltreatment); a conceptual
framework. Child Abuse & Neglect; 26:697–
714.
Kantor GK, Holt MK, Mebert CJ, Straus, MA,
Drach KM, Ricci LR, MacAllum CA & Brown

Continued on p. 8
Joining Forces/Joining Families • 7

Websites of Interest■■ A link to the Child Welfare Information Gateway
provides a wide variety of material on the National
Incidence Study-4 and the other three NIS studies.
https://www.childwelfare.gov/systemwide/statistics/
nis.cfm. Additional material includes links to resourceson domestic violence, mental health, laws and policies
and many other topics of interest.
■■ The Children’s Bureau of the Department of Healthand Human Services gives the link to the latest nationalchild maltreatment statistics: http://www.acf.hhs.gov/
programs/cb/resource/child-maltreatment-2011.
The site allows the viewer to search by chapter and to
download tables of interest.
■■ The CDC Injury Center for Violence Prevention gives awide variety of helpful information in addition to childmaltreatment such as intimate partner violence, sexual
violence, suicide and many others. http://www.cdc.gov/
violenceprevention/childmaltreatment/.
■■ A very interesting and informative video is available
at the website below. It is presented by the NIMH
Translational Research on Child Neglect Consortium:
Research on Child Neglect,
Progress Over a Decade. Itfeatures research by David
Olds on home visiting andmany other topics specificto child neglect. http://videocast.nih.gov/summary.
asp?live=11900&bhcp=1

Child Emotional Neglect, from page 7
W. (2004). Development and preliminary properties of themultidimensional neglectful behavior scale-child report.
Child Maltreatment; 9:409–428.

Straus MA & Kantor GK. (2005). Definition and measurementof neglectful behavior: Some principles and guidelines. Child
Abuse & Neglect; 29:19–29.

O’Conner TG, Marvin RS, Rutter, M, Olrick JT, & Britner PA.
(2003). Child-parent attachment following early institutional
deprivation. Development and psychopathology; 15:19–38.

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8 • Joining Forces/Joining Families

deprives them of sharing feelings with others.

Spring 2013