Child Health and Developmental Problems and Child Maltreatment among AFDC Families

This paper explores the complex interrelationship among the physical health and developmental problems of a child, child abuse and neglect, and poverty. Gaps in agency attention to children's medical needs are identified and recommendations made for reducing these gaps. The analysis is based on interview and agency data for 45 families randomly selected from a group of 365 AFDC recipient families under supervision for child abuse and neglect. A prominent theme in the child abuse and neglect literature is that certain children have characteristics that increase their vulnerability to abuse and neglect. Characteristics that have been identified are mismatches between the personalities of mother and child (Schaffer and Emerson, 1964; Steele and Pollack, 1968), unattractiveness (Dion, 1974), and the resemblance of a child to a disliked relative of the parent (Helfer, 1970). Exceedingly limited attention has been paid to the way in which the physical health problems and developmental disabilities of a child contribute to parental frustrations and difficulties, thereby increasing the likelihood of child abuse and neglect. Among the wide range of children's physical health and developmental problems which are potential precipitants of maltreatment, only prematurity of low birth weight of newborns has received much attention. The higher rate of abuse found among these infants has been attributed, in part, to the fact they tend to be less attractive and more difficult to care for than normal babies and consequently, more likely to evoke a negative response from their parents. In addition, such infants often require prolonged hospitalization and special medical care which separates them from their mothers shortly after birth. This separation, to the extent that it interferes with the establishment of emotional bonds between infant and parent, is thought to increase the likelihood of subsequent abusive behavior (Brown and Bakeman, 1974; Elmer and Gregg, 1967; Klein and Stern, 1971; Silver, Dublin, and Lourie, 1971; Skinner and Castle, 1969; and Stern, 1973). Helfer (1970) observes that a child who imposes special demands upon its parents, such as a handicapped, mentally retarded, or hyperactive child may repre'Medical consultation was provided by Richard S. Schlesinger, M.D. This analysis was based on research funded by the National Center on Child Abuse and Neglect, Administration for Children, Youth and Families, Department of Health, Education, and Welfare (Grant No. 90-C-418). sent an intolerable stress factor, provoking the parent to rejection or abusive behavior. Friedman (1976) in a review of the child abuse and neglect literature, notes that a number of studies reveal that abused children have a higher rate of physical and developmental problems than children in comparison groups. Although there is little evidence to support it, the prevailing interpretation is that these problems are the result rather than the cause of the maltreatment (Helfer, 1976). There is little doubt that severe physical abuse or neglect has the potential to impair a child's physical health and development. There is also little doubt, albeit an interpretation receiving much less attention, that the physical health and developmental problems may contribute significantly to parental maltreatment of a child. Raising a child with an acute or chronic illness, a physical disability, or a developmental problem is an extremely difficult task for any parent. It is even more of a burden for poor parents who live in deprived material circumstances and may, themselves, suffer from some physical or emotional problem. Children's health and developmental problems and the capacity of parents living in poverty to provide adequate care are viewed as closely interrelated, each often the cause and effect of the other. This paper, based on a study which focused upon the total set of physical health and developmental problems of poor children, seeks to demonstrate how these factors, occurring in a context of poverty, are related to parental behavior that comes to be identified as abuse and neglect. Study Methodology The analysis is based on a study of 45 families randomly selected from a larger sample of families receiving Aid to Families of Dependent Children (AFDC). All were under the supervision of the public child welfare agency for child abuse and neglect. The small sub-sample, representative of the larger group of maltreating families, afforded a concrete and in-depth picture of the complex interrelationships among children's health and developmental problems, difficulties associated with living in extreme poverty, and parental neglect and abuse of children. Sources of data were interviews with parents, comments and observations of interviewers, and reviews of agency case records of the families interviewed (Wolock and Horowitz,