Pergamon

Child Abuse & Neglect 26 (2002) 679 695

Child neglect: developmental issues and outcomes

Kathryn L. Hildyard, David A. Wolfe*
Department of Psychology, The University of Western Ontario, London, Ontario, N6A 5C2, Canada

Abstract
Objective: This article highlights the manner in which child neglect, the most common form of
maltreatment, affects childrens 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 childrens 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 childrens 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

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
(DW).
* Corresponding author.

0145-2134/02/$ see front matter 2002 Elsevier Science Ltd. All rights reserved.
PII: S 0 1 4 5 - 2 1 3 4 ( 0 2 ) 0 0 3 4 1 - 1
680 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695

Introduction

The neglect of neglect has been acknowledged for over two decades (Wolock &
Horowitz, 1984), yet child neglect remains the poor cousin of child maltreatment research.
Many individuals, including those working in related fields of childcare, family, and child
development, are often surprised to learn that the consequences of child neglect are as severe
as those associated with physical abuse, sexual abuse, and witnessing domestic violence,
based on the limited findings available (Hart, Binggeli, & Brassard, 1998; Trickett &
McBride-Chang, 1995). The significance of child neglect, however, should come as no
surprise, given that a lack of parental care and nurturance hallmarks of neglectposes one
of the greatest threats to childrens healthy growth and well-being (Rutter & Sroufe, 2000;
Sameroff, 2000).
It is self-evident that neglected children face a multitude of risk factors known to impair
normal development (Schumacher, Slep, & Heyman, 2001). Chronic poverty, serious care-
giving deficits, parental psychopathology, substance abuse, homelessness, family breakup,
and poor prenatal and postnatal care are all associated with neglect (Pelton, 1994), and each
of these risk factors has been shown independently to increase childrens vulnerability to
psychopathology, especially in the absence of compensatory strengths and resources
(Brooks-Gunn & Duncan, 1997; McCall & Groark, 2000).
Child neglect continues to be the most commonly reported form of child maltreatment,
affecting almost 30 children out of every 1000 in the US, and accounting for 70% of all
reported maltreatment in that country (Sedlak & Broadhurst, 1996). Physical, sexual, and
emotional abuse affects another 18 children per 1000, or 43% of the total [these percentages
exceed 100% because of overlap; US Department of Health and Human Services (US-
DHHS), 2000]. Incidence studies also indicate that the rate of child neglect increased by
nearly 100% from 1986 through 1993, with emotional neglect showing the greatest increase
(which is likely because of increased recognition and identification of child witnesses to
domestic violence).
Unlike physical or sexual abuse, which is usually incident-specific, neglect often involves
chronic situations that are not as easily identified as specific incidents. In North American
incidence studies, the most common form of child neglect (accounting for about half of
investigated cases) involves failure to supervise the child properly, leading to physical harm
(Trocme & Wolfe, 2001; USDHHS, 2000). Physical neglect (i.e., failure to meet adequately
the physical needs of children), permitting criminal behavior, abandonment, and educational
neglect account for the majority of other cases, with medical neglect, failure to supervise
leading to sexual abuse, and failure to provide necessary treatment for a child being less
common. Emotional neglect (i.e., acts or omissions by the caregiver that could cause the
child to develop behavioral, cognitive, emotional, 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. Nonetheless, a two- to three-fold increase
(based on either the harm or endangerment standard, respectively) was found in reported
emotional neglect between the second and third National Incidence Studies in the US,
reflecting a growing awareness of these forms of maltreatment and their insidious impact on
 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695 681

the course of development (Jellen, McCarroll, & Thayer, 2001; Kaplan, Pelcovitz, &
Labruna, 1999).
This article highlights the manner in which the principal forms of child neglect exert their
influence on development. Child neglect most typically begins at an early age and has an
accumulating effect on subsequent developmental abilities and limitations. Therefore, the
following 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). 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. Although our
focus is on specific and unique effects of various forms of child neglect, we pay particular
attention to studies that allow comparisons of neglect and abuse that clarify their similarities
and differences. We caution that it is quite likely that some neglected children in these studies
would also have been abused, which cannot be unconfounded at this stage of research
development. Furthermore, because of space limitations, the current discussion is restricted
primarily to physical and emotional neglect; childrens exposure to family violence and other
forms of emotional maltreatment and abuse are therefore not reflected in the conclusions.

Infants and preschoolers

Cognitive and moral development

Observations of maltreated children participating in the Minnesota Mother-Child Project,

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, provide some of the
strongest evidence for the negative impact of neglect on early cognitive and academic
development. In this study, two groups of neglectful mothers were identified: neglectful
mothers and psychologically unavailable mothers. Whereas the mothers in the neglectful
group failed to provide adequate physical care or protection for their children, the mothers
in the psychologically unavailable group were characterized by emotional detachment and
unresponsiveness to their childrens bids for attention and care. The experience of the
children of these mothers would be consistent with what is typically considered emotional
neglect.
Compared to other maltreatment groups, 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, at
24 months the average DQ had dropped to 87) (Egeland & Sroufe, 1981). At 24 months of
age, children with a history of physical neglect were less enthusiastic, more frustrated, and
angrier in problem-solving tasks than nonmaltreated and other maltreated children. At 42
months, when confronted with an obstacle box where a toy was visible but inaccessible, the
neglected children showed poor impulse control and demonstrated less flexibility and
creativity in problem-solving than control and other maltreated children (Egeland, Sroufe, &
682 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695

Erickson, 1983). By kindergarten, physically neglected childrens performance on standard-

ized tests of intellectual functioning and academic achievement were the lowest of all the
maltreatment groups, including the emotionally neglected children (Erickson, Egeland, &
Pianta, 1989).
Other studies have also linked neglect with lags in early cognitive development. Gowen
(1993), for instance, found that the adequacy of received psychological care predicted young
childrens IQ scores and ability to engage in age-appropriate play. At ages 12, 18, 24, and
36 months, children who received inadequate psychological care scored lower on IQ
measures than those with adequate psychological care.
A history of neglect has also been shown to be predictive of problems in expressive and
receptive language among preschool children, and these problems were more severe than
those associated with physical abuse (Allen & Oliver, 1982; Culp et al., 1991; Gowen, 1993).
Interestingly, Allen and Oliver (1982) found that neglect occurring alone is more problematic
for language development than abuse and neglect together.

Moral development. In an early study of moral development, Smetana, Kelly, and Twenty-
man (1984) examined maltreated childrens judgments regarding different types of moral
transgressions. Abused, neglected, and control preschoolers were compared in their judg-
ments regarding the seriousness, deserved punishment, rule contingency (the permissibility
of actions in the absence of rules), and generalizability of hypothetical familiar moral and
social-conventional nursery school transgressions. Few differences were found between
maltreated and nonmaltreated childrens moral and social judgments. Both groups judged
moral transgressions relating to physical and psychological harm and unfair resource distri-
bution to be more serious, punishable, and wrong than social-conventional transgressions.
Differences were found, however, between the two groups of abused and neglected children.
Abused children considered transgressions entailing psychological distress to be more
universally wrong for others (but not for themselves), whereas neglected children considered
the unfair distribution of resources to be more universally wrong for themselves (but not for
others). Smetana et al. (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.
A recent study by Smetana et al. (1999) similarly found that physically abused, neglected,
and nonmaltreated children did not differ in their evaluations of moral transgressions, and
that they all judged them as very serious, punishable, and generally wrong. When they
examined childrens judgments of emotional responses to the transgressions, however,
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. They also reported that perpetrators would feel less sadness than did nonmaltreated
children.
Recent observational studies of maltreated youngsters have shed additional light on the
development and expression of moral development, as shown during mother-child compli-
ance tasks. Koenig, Cicchetti, and Rogosch (2000) observed maltreated and nonmaltreated
preschoolers interacting with their mothers during a clean-up session following a free-play
period, to observe their compliance to the less-desired tasks and spontaneous displays of
 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695 683

negative affect. Whereas physically abused preschoolers showed less moral internalization
(i.e., less of a shift from reliance on external controls to internal mechanisms) than nonmal-
treated children, neglected children did not differ from the nonmaltreated group. Koenig et
al. (2000) did find, however, 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). These findings are consistent with other research,
which has found that when interacting with their mothers, abused preschoolers engage in
compulsive compliance in which negative behaviors are suppressed and the child imme-
diately complies with maternal demands, and neglected children display, rather than inhibit,
expressions of anger (Crittenden & DiLalla, 1988). Taken together, this research suggests
that neglected children may have difficulties with emotion regulation in compliance situa-
tions, whereas physically abused children may be likely to comply out of fear.

Social, emotional, and behavioral development

Attachment. Similar to studies of abused children, neglected children are more likely to
have anxious (i.e., insecure) attachments to their caregivers than nonmaltreated children
(Crittenden & Ainsworth, 1989; Egeland & Sroufe, 1981). Children who experience early
emotional neglect seem to be particularly at risk for attachment problems; whereas 57% of
the emotionally neglected children participating in the Minnesota Mother-Child Project were
securely attached at 12 months of age, at 18 months of age the classifications of these
children had changed to anxious attachment (Egeland & Sroufe, 1981).
Many maltreated children lack an organized attachment strategy, which is referred to as
disorganized attachment (Carlson, Cicchetti, Barnett, & Braunwald, 1989; Hesse & Main,
2000; Lyons-Ruth, Connell, Grunebaum, & Botein, 1990). Attachment theorists have pro-
posed that for disorganized infants, 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, 2000).
When the attachment behavioral system is activated, these infants are caught in an irresolv-
able conflict (George, 1996). As a result of this irresolvable paradox, breakdowns in the
infants attachment strategy for enlisting caregiver protection occur and disorganized attach-
ment behaviors are expressed (Hesse & Main, 2000).
The likelihood that child neglect is significantly associated with disorganized attachment
is evident from a closer look at Carlson et al.s (1989) sample, of which 82% of maltreated
children were classified as disorganized. The sample was comprised of many neglect cases:
59% physical neglect, 27% emotional maltreatment (including emotional neglect), and 18%
combined abuse and neglect. Because neglect cases were well represented in this sample,
conclusions regarding disorganized attachment would correspondingly apply to this popu-
lation. Furthermore, in subsequent analyses with the same sample, the researchers deter-
mined that abused and neglected children could not be reliably distinguished on the basis of
attachment classifications, lending further support to the conclusion that neglected children
are equally as likely as abused children to show a disorganized attachment strategy (Barnett,
Ganiban, & Cicchetti, 1999).
Representations of self and others. Abused and neglected preschoolers often have nega-
tive mental representations (i.e., internal working models) of the self and others (Toth,
684 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695

Cicchetti, Macfie, & Emde, 1997; Toth, Cicchetti, Macfie, Maughan, & Vanmeenen, 2000;
Waldinger, Toth, & Gerber, 2001). The unresponsive, insensitive, or traumatizing care that
they have experienced often leaves them with models of themselves as unworthy of love and
others as unavailable or rejecting. For example, 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., 2001). Neglected children, in
particular, were also found to represent others as hurt, sad, or anxious more often than
physically abused, sexually abused, and nonmaltreated children.
Neglected children seem to have particularly restricted positive views of the self. Toth et
al. (1997) used narrative story stems to examine the maternal and self-representations of
maltreated preschoolers and found that, as expected, the narratives of maltreated children
contained more negative maternal representations and more negative self-representations
than the nonmaltreated children. They also found, however, that whereas the physically
abused children had high levels of negative self-representations, the neglected children had
low levels of positive self-representation. As Toth et al. (1997) remark:
. . . these two groups of maltreated children differ in the positive versus negative valence of
their self-views. The fact that the neglected children have the restricted positive self-
representations is consistent with the reality of these childrens lives, in which they most
likely receive minimal attention to their basis needs. In essence, the neglect that they
experience may impede their overall development of self. Conversely, physically abused
children, although confronted with parenting dysfunction, may experience periods during
which they are responded to, possibly even positively, by their physically abusive parents.
Thus, it may well be that physically abused children are more likely to develop some sense
of the self as positive, whereas neglected children have far fewer opportunities to do so (pp.
192193).
Social and behavioral problems. The early social development of neglected children is
also compromised in a manner suggestive of poor social adaptation, as characterized by
social withdrawal and few positive interactions with peers. Emotionally neglected infants
participation in feeding and play situations declines considerably between 3 and 6 months of
age (Egeland & Sroufe, 1981). In the preschool years, neglected children tend to be socially
withdrawn. For example, Crittenden (1992) brought neglected, abused, abused-and-ne-
glected, marginally maltreated, and nonmaltreated preschoolers into the laboratory to ob-
serve peer interactions. 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. In a related study involving preschool and daycare settings, neglected children
engaged in fewer social interactions with other children, were more avoidant in their
interactions, and were more socially isolated than abused and nonmaltreated children (Cam-
ras & Rappaport, 1993; Erickson et al., 1989; Hoffman-Plotkin & Twentyman, 1984).
Although neglected preschoolers tend to be more aggressive than nonmaltreated children
(Bousha & Twentyman, 1984; Erickson et al., 1989), they are less aggressive than their
physically abused counterparts (Crittenden, 1992; Haskett & Kistner, 1991; Hoffman-Plotkin
& Twentyman, 1984). Neglected preschoolers are also more uncooperative and noncompli-
ant than nonmaltreated children but, again, they are typically less so than physically abused
 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695 685

children (Bousha & Twentyman, 1984; Egeland et al., 1983; Erickson et al., 1989; Shields
& Cicchetti, 1998).
Emotional development. Compared to their nonmaltreated and abused counterparts, phys-
ically and emotionally neglected preschoolers often demonstrate notable problems in coping,
personality development, and emotion regulation. Neglected preschoolers are generally
confused by the emotional displays of others and are less able to discriminate emotions than
nonmaltreated and abused children (Pollack, Cicchetti, Hornung, & Reed, 2000). When they
find themselves in stressful situations, neglected preschoolers tend to be more hopeless than
physically abused children, who in turn tend to be more angry (Crittenden 1985; 1992).
In a problem-solving task at 24 months of age, 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, 1981). They also received the lowest ratings on
agency (i.e., confidence and assertiveness in dealing with the environment) at 42 months of
age (Egeland et al., 1983). In the preschool setting, the physically neglected children were
observed to be the most dependent and to demonstrate the lowest ego control (Egeland et al.,
1983). The neglected children also received the lowest ratings on self-esteem and were
observed to be the most unhappy group of children, displaying the most negative affect and
the least positive affect. They also did not demonstrate a sense of humor (Erickson et al.,
1989). The emotionally neglected children, in particular, were also very dependent and
negativistic (Egeland et al., 1983). The most striking feature about these children, however,
was the large number of pathological behaviors they exhibited (examples of behaviors
included in the pathology score included tics, tantrums, stealing, soiling accidents, frequent
physical complaints, self-punishing behaviors, clinginess, and so forth).
Neglected preschoolers may also show symptoms of dissociation. Macfie, Cicchetti, and
Toth (in press) studied dissociation in a sample of maltreated and nonmaltreated preschoolers
and found that physically abused, sexually abused, and neglected children each demonstrated
more dissociation than nonmaltreated children. Only physical abuse, however, was signifi-
cantly associated with clinical levels of dissociation. Other studies have failed to find an
association between neglect and dissociation, however (e.g., Macfie, Cicchetti, & Toth,
2001).

Summary

This review reaffirms and expands previous conclusions that child neglect has a pervasive,
negative impact on childrens early competence across major developmental dimensions.
Moreover, neglected infants and preschoolers are distinguishable from abused children in
several areas, including cognitive and language problems, and fewer positive social inter-
actions. They also appear to have particularly poor coping abilities, and present as dependent
and unhappy. Physically abused youngsters, in contrast, have more externalizing problems,
including increased noncompliance and aggression towards adults and other children.
Emotional neglect appears to be particularly detrimental in infancy. Over the course of
several months, emotionally neglected infants show major declines in performance on the
Bayley Scales of Infant Development, and their attachment problems worsen dramatically.
Such findings underscore the importance of emotional nurturance in the beginning stages of
686 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695

life on subsequent psychological development, comparable to the significance of food and

safety on physical development (Scarr, 1992). This conclusion is consistent with the failure
to thrive literature, wherein mothers of these infants dismiss the importance of relationships,
including the early attachment relationship and related emotional needs (Attie & Brooks-
Gunn, 1995; Benoit, Zeanah, & Barton, 1989).
Although counter-intuitive, 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. For example, neglect occurring alone is
associated with more severe language problems than neglect occurring alongside abuse. In
addition, Egeland and Sroufe (1981) observed that emotional neglect alone was associated with
worse consequences than when it was accompanied by physical abuse. Thus, researchers have
surmised that physical contact occurring in the form of abuse may be less harmful than no contact
at all (i.e., neglect) because such parents may be less emotionally detached and disinterested in
their infants and may be somewhat more likely to respond to their childrens important signals
than neglectful parents (Egeland & Sroufe, 1981; Toth at al., 1997).

School-aged children and younger adolescents

Cognitive development

Not surprisingly, the aforementioned problems in cognitive development continue un-

abated into middle and late childhood. Physically neglected children in Minnesota Mother-
Child Project demonstrated a significant decline in functioning during the early school years.
They had considerable difficulty coping with the demands of school, scored significantly
lower on tests of achievement, and by the second grade all of them had been referred for
special educational services (Egeland, 1991). They also tended to be inattentive and unin-
volved in learning (Erickson & Egeland, 1996). 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, 2, 3, and
6 (Erickson & Egeland, 1996).
Eckenrode, Laird, and Doris (1993) found that neglect, regardless of whether it occurred
by itself or in conjunction with other forms of maltreatment, was associated with the lowest
academic achievement levels. Similarly, Wodarski, Kurtz, Gaudin, and Howring (1990)
found that, although both physically abused and physically neglected children perform
poorly on measures of academic performance, the academic deficits of neglected children are
more severe than those of abused children. For example, both neglected and abused children
differed from comparison children on standardized tests in math, but neglected children also
performed significantly worse in language and reading.

Social, emotional, and behavioral adjustment

Representations of self and others. In middle childhood, maltreated children continue to have
negative mental representations of themselves and others (Lynch & Cicchetti, 1991; McCrone,
 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695 687

Egeland, Kalkoske, & Carlson, 1994; Stovall & Craig, 1990; Shields, Ryan, & Cicchetti, 2001).
The negative self and other representations of maltreated children, however, are not limited to the
caregiving relationship. McCrone et al. (1994) assessed maltreated childrens mental represen-
tations of relationships among school-aged children using a projective storytelling task. Com-
pared to the stories of the nonmaltreated children, the stories of the maltreated children suggested
that they had a much more negative view of the social world, one that was characterized by
negative interpersonal expectations and difficulty solving problems within relationships. More
specifically, the maltreated childrens stories tended to be preoccupied with negative relational
dynamics, to the exclusion of positive relational dynamics such as empathy, peer acceptance, and
problem-solving. No significant differences were found between the stories of neglected and
abused children, suggesting that the mental representations of neglected and abused school-aged
children are more similar than different.
Social and behavioral problems. As with their younger counterparts, neglected school-
aged children tend to have social difficulties and continue to be characterized as socially
withdrawn, differences that set them apart from both abused and nonmaltreated youngsters
(Erickson & Egeland, 1996; Erickson et al., 1989). They are predominantly avoidant in their
peer interactions (Kaufman & Cicchetti, 1989), are unpopular with peers (Erickson &
Egeland, 1996; Erickson et al., 1989), and have fewer reciprocated playmates than other
children (Bolger, Patterson, & Kupersmidt, 1998).
Although neglected children are also more likely to be aggressive, disruptive, and
noncooperative in comparison to nonmaltreated children, they are significantly less so than
their physically abused peers (Erickson & Egeland, 1996; Manly, Kim, Rogosch, & Cic-
chetti, 2001; Reidy, 1977). Not surprisingly, teachers and parents describe physically abused
children as being more difficult to manage, less socially mature, and less capable of
developing trust with others (Herrenkohl, Herrenkohl, Toedter, & Yanushefski, 1984; Ki-
nard, 1980; Salzinger, Kaplan, Pelcovitz, Samit, & Kreiger, 1984; Wolfe & Mosk, 1983).
These perceptions are consistent with behavioral observations that reveal that abused chil-
dren behave more aggressively during interactions with parents or siblings, including hitting,
yelling, and destructiveness (Bousha & Twentyman, 1984; Lahey, Conger, Atkeson, &
Treiber, 1984). Consistent across studies, therefore, abused children stand out in terms of
their behavior problems. Though neglected children also have elevated behavior problems,
they are more likely to present with a general lack of social skill and emotional problems (see
following discussion).
Emotional development. In contrast to the aggressive tendencies of abused children,
neglected school-aged children, like their younger counterparts, are more isolated and
withdrawn in their social interactions. In a recent investigation, Manly et al. (2001) inves-
tigated the outcomes associated with physical neglect, emotional neglect, physical abuse, and
sexual abuse. Whereas neglected, physically abused, and sexually abused children were all
rated higher in externalizing problems than nonmaltreated children, one of the most distinc-
tive features of the neglected group was the elevation in internalizing problems. In fact, 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. Severe neglect, particularly when it occurred during the preschool years, was
particularly detrimental on school-aged childrens emotional well-being. Furthermore, se-
688 K.L. Hildyard, D.A. 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, aggressiveness, ego control, and lower ego resil-
ience in middle childhood. This was true even when the severity of all other co-occurring
forms of maltreatment were considered, which led the researchers to conclude that this form
of early maltreatment represents extreme risk for later successful adaptation.
Findings from the Minnesota project similarly suggest that school-aged children with a
history of neglect exhibit emotional problems. Children were assessed in kindergarten, and
follow-up assessments were done throughout the elementary school years. The physically
neglected children were found to display the most varied and most severe socioemotional
problems, and many of these problems tended to be of an internalizing nature (Erickson et
al., 1989). The emotionally neglected group of children also received low teacher rankings
on overall emotional health, and at all grades they were rated as exhibiting more internalizing
type problems than nonmaltreated children (Erickson & Egeland, 1996). Whereas the above
studies report significant internalizing problems among neglected children, often more so
than abused children, it should be noted that others have not found such differences on
socio-emotional development (Wodarski et al., 1990), depression (Toth, Manly, & Cicchetti,
1992), or suicidality (Finzi et al., 2001).

Summary

The picture that emerges of the school-aged neglected child is quite similar to the picture
of the neglected preschooler. Again, we see that neglect is associated with severe cognitive
problems, problems that are often worse than those associated with abuse. The theme of
social withdrawal also persists. 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. Finally, as with the younger
group, neglected children seem to exhibit fewer externalizing problems than physically
abused children, although peers and adults see them as being disruptive and uncooperative.
Manly et al.s (2001) findings provide additional support for the idea that neglect
occurring early in life is particularly detrimental on childrens development. Presumably, this
is because of the fact that subsequent developmental tasks build on previous milestones and
competencies. Because neglected children fail to achieve important milestones, they continue
to be challenged by normal developmental tasks.

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. Much of the research relies on the
longitudinal investigation of Cathy Widom and her colleagues, who are following a large
sample of maltreated children into adulthood. In addition, 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, Brown, & Smailes, 2001). Although findings to date make it
 K.L. Hildyard, D.A. 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, research points to neglect being associated with significant negative
outcomes in late adolescence and adulthood, commensurate with the developmental impact
noted in early and middle childhood.
Both abuse and neglect appear to have long-term effects on cognitive abilities. In a large
follow-up study, 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, 1994).
A history of abuse or neglect in childhood is also associated with an increased likelihood
of running away from home (Kaufman & Widom, 1999). A US nationwide study of 587
runaway and homeless adolescents revealed that just under half had experienced physical
abuse in the home, and about half could be classified as thrownaways (Greene, Ringwalt,
& Kelly, 1995). Similarly, Widoms group found that sexual abuse and neglect were both
significant predictors of prostitution for females, whereas physical abuse was only margin-
ally associated with prostitution (Widom & Kuhns, 1996). In this latter study, abuse and
neglect were not associated with increased risk for promiscuity or teenage parenthood;
however, a related study did find that preschool and school-aged physical abuse, occurring
alone or in combination with neglect, was associated with teenage parenthood (Herrenkohl,
Herrenkohl, Egolf, & Russo, 1998).
Persons with histories of neglect are also at-risk for delinquency, adult criminal behavior,
and violent criminal behavior (Maxfield & Widom, 1996; Rivera & Widom, 1990; Widom,
2001). 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. 21% for physical
abuse) (Maxfield & Widom, 1996).
In an investigation of the relationship between childhood maltreatment and risk for
personality disorders in early 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, Cohen, Brown, Smailes, & Bernstein, 1999). In a related
study, childhood emotional, physical, and supervision neglect were also associated with
increased risk of personality disorders and with elevated symptoms of anxiety and depres-
sion, especially during early adolescence, even after childhood physical or sexual abuse were
controlled statistically (Johnson, Smailes, Cohen, Brown, & Bernstein, 2000). By adulthood,
however, these problems were in remission among the adults with known neglect back-
grounds, whereas those with physical abuse backgrounds showed increasing antisocial and
problem behaviors (Cohen et al., 2001). Horowitz, Widom, McLaughlin, and White (2001)
also investigated the relationship between childhood maltreatment and adult mental health.
Although they found relationships among childhood abuse and neglect and adulthood
dysthymia, antisocial personality disorder, and alcohol problems, childhood maltreatment
was found to have little direct impact on mental health once the presence of stressful life
events was controlled. Finally, both neglect and physical abuse have been linked with
dissociation in adulthood (Ogawa, Sroufe, Weinfield, Carlson, & Egeland, 1997).

Summary. Child physical abuse and neglect both continue to be associated with significant
negative outcomes into late adolescence and adulthood, with few differences in outcomes
690 K.L. Hildyard, D.A. 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., 2001). However, conclusions regarding the carry-over
of themes that characterized younger neglected individuals (i.e., cognitive deficits, social
withdrawal, internalizing problems) cannot be drawn on the basis of limited knowledge. In
general, both forms of maltreatment are associated with subsequent criminal behavior,
personality disorders, substance abuse, and stressful life events. More research examining the
long-term consequences of neglect is clearly needed.

Conclusions

Child abuse and neglect have considerable psychological importance because they occur
within ongoing relationships that are expected to be protective, supportive, and nurturing
(American Psychological Association, 1996). Children from abusive and neglectful families
grow up in environments that fail to provide consistent and appropriate opportunities that
guide development; instead, they are placed in jeopardy of physical and emotional harm
(Wolfe & Jaffe, 1991). In this regard, the current review offers further support for the
long-standing conclusion that child neglect poses a significant challenge to childrens
development and well-being. Notably, neglect is associated with effects that are, in many
areas, unique from physical abuse, especially throughout childhood and early adolescence. In
particular, neglected children are distinguishable from their physically abused counterparts in
terms of more severe cognitive and academic deficits, social withdrawal and limited peer
acceptance, and internalizing (as opposed to externalizing) problems.
It is important to acknowledge the limitations in this state of knowledge. Additional
studies taking a prospective approach and studies investigating the long-term effects are
needed. Furthermore, researchers need to take into account important developmental con-
texts and processes, such as the developmental period in which maltreatment begins (i.e.,
timing) and the severity and chronicity of the events themselves. Manly et al.s (2001) study
serves as a good example in this regard. They found that severe neglect occurring in the early
childhood years is particularly detrimental to successful adaptation. Other recent research has
suggested that chronicity, rather than type and/or severity, of maltreatment best predicts
negative outcomes (Bolger & Patterson, 2001; Bolger, Patterson, & Kupersmidt, 1998).
Given that neglect tends to be more chronic than all other forms of maltreatment, we might
expect that children who experience neglect will be at particular risk for maladaptive
outcomes.
Finally, there has been little attention paid to how boys and girls may differ in their
response and adaptation to abuse and neglect experiences. In a study of the relationship
between different forms of child maltreatment and subsequent adolescent adjustment, Wolfe
and McGee (1994) found important interactions between the childs sex and the timing and
nature of maltreatment experiences. For boys, adolescent adjustment was accounted for in
large part by the interaction of physical and psychological abuse, as well as the interaction
of neglect and witnessing spouse assault, during early childhood. For girls, adolescent
adjustment was significantly related to the developmental period in which maltreatment had
occurred. That is, if experiences of neglect or psychological abuse increased during mid-
 K.L. Hildyard, D.A. Wolfe / Child Abuse & Neglect 26 (2002) 679 695 691

childhood relative to early childhood, adjustment problems during adolescence were ele-
vated.
A prime factor in how children respond to various forms of stress, including chronic
neglect, is the degree of support and assistance they receive from their caregivers to help
them cope and adapt. Caregivers provide a model for the child that teaches him or her how
to exert some control even in the midst of confusion and upheaval. Maltreated children may
have the hardest time adapting appropriately to any form of stress to the extent that they are
deprived of positive adult relationships, effective models of problem solving, and a sense of
personal control or predictability (Luthar, Cicchetti, & Becker, 2000).
With the growing awareness of the harmful, enduring effects of child neglect comes the
urgent responsibility to develop effective treatment and prevention programs. Sadly, this
responsibility remains a low priority, with very few new resources or initiatives planned to
address a long-recognized threat to child, family, and public health and well-being. To
diminish the invisible grip child neglect has on the lives of a significant number of children
requires both political will and concerted effort. Significantly, progress has been made in
other complex public health issues facing children and adolescents [for example, domestic
violence (Wolfe & Jaffe, 2001); substance abuse and peer violence in schools (Cunningham
& Henggeler, 2001; Farrell, Meyer, Kung, & Sullivan, 2001); personal safety and injury
prevention (Tremblay & Peterson, 1999)]. Without delay, ideas and findings from these and
many other initiatives should be brought to bear on the pervasive problem of child neglect.

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Resume

Cet article souligne la facon dont la negligence des enfants, laquelle est plus commune que les autres
types de maltraitance, affecte le developpement de lenfant. Des constats anterieurs et recents
confirment que la negligence peut causer des effets graves et nefastes, a court et a long terme, au
niveau du developpement cognitif, socio-affectif et du comportement. Comme le demontrent les
theories sur lattachement ainsi que dautres theories connexes, cest la negligence vecue en tres bas
age qui risque le plus de defavoriser le developpement de lenfant. Par ailleurs, les effets de la
negligence sont souvent distincts de ceux des mauvais traitements physiques, surtout durant la pleine
duree de lenfance et le debut de ladolescence. Compares aux enfants victimes de mauvais traitements
physiques, les enfants negliges connaissent des deficits cognitifs et scolaires plus graves, ils sont plus
antisociaux et leurs contacts avec leurs paires plus limites; enfin, ils refoulent leurs difficultes
davantage. Larticle discute de la carence des donnees dans ce domaine et propose de nouvelles pistes
de recherches.

Resumen

Este artculo destaca la manera en que la negligencia hacia los ninos, la mas comun de las formas de
maltrato, afecta el desarrollo infantil. Hallazgos pasados as como los muy recientes, confirman la
conclusion de que la negligencia contra los ninos puede tener efectos severos a corto y largo plazo
sobre el desarrollo cognitivo, socio-emocional y conductual infantil. De acuerdo con las teoras del
apego y otras relacionadas, la negligencia que ocurre temprano en la vida es particularmente danina
para el desarrollo posterior. Ademas, la negligencia esta asociada con efectos que son, en muchas
areas, unicos del abuso fsico, especialmente durante la infancia y la adolescencia temprana. En
relacion a los ninos abusados fsicamente, los ninos que sufren de negligencia tienen deficiencias
cognitivas y academicas mas severas, aislamiento social e interacciones limitadas con sus pares, e
internalizacion (opuesto a la externalizacion) de sus problemas. Se discuten y se ofrecen sugerencias
sobre las limitaciones relacionadas con el nivel de sus conocimientos.