course, it could well be that chronic poverty plays a part in many instances of physical child neglect, possibly by reducing morale, or by increasing a sense of general hopelessness and passivity (see also Chapter Two). It is also clear that there are stressors which could be related to neglect both directly and indirectly such as alcohol and drug abuse, and that some forms of mental illness might cause neglect directly, or cause it indirectly by dragging families into poverty.
unintentional or arises out of indifference. We could say that physical neglect is distinguished from emotional neglect by the presence of clear physical signs, such as untreated medical conditions, lack of adequate clothing, food or shelter, and failure to supervise young children properly.
However, it would be unhelpful to think of neglect as consisting of two sharply distinct types: physical and emotional. At the heart of both types is the serious failure to meet children’s basic needs, physical and/or emotional. Box 4.1 describes a study whose findings suggest that where there is physical neglect there is also likely to be emotional neglect, and that if children are to have their needs attended to, their emotional and cognitive needs must also be recognized, and addressed. On the other hand, it is my experience that CAMHS (Child and Adolescent Mental Health Services) Teams rarely see cases of routine physical neglect, but not infrequently see cases where severe emo-tional neglect and abuse are crucial. It follows that the relationship between physical and emotional neglect appears to be asymmetrical. Physical neglect often includes emotional neglect, but the reverse seems often not to be the case.
On the whole it would seem that parents who fall seriously short of meeting children’s physical needs also fall short of meeting their emotional needs, but (as we have already seen) many parents and carers fall seriously short of meeting children’s emotional needs, but do manage to meet their physical needs. To talk of physical neglect is usually shorthand for talking of both physical and emotional neglect. In fact it could be said that the physical neglect of children is a very cognitive and emotional matter, and children who experi-ence it are almost always impoverished both cognitively and emotionally.
Box 4.1 Correlations between physical and emotional neglect
Minty and Pattinson (1994) found, in one NSPCC team in the North of England, correlations between indices of traditional (physical) child neglect and what could be called emotional neglect. Physical neglect was measured by social workers rating the absence of adequate:
· food and nutrition
· health and hygiene
· warmth and clothing
· safety.
Emotional neglect was established by ratings regarding:
· the absence of a responsiveness to children’s emotional needs
· a lack of any guidance over television watching
Emotional neglect and abuse can also be distinguished from physical and sexual abuse, in that the former are rarely single events or even a series of events.
Emotional neglect is similar to emotional abuse in that they both constitute the air some children have to breathe, and the climate they have to live in, rather than isolated events or a series of events. Emotional child neglect and abuse often appear to constitute a persistent ‘background’ which does not become noticeable until a striking event in the foreground alerts us to their importance.
This event may be physical or sexual abuse, or a particularly gross expression of emotional abuse. Examples of this happening are shown in the case example in Box 4.2. In terms of the child’s welfare, attending to the ‘background’ may be more important and more challenging than attending to the abusive incident.
· a marked incapacity to control even young children
· frequent marital rows in front of the children
· suicidal gestures or threats in front of the children.
Ratings were made by child protection workers on a four-point scale. On Spearman’s rho tests (a test of correlation through ranking), we found correlations between the aggregate score for ‘emotional’ neglect and aggregate scores for aspects of ‘physical’ neglect that ranged from 0.68 for food and nurture to 0.84 for safety; with warmth/clothing scoring 0.68, and health/hygiene 0.7 (n = 41). It is not clear to what extent the sample studied was typical of clients referred to community NSPCC teams, but there was no reason to assume that it was very different from the families referred to other NSPCC community teams.
Box 4.2 Case example: John
John (eight years of age) was the younger son of a working-class couple, and was referred by education social workers for chronic school non-attendance. At first sight this seemed to be a fairly typical case of school refusal, with John and his mother over-anxiously attached to one another, until John alleged his father had tried to strangle him. A case conference was called, but the claim could not be substantiated. However, further investigation revealed that the parents had a chronically unhappy marriage, and that the older son and the father were involved almost daily in physical fights. In addition, his teacher had stated at the case
confer-Definition of Emotional Abuse
It has now become widely accepted that there is a need for a specific category of emotional abuse, separate from physical or sexual abuse and neglect, for children who have been the victims of rejection, humiliation, isolation, ignoring, tormenting, terrorizing, corruption, constant criticism and marked discrimination in comparison with siblings (the Cinderella syndrome). The cat-egories were recognized by Hart and Brossard (1991) and Garbarino and col-leagues (Garbarino, Gutteman and Seeley 1986), and have received further attention from Bifulco et al. (1994), who propose that the term ‘psychological abuse’ be reserved to refer to sadistic abuse, leaving the rest of emotional abuse to be covered by the term ‘parental antipathy’. The term ‘parental indifference’
is used by Bifulco and colleagues to refer to the absence of warmth, and the lack of comforting or support, described in this chapter as aspects of emotional neglect. Some of these distinctions are (rather crudely) set out in Table 4.1.
Table 4.1 Distinctions between different forms of abuse and neglect
Maltreatment Acts of
commission Intentionality Harm to child Physical signs
NAI yes yes yes yes
Emotional
abuse yes yes yes no
Physical
neglect no no yes yes
Emotional
neglect no no yes no
ence that John regularly came to school with his bottom plastered with layers of faeces and paper, and his trouser turn-ups full of fragments of faeces. It also emerged that his mother refused to let him have birthday parties, and had prevented him from having contact with other children in the area. Social services applied for care proceedings, and a Care Order was eventually granted – the judge being impressed by the level of emo-tional, as well as of physical, neglect. He also criticized social and educa-tional services for delay in bringing the case to court.
There are analogies between the way in which the terms ‘emotional abuse’ and
‘emotional neglect’ are used. Just as with physical neglect, so also with physical abuse, it is impossible not to acknowledge that virtually all physical (and sexual) abuse involves emotional distress and cognitive effects. As with emo-tional neglect, emoemo-tional abuse can also be used as a residual category for all types of abuse that are not physical or sexual. Practitioners have, on the whole, refused to make official such terms as ‘cognitive abuse’ or ‘psychological abuse’, preferring the one residual category: ‘emotional abuse’. This does not prevent researchers subdividing existing categories in order to try to discover the consequences for children suffering very specific forms of abuse. As already indicated, Bifulco and colleagues (Bifulco et al. 2002) reserve the category ‘psy-chological abuse’ for particularly sadistic and malevolent forms of abuse, such as are perpetrated by sociopathic parents, and use the milder term ‘parental antipathy’ for expressions (verbal or practical) of parental dislike (which are none the less extremely hurtful), or constant criticism. Whether or not area child protection committees and child protection workers make official use of the idea of ‘sadistic’ abuse (in addition to the currently used category of psycho-logical or emotional abuse), it is important that they recognize sadistic abuse and are very wary of failing to protect children from it when it exists. The case in Box 4.3 shows parental behaviour verging on the sadistic.
Forms of emotional neglect
Examples of specifically emotional neglect could include failure to show any warmth or stimulation to children, or appreciation of their efforts and achieve-ments. Neglectful parents rarely attend school open days, show their children positive attention, play with them or take them on outings. In extreme forms
Box 4.3 Case example: Peter
Peter is aged 10. Peter’s father had been imprisoned for causing severe bodily harm to his mother. He also had other convictions for violence.
His relationship with his son varied. At times he was generous, and at other times downright selfish; for example, on one occasion, finding himself short of cash, he sold Peter’s bicycle. The night before he was dis-charged from prison, he phoned Peter, and told him to let his mother know he was to be discharged the following day, and that his first priority would be to come and ‘sort his mother out’.
This is a case of emotional abuse, with the abuse verging on the sadistic.
neglect could involve completely ignoring a child, or hardly acknowledging he or she existed. It could include failure to send children to school at all, or to take them to a doctor when they are sick. At a hardly less significant level, neglectful parents offer little comfort or reassurance when a child is ill or upset.
Such failures to respond to children’s emotional needs often seem to indicate a marked lack of empathy, or an inability or unwillingness to act on it, rather than a deliberate intent to make the child suffer, even though they can involve gross indifference to a child’s welfare or feelings.