Just call it abuse

In child care literature, writers, researchers and social services departments increasingly rely on all-embracing definitions of child abuse, such as child maltreatment, psychological maltreatment and neglect. This may be convenient, but it can also be dangerously flawed. By examining the definition of neglect we can see how.

Researchers have long recognised neglect as one of the most common forms of child abuse. Yet the term neglect has the same deficiency as “child maltreatment” because we need to know what type of neglect or maltreatment for either term to have any meaning. It is too often taken for granted that we all know what neglect is, so it is often added to other terms such as “child abuse and neglect” or “emotional abuse and neglect” without explanation. You could therefore deduce that, whatever neglect is, it is something uniquely different from child abuse, emotional abuse or psychological maltreatment. It is as though neglect has specific features that do not even have to be explained.

The Department of Health defines neglect as: “The persistent failure to meet a child’s basic physical and/or psychological needs likely to result in the serious impairment of the child’s health or development. It may involve a parent or carer failing to provide adequate food, shelter and clothing, failing to protect a child from physical harm or danger or the failure to ensure access to medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.”

This is truly a catch-all definition. It includes neglect of physical, emotional and psychological needs. Writers on child care try to grasp the concept of neglect by differentiating between its many forms such as prenatal or perinatal neglect, physical neglect, emotional neglect, psychological neglect, educational neglect and deprivation. Others may be concerned with the behaviour that constitutes neglect, its causes and, most importantly, its effects.

The increasing use of an ever-expanding, all-embracing definition of neglect coincides with substantial increases in neglect cases. In England, the number increased from 11,200 in 1996 to 12,400 in 2001. By 2003, of 26,000 child abuse registrations, the number of neglect cases had risen to 39 per cent.(1)

In Scotland, between 2000 and 2003, the percentage of registered physical neglect cases increased by 70 per cent, by far the largest increase of all child abuse categories.(2) In Wales, figures released for the year ending March 2003 showed that “risk of neglect” registrations made up 49 per cent of the total.(3) In Northern Ireland, 53 per cent were registered for neglect and other abuses in 2003.(4)

Surely social services have not suddenly become inundated with neglect referrals? Could it be that many of these neglect registrations might have been designated as something else several years ago? “Grave concern” was the convenient, catch-all category used before the Children Act 1989. The term was the dustbin of child abuse registration, a fact acknowledged by the Department of Health, which abolished it. There are several possible explanations why neglect has replaced grave concern.

First, participants in child abuse case conferences may be using the neglect category inaccurately. This has implications for practice, the collation of statistics in social services departments and the quality of service to children and their families. Given the apparent increase in neglect cases, child protection agencies are certain to be caught out at some point, for example, in a review or in a public inquiry, for having failed to recognise both the nature and extent of more specific and damaging forms of abuse that a child may be enduring beneath the blanket cover of neglect.

Jan Horwath’s research on agency responses to neglect cases provides evidence to support this.(5) She reveals that workers did not consider the impact of neglect on the child; that they did not regard neglect as seriously as they did physical or sexual abuse; that they often failed to see or communicate with the child. Above all, she believes, workers were interested in “snapshot” incidents of possible neglect, rather than attempting to “provide a video over time of the life of the child” which is, or should be, the core aim of assessment.

Second, the increase in neglect cases may stem from the all-embracing definitions of the concept. The DH definition (like many others) is inadequate, lacking rigour and sense. Confusingly, it includes specific forms of child abuse that are already defined and categorised, for example, physical abuse. A common opening sentence in all definitions of neglect speaks of a parent or carer failing to provide adequate food, shelter, clothing and hygiene. If a mother repeatedly neglects changing her baby’s nappy, resulting in the baby’s skin around the genitalia becoming infected, and the baby persistently cries in pain and distress, isn’t that physical abuse? More pertinently, is it not more honest to the parent to call it physical abuse rather than neglect?

However we answer the questions, such abuse tells us something of critical importance about the relationship between child and carer. The relationship between a child enduring hunger, cold, pain, infections and danger, and the supposed carer, is not just a physically abusive relationship but also an emotional and psychologically abusive relationship. You cannot deprive a child of food, clothing, safety and comfort and have a satisfactory, healthy emotional and psychological relationship with that child.

Every definition of neglect that I have encountered is describing physical abuse, emotional abuse and psychological abuse rather than defining neglect.

Third, neglect is a preferred designation on the front line. Social workers are famously reluctant to confront carers with their belief that a child is being abused. They are even more reluctant to consider child abuse. Neglect is less harsh, less accusatory and encompasses an array of abuses that the worker may not wish to specify. Neglect can be applied to any abuse within any sphere of the child’s life, such as, physical, emotional, psychological, social, sexual, educational and cultural. Children may be subjected to multiple abuses within all these spheres; how much less challenging then, to avoid exploring each abuse, and packaging them away in the deeper recesses of neglect.

Neglect also raises the issue of poverty and inadequacy, parents in need rather than abusing parents. Parents themselves are less likely to be provoked by the allegation of neglect than that they are physically, emotionally and psychologically abusing their child.

It is important to avoid labelling parents but, if they are repeatedly not responding emotionally or responding inappropriately, they are emotionally abusing. They have a right to know the damage they are inflicting on their child, and telling them only that they are neglecting denies them that right. The implications for the child and for the working relationship with parents are much more serious.

The popularity of all these broad terms – neglect, psychological maltreatment, child maltreatment – may stem from the same motivation: to avoid using the term abuse; to avoid having to specify and explain whichever abuse is being perpetrated; and to avoid having to cope with the reactions of carers. Child protection has seriously regressed, not just in the increased reluctance to use the term abuse, but in the quality of definitions formulated, intentionally or unwittingly, for the convenience of avoiding its use. There may well be a correlation between that degree of reluctance, and the lack of clarity and rigour in many of the definitions. 

Kieran O’Hagan was a front-line child protection worker for more than 20 years. He became a reader in social work at Queen’s University, Belfast, in 1991 and took early retirement in 2000. He has written eight books, most of them on child protection.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

Abstract
This article highlights dramatic increases in the use of neglect as a category in child abuse registrations. It suggests that the reasons for the increase stem from a lack of clarity in the definition of neglect and a convenient avoidance of the reality of specific types of abuse being perpetrated against children. This regrettable trend poses risks to children and workers alike. 

References
(1) Department for Education and Skills, Referrals, Assessments, and Children and Young People on Child Protection Registers, 2005
(2) Scottish executive: Statistics Online, Children’s Social Work Statistics 2002-3, 2004
(3) Local Government Data Unit, Wales, Children and Young Persons on the Child Protection Register, 2005. www.lgdu-wales.gov.uk
(4) Department of Health and Social Services, N Ireland, Children Order Statistics 1 April 2002-31 March 2003
(5) J Horwath, “Identifying and assessing cases of child neglect: learning from the Irish experience”, Child and Family Social Work, 10(2) 99-110, 2005

Contact the author
coh50@tiscali.co.uk