Nicole A. Sciarrino

Neglect and Attachment Insecurity

The parent-infant relationship serves as a blueprint for future relationships with others and the world. From this relationship, the infant learns whether he can depend on others to meet his needs, whether he can communicate with others effectively, and whether it is safe to explore his world. Attachment theory postulates that the parent-infant relationship provides the infant with the first opportunity to form a secure attachment to another human being, ideally characterized by warmth, trust, synchronicity, and reciprocity (Bowlby, 1969). However, in cases of childhood neglect, the parent or caregiver has not provided the scaffolding necessary for establishing a secure attachment. Consequently, neglect has been linked to increased psychological problems (e.g., depression and anxiety) and attachment insecurity in children and adolescents (Claussen & Crittenden, 1991; Gauthier, Stollak, Messe, & Aronoff, 1996; Hobbs & Wynne, 2002; Shipman, Edwards, Brown, Swisher, & Jennings, 2005). This chapter will include a brief discussion of attachment theory, attachment insecurity, and the impact of neglect on attachment. Additionally, implications for romantic relationships for individuals reared in a neglectful family of origin will be discussed.

Unveiling Covert Abuse

Neglect has been found to adversely influence neurological development, attachment formation, and both child and adult psychopathology. Due to the covert nature of neglect, detection of neglectful parenting may be difficult to determine by both uninformed and informed providers; this may be exceptionally challenging when faced with subtypes of neglect where physical harm is less apparent. Difficulties in establishing a clear definition of neglect have implications for both the research and legal contexts (i.e., incidents of neglect resulting in a referral to child protective services agencies). As a result, it is important to be abreast of associated contextual risk factors, including parental substance abuse or mental health stressors, low SES, and young maternal age, among others. Similarly, problem child behaviors, deficient physical development (i.e., associated with malnutrition), impaired intellectual functioning, and limited peer support may serve as red flags that the child is being reared in an impoverished or neglectful family environment. Consequently, primary care physicians are in a unique evaluative position of monitoring a child’s health and development, and may be able to provide resources to families where neglect is suspected. Teachers may also have the ability to recognize when a child is exhibiting “symptoms” of neglect, such as an inability to grasp grade-appropriate information, coupled with behavioral difficulties, malnourishment, or inappropriate or dirty clothing.

The Sequelae of Neglect

In childhood, abused and neglected individuals can develop seemingly functional coping strategies and behaviors; however, certain internalizing and externalizing behaviors can become increasingly maladaptive at subsequent developmental stages, contributing to the development of further difficulties (Widom, 2000). Although the impact of neglect is not as well understood as that of abuse, research examining individuals reporting perceived childhood neglect, as well as survivors of co-occurring childhood maltreatment and neglect, has revealed various functional difficulties beginning in childhood and persisting into adulthood (e.g., De Bellis, 2005; Gauthier, Stollak, Messe, & Aronoff, 1996; Glaser, 2000; Grassi-Oliveira & Stein, 2008; Kessler et al., 2010; Spertus, Yehuda, Wong, Halligan, & Seremetis, 2003; Sperry & Widom, 2013; Widom, 2000). These problems include cognitive impairments and lower intellectual functioning (De Bellis, Hooper, Spratt, & Woolley, 2009; Joseph, 1999; Strathearn, Gray, O’Callaghan, & Wood, 2001; Widom, 2000), psychopathology (Gauthier et al., 1996; Kessler et al., 2010; Powers, Ressler, & Bradley, 2009; Spertus et al., 2003; Widom, 2000), lower levels of interpersonal skills and support (Kim & Cicchetti, 2010; Sperry & Widom, 2013), impairments in emotion identification and regulation (De Bellis, 2005; Kim & Cicchetti, 2010; Pechtel & Pizzagalli, 2011), and physical health concerns (Moxley, Squires, & Lindstrom, 2012; Stirling & Amaya-Jackson, 2008; Walker et al., 1999), among others. Both direct and indirect pathways have been proposed to account for problems in adjustment in adulthood, which may stem from early childhood neglect. Most explanatory models consider not just the role of the abusive or neglectful acts themselves, but also take into account the influence of the family of origin (Gold, 2000; Widom, 2000), which may be due to the impact of the child’s perception of parenting behaviors—or lack thereof.

The Effects of Childhood Neglect on Neurological Development

Brain maturation occurs continuously from birth into young adulthood (Carlson, 2013; De Bellis, 2005) with continued modifications throughout life associated with exposure to sensory stimulation and experience (Carlson, 2013; Perry, 2002; Joseph, 1999). However, the early childhood environment plays an integral role in the neurodevelopmental process (Perry, 2002), such that a lack of sensory stimulation and experience (e.g., physical and cognitive neglect) can contribute to adverse neurological functioning. Consequently, altered neurological development associated with an impoverished childhood environment can present in childhood and remain into adulthood (De Bellis, 2005; Glaser, 2000; Joseph, 1999; Perry, 2002).

Assessment, Prevention, and Treatment

As previously established, childhood neglect often co-occurs with other child maltreatment, thus making it difficult to identify or assess. Moreover, the lack of agreement about what constitutes minimally acceptable standards of childcare, coupled with uncertainty as to the point at which subpar parenting has adverse consequences to child development, contributes to difficulty in assessing for neglectful parenting behavior (Howard & Brooks-Gunn, 2009; McDaniel & Dillenburger, 2007). That is, certain parenting behaviors may not legally be defined as neglect (e.g., leaving a child of a certain age at home without supervision), yet can have damaging effects on the child. Perhaps due, in part, to difficulties in the recognition of childhood neglect, efforts to improve surveillance of subthreshold parenting have been most frequently discussed in the literature by way of primary prevention (e.g., Evans, Garner, & Honig, 2014), such that established programs (e.g., home-visiting programs) aim to provide support to at-risk families prior to any indication of neglect or abuse to the child. It is also important to consider that different subtypes of neglect may require different types of prevention and treatment efforts (Straus & Kantor, 2005).

Clinical Case Examples

As is evident from the previous chapters, childhood neglect is an insidious form of childhood maltreatment that can go undetected by both the untrained and trained eye, and can have negative implications across cognitive, emotional, interpersonal, and occupational domains. As a result, this chapter serves to illustrate the conceptualization and approach to treatment of several adult survivors of childhood neglect and co-occurring abuse.