Child Maltreatment

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Toward a Definition of Neglect in Young Children

Diana J. English, Richard Thompson, J. Christopher Graham and Ernestine C. Briggs
Child Maltreat 2005; 10; 190
DOI: 10.1177/1077559505275178

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CHILD MALTREATMENT
10.1177/1077559505275178
English et al. / DEFINITION
/ MAY
OF NEGLECT
2005 IN YOUNG CHILDREN
Toward a Definition of Neglect in Young Children
Diana J. English
Washington State Department of Social and Health Services
Richard Thompson
Juvenile Protective Association
J. Christopher Graham
Washington State Department of Social and Health Services
Ernestine C. Briggs
Duke University
This study examined the relationship between child experi-
ences identified conceptually as “neglectful” prior to age 4
and child outcomes at age 4. This was done using measures
from two sites collected as part of LONGSCAN. Child needs
were included within categories of physical and psychological
safety and security. Problems with residence safety or cleanli-
ness and untreated behavioral problems predicted child im-
pairments in language. CPS reports of failure to provide
shelter predicted impairments in several developmental out-
comes. A stimulating home environment predicted less im-
pairment in cognitive development. Multiple changes in
residence predicted externalizing behavior problems. Expo-
sure to verbally aggressive discipline predicted more behav-
ioral problems overall. Conversely, some indicators (such as
caregiver transitions and lack of medical care) predicted less
developmental impairment or fewer behavior problems in cer-
tain domains. The approach supports a conceptualization of
neglect based on child developmental needs. Implications for
practice and future research are discussed.
Keywords: definitions; child neglect; safety and security;
behavior and emotion; development
Recent national statistics indicate that neglect is the
type of maltreatment that is most frequently reported
to Child Protective Services (CPS), the most fre-
quently substantiated, and the type of maltreatment
CHILD MALTREATMENT, Vol. 10, No. 2, May 2005 190-206
DOI: 10.1177/1077559505275178
© 2005 Sage Publications
190
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most frequently associated with child placement
(Hildyard & Wolfe, 2002; National Child Abuse and
Neglect Data System [NCANDS], as cited in U.S. De-
partment of Health and Human Services, 2003). Fur-
thermore, neglect referrals to CPS have continually
increased during the past decade.
This nationwide increase in CPS neglect referrals
has continued despite a 3 decade-old controversy
about whether neglect should be included in a
national definition of maltreatment and controversy
regarding the criteria to be used to define neglect.
Neglect as a form of maltreatment was originally con-
ceptualized as omissions on the part of a parent that
led to lack of adequate care for a child (see Rose &
Meezan, 1995, for review). However, this definition
was considered problematic because it did not
address the issue of parental intent and because of a
lack of empirical standards regarding conditions nec-
essary for optimal child growth and development. In
terms of legally sanctioned definitions of neglect,
advocates for a narrow definition of neglect argued
that neglect should be defined by parental behaviors
Authors’ Note: This research was supported by grants to the Con-
sortium of Longitudinal Studies of Child Abuse and Neglect
(LONGSCAN) from the Children’s Bureau, Office on Child Abuse
and Neglect, Administration for Children, Youth and Families and
the National Institutes of Health, Institute for Child Health and De-
velopment and by grants from the National Institutes of Health.
Address correspondence to Dr. English at The Washington State
Department of Social and Health Services, Office of Children’s Ad-
ministration Research, 4045 Delridge Way SW, Suite 400, Seattle,
WA 98106; e-mail: endi300@dshs.wa.gov.
 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
that result in imminent risk and/or observable harm
(Besharov, 1985; Mnookin, 1978; Wald, 1975). Oth-
ers argued that neglect should be defined by child
experiences of unmet needs, not by parental behavior
(see Dubowitz, Black, Starr, & Zuravin, 1993). Advo-
cates for a narrow definition have generally prevailed.
Most state statutes related to neglect include language
that requires observable harm/injury or imminent
risk of harm as the basis for state intervention (Rose &
Meezan, 1995).
To date, the majority of research on neglect has
relied on CPS designation of a “case” as neglect,
despite concerns regarding the inadequacy of official
classification of neglect in CPS systems. Although
there is some consensus on the different “subtypes” of
neglect (failure to provide basic needs, abandon-
ment, failure to provide medical care, and failure to
provide for the emotional well-being of the child) and
some commonality in legal definitions of neglect (im-
minent risk; immediate, substantive, observable
harm), biases in reporting and in CPS case processing
raise some doubt about the meaning of the designa-
tion of cases as neglect by different CPS systems (see
Coohey, 1995; English, Brummel, Graham, &
Coghlan, 2002; Rose & Meezan, 1995; Runyan et al.,
in press; Sedlak & Broadhurst, 1996). The study by
Runyan et al. (in press) found that when reclassifying
CPS referrals using different maltreatment classifica-
tion schemes, as many as 25% of cases were mis-
classified as to actual type of abuse/neglect experi-
enced by the child. Furthermore, because many
neglect referrals do not rise to the standard of immi-
nent risk, substantive risk, or observable harm, they
cannot be “substantiated” as a result of investigation.
The “harm” to a child as a result of omissions in care is
often not imminent or observable. Some research
suggests that the harm from neglect is cumulative,
with harm accumulating based on the extent and type
of caregiver omissions as well as the child’s age and
length of time the child experiences the omission
(see Costin, Karger, & Stoesz, 1996; Dubowitz et al.,
1993; Gaudin, 1993; Kaufman-Kantor & Little, 2003).
Furthermore, research suggests that neglect can have
long-lasting impact on physical and emotional well-
being into adulthood (English, Widom, & Brandford,
2001; Horowitz, Widom, McLaughlin, & White, 2001;
Repetti, Taylor, & Seeman, 2002; Widom, 1989).
There are a number of conceptual issues that make
the definition and assessment of neglect more dif-
ficult than the definition and assessment of abuse.
First, neglect usually refers to a complex situation,
rather than a particular act as is the case with abuse
(Hildyard & Wolfe, 2002). Neglect is the absence of a
desired set of conditions or behaviors, as opposed to
CHILD MALTREATMENT / MAY 2005
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191
the presence of an undesirable set of behaviors. A def-
inition of neglect, therefore, implies a certain set of
desired behaviors as well as a designation as to who
should be responsible for meeting the needs or per-
forming the desired behaviors (Golden, Samuels, &
Southall, 2003).
The Needs of Young Children
Garbarino and Collins (1999) argued that child
development is dependent on the context of experi-
ence and that for development to proceed effectively,
a child’s basic needs must be met. Failure to meet a
child’s basic needs constitutes the essence of neglect;
however, standards of minimum care have not been
firmly established. Legally, the standard is omissions
in care resulting in imminent risk or observable harm;
however, developmentally, a pattern of caregiver
omissions may result in significant physical and emo-
tional harm to children.
In 1996, the National Advisory Mental Health
Council established a Basic Behavioral Science Task
Force (BBSRMH) to review research on the processes
and dynamics within family relationships that are
related to normal and abnormal physical, mental, and
emotional development of children (see BBSRMH,
1995). The focus of the report was on caregiver behav-
iors that affect physical and psychological growth and
development of children. The 1995 BBSRMH Report
concluded that effective caregiving consists of the
provision of physical and emotional caring that
includes sensory stimulation of the child, promotion
of healthy physical growth and survival, and comfort
and security associated with healthy social and emo-
tional growth and development. Confirming these
conclusions, a research review on the characteristics
of healthy families by Repetti et al. (2002) concluded
that healthy families promote the physical safety
and well-being of children as well as emotional secu-
rity and social integration. In the broadest terms
(whether or not these omissions meet the legal defi-
nition of imminent risk or observable harm), paren-
tal omissions in caregiving behaviors that promote
physical health and safety, emotional security, and
social integration of children could be construed as
neglectful.
Physical Safety, Security, and Well-Being
During the first 4 years of life a child is particularly
fragile and dependent physically; provision for physi-
cal needs such as food, shelter, clothing, health care,
and physical safety is especially important. Physical
health and safety includes proper diet and nutrition
as well as provision of a safe, stable, and hazard-free
living environment. Physical safety also requires ade-
192 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
quate supervision of vulnerable children. In terms of
physical health, one study found that dietary inade-
quacies are associated with a host of chronic health
conditions in children, including impairment of cog-
nitive development and increased risk of cardio-
vascular disease and cancer throughout the lifetime
(Caballero, 2002). Furthermore, prenatal and post-
natal health care is associated with better physical
health outcomes for children and lowers the risk of
sudden infant death (Alexander & Korenbrot, 1995;
Butz, Funkhouser, Caleb, & Rosenstein, 1993;
Finello, Litton, deLemos, & Chan, 1998; Ford,
Mitchell, & Taylor, 1994). Research on the long-term
consequences of being parented in a “risky” family
indicates a wide variety of physical health problems
throughout life (Repetti et al., 2002). No research was
identified relating the provision of adequate clothing
for children to child outcomes.
The provision of an environment that is physically
safe is important, not only because of long-term subtle
influences on child development but also because of
the immediate potential for accidental injury. Acci-
dental injury is a leading cause of disability and death
among children; the vast majority of these deaths
are considered preventable (Onwuachi-Saunders,
Forjuoh, West, & Brooks, 1999). Many child injuries
are associated with lack of adequate adult supervision
(Landen, Bauer, & Kohn, 2003). Furthermore, ade-
quate supervision of children has implications not
only for child physical safety but also for emotional
and social development. Children who are not ade-
quately supervised have been found to be at risk for
externalizing behavior problems, poor social skills,
and later school problems (Bolger, Patterson,
Thompson, & Kupersmidt, 1995; Patterson,
DeBaryshe, & Ramsey, 1989).
Most research on homelessness has focused on
older children; little is known about the impact of
inadequate shelter on young children. However, the
impact of homelessness or inadequate shelter on
child development and adjustment appears to
increase as the child grows older (Coll, Buckner,
Brooks, Weinreb, & Bassuk, 1998). Despite the lack of
research, there is some evidence that homelessness/
inadequate shelter is associated with health prob-
lems, cognitive developmental delays, and behavioral
problems (Alperstein, Rappaport, & Flanigan, 1988;
Rafferty & Shinn, 1991).
Psychological Safety and Security
Infancy and toddlerhood are periods of time when
attachment to an adult caregiver, cognitive stimula-
tion, and positive social relationships are important
for healthy child growth and development. The devel-
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opment of a positive basic working model of relation-
ships through the experience of stable and nurturing
relationships with caregivers has wide-reaching im-
plications for subsequent development in a variety
of domains from self-concept to affect regulation
(Lieberman & Pawl, 1990; Matas, Arend, & Sroufe,
1978). As well, given the normatively rapid cognitive
(and language) development that occurs during this
period, the availability of a stimulating environment is
important.
The degree to which caregivers interact with chil-
dren, provide stimulation, and are socially responsive
to them is especially important for young children’s
cognitive development (Poehlmann & Fiese, 2001).
Brain development is most rapid during the first 2
years of life (Johnson, 1997), and this development is
dependent on, among other things, adequate stimu-
lation. Parental attention and stimulation are strongly
predictive of child cognitive and developmental out-
comes (Fonagy, 2001), especially in low-birth-weight
children (Smith et al., 1996). Indeed, many interven-
tions targeted toward high-risk children involve
ensuring adequate levels of sensory and cognitive
stimulation (for a review, see Dieter & Emory, 1997).
Thus, the impact of suboptimal cognitive and social
stimulation may explain many of the developmental
deficits associated with neglect.
Aside from the impact of cognitive and sensory
stimulation, the relationship between caregiver and
young child is important in other ways. Children need
positive social relationships and interaction, and
there is considerable evidence of the negative con-
sequences of the absence of such relationships on
children’s social-emotional development. In the
psychopathology model of development, a child’s
attachment with primary caregivers holds a central
place. First, a stable, positive relationship allows chil-
dren to learn to soothe themselves and regulate their
own arousal, and failure to experience such a rela-
tionship results in elevated risk of both internalizing
and externalizing behavioral outcomes (Cicchetti &
Beeghly, 1990; Rogosch, Cicchetti, Shields, & Toth,
1995; van der Kolk & Fisher, 1994). A lack of a stable
relationship also is associated with inhibited explora-
tion of the environment (Lieberman & Pawl, 1990),
and suboptimal attachment relationships are associ-
ated with a host of problems related to later peer
relationships (Sroufe, 1989).
Finally, research suggests a link between the stabil-
ity and predictability of environment, changes in the
structure of the family or relocation of the family, and
negative child social-emotional and behavioral out-
comes. Several studies have identified a link between
residential instability and impairment in children’s
CHILD MALTREATMENT / MAY 2005
 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
emotional and academic adjustment and behavioral
problems (Eckenrode, Laird, & Doris, 1993;
Haveman & Wolfe, 1994; Humke & Schaefer, 1995;
McLloyd & Wilson, 1991). Rieder and Cicchetti
(1989) found that predictability of environment has
implications for the development of affective and
behavioral self-regulation. Other studies have found
an association between caregiver relationship transi-
tions and increased risk for children, including aca-
demic and behavioral problems, drug use, and delin-
quency (Hetherington, Bridges, & Insabella, 1998;
Martinez & Forgatch, 2002; Thornberry, Smith,
Rivera, Huizinga, & Stouthamer-Loeber, 1999).
Again, the majority of studies on the impact of resi-
dential and relationship instability on child outcomes
have focused on school-age or older children. Few
studies have examined the effects on very young chil-
dren of these failures to provide a stable environment.
In summary, official data suggest neglect of chil-
dren is a significant social issue, and official reports of
neglect have dramatically increased during the past
decade. Research on neglect is limited and most often
based on defining neglect using official designations
by CPS systems. However, many researchers have
questioned the validity of CPS designations of neglect
as a basis for research on neglect. Effective caregiving
consists of the provision of physical and emotional
caring that includes sensory stimulation of the child,
promotion of healthy physical and emotional growth,
and comfort and security. Research suggests that
omissions of physical and emotional caring can result
in short- and long-term negative emotional and
behavioral outcomes for children.
Toward a Definition of Neglect
Several researchers have argued that definitions of
neglect should be considered in the context of child
development (Cicchetti & Beegley, 1990; Dubowitz,
1999; Erickson & Egeland, 1996; Garbarino & Collins,
1999; Zuravin, 1999). Child development theory sug-
gests that children have specific stage-salient develop-
mental needs that, if unmet, hinder successful adapta-
tion within and between developmental stages
(Cicchetti & Beegley, 1990). Furthermore, this theory
suggests that developmental needs can be identified
and that healthy growth and development requires
the “meeting” of these needs, at least on a minimal
level. Criteria related to a child’s basic needs have
been identified. Young children need physical safety
and security and psychological or emotional safety
and security, as well as stimulation, for healthy growth
and development. Although the needs of children
have been established, the “minimal” dosage of care-
giving has not been established nor have accepted
CHILD MALTREATMENT / MAY 2005
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193
methods of defining alternative (to CPS designation
of neglected) constructions of neglect been estab-
lished. Working definitions of neglect are usually
driven by legal and/or policy considerations, rather
than empiricism or a consideration from the child’s
perspective.
A child-centered approach to defining neglect is
proposed in this article. Neglect is defined in terms of
child needs that are potentially unmet and the subse-
quent impact on child functioning or development.
Neglect defined this way characterizes a situation in
which the basic stage-salient physical or psychological
needs of the child are not met, resulting in a risk of
harm or less-than-optimal development. In this study,
the focus is on a definition of neglect for children who
are infants or toddlers (i.e., children younger than
the age of 4). During the first 4 years of life, a child is
particularly fragile and dependent physically; pro-
vision of basic physical needs such as food, shelter,
health care, and physical safety is especially impor-
tant, as there is little the child can do to meet these
needs. Furthermore, during the first 4 years of life, a
child’s experience of nurturance and bonding, devel-
opment of self-concept in relation to others, and
expectations regarding the safety and security of rela-
tionships set the stage for future emotional and social
development.
To examine the relationship between unmet need
and child outcome, alternative criteria for neglect
were constructed in this study based on a develop-
mental model of child growth and development. This
construction includes the use of CPS report data
(whether substantiated as maltreatment or not) and
other data available that “represents” potential omis-
sions in caregiving that could be construed as
neglectful—that is, omissions associated with poten-
tial negative child developmental outcomes. These
representations of neglect, experienced by children
before the age of 4, are then examined for their rela-
tionship to child developmental, emotional, and
behavioral functioning at age 4.
The Longitudinal Studies of Child Abuse and
Neglect (LONGSCAN) study provides a unique
opportunity for examining different ways of concep-
tualizing neglect (or omissions in caregiver behav-
iors) that are associated with children’s basic needs
and/or are predictive of poor child outcomes.
LONGSCAN is a proposed 20-year longitudinal study
examining the antecedents and consequences of mal-
treatment on children’s growth and development. In
its 12th year, the LONGSCAN study was designed
based on an ecological theory of maltreatment. Using
data from LONGSCAN, the purpose of this study is to
examine the relationship between behaviors identi-
194 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
TABLE 1: Sample Characteristics
Overall Sample
Sample Descriptors N (Percentage)
Size of sample 212 (100)
Sex of child (female) 109 (51.4)
Race/ethnicity (minority status) 171 (80.7)
Living with biological caregiver 201 (94.8)
Median family annual income (mode) $10,000-$15,000
($5,000-$10,000)
fied as conceptually “neglectful” (that is, which are
omissions in behaviors that promote age-specific
healthy child growth and development), children’s
experience of those behaviors prior to age 4, and
child outcomes at age 4. Based on this conceptualiza-
tion of child neglect as caregiver omissions related to
age-salient child developmental needs, we would
expect to find a significant relationship between these
omissions and negative child outcomes.
METHOD
Sample
All participants in this study are a part of
LONGSCAN, which is a multisite longitudinal study
of the long-term effects of maltreatment on children’s
growth and development (Runyan et al., 1998). Data
collection in LONGSCAN is designed to measure
child outcomes over time (from age 4, or before, to
age 20) as well as intervening variables that may influ-
ence the link between risk status and outcomes. There
are five research sites nationwide (Midwest, South,
Southwest, Northeast, and Northwest). The child par-
ticipants were identified in infancy or early childhood
as being maltreated or at risk of maltreatment.
Only the Midwest (MW) and Northwest (NW) sam-
ples were used in the present analyses because only
these two sites collected additional data on children
before the age of 4. The NW site recruited children
who had been reported to CPS and were judged to be
at moderate or high risk for maltreatment based on a
CPS risk assessment process. The NW site selected
children that may or may not have been substantiated
for maltreatment at the time of recruitment. The MW
site included three groups of children. Two groups
had been reported to CPS; one group was in a thera-
peutic intervention program, and the other was
receiving standardized care. A third MW group was
recruited from nonmaltreated neighborhood chil-
dren, matched on children’s age, ethnicity, and fam-
ily socioeconomic status. The 212 children included
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Midwest Site Northwest Site
N (Percentage) N (Percentage)
173 (81.6) 39 (18.4)
90 (52.0) 19 (48.7)
147 (85.0) 24 (61.5)
173 (100) 28 (71.8)
$10,000-$15,000 $15,000-$20,000
($5,000-$10,000) ($5,000-$10,000)
in this study are the children from MW and NW sites
with interview visits at both ages 1 and 4. Most of the
children in this sample are from the MW site (n =
173); fewer are from the NW site (n = 39) because the
NW site staggered interviews at enrollment so that
children were given a baseline interview at either ages
1, 2, 3, or 4, whereas all of the MW children were
interviewed at age 1.
Table 1 provides a demographic overview of the
sample of 212 LONGSCAN children in the sample. As
noted in Table 1, the sample of children is primarily
minority ethnic status (i.e., African American and
Latino), living with biological caregivers, and poor
(with a median income from $10,000 to $15,000).
Procedures
The LONGSCAN consortium of research studies
operates under common bylaws and procedures. The
procedures of the present study included obtaining
Institutional Review Board approval, training inter-
viewers, obtaining consent by families, and conduct-
ing in-person interviews with both the caregiver and
child at ages 1 and 4. In addition, annual telephone
interviews at child ages 2 and 3 allowed us to track fam-
ilies and assess yearly service utilization and important
life events of the children. For both types of inter-
views, caregivers and children were provided incen-
tives to contribute their time and effort. Data from
face-to-face interviews at visits 1 and 4 and telephone
interviews at visits 2 and 3 are used in these analyses.
Each interviewer had to meet an interrater reliabil-
ity standard (Kappa = .90) before they could proceed
with administering the interview protocol with the
primary caregiver and child. Data collected via inter-
views at the sites are uploaded at the Collaborative
Studies Coordinating Center (CSCC) at the Univer-
sity of North Carolina, Chapel Hill, where standard
and derived variables are computed and established
error-checking protocols are implemented.
CHILD MALTREATMENT / MAY 2005
 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN 195

TABLE 2: Descriptive Information for Measures of Children’s Needs for Safety and Security (Physical and Psychological)

Safety and Independent Variables No. of Items Child Information

Security Domain Basic Need or Issue and Source Measure Based On Type of Variablea Age Source

Physical Clean/safe abode Residence problems (A) 3 Index 1 Interviewer

Physical Medical needs met Any accident or injury (B, C) 10 Indicator 1-3 Parent
Physical Medical needs met Any medically untreated injuries (B) 5 Indicator 1 Parent
Physical Medical needs met Any untreated behavioral/emotional
problems (D) 1 Indicator 2-3 Parent
Physical Medical needs met No place for regular medical care (D) 1 Indicator 2-3 Parent
Physical Medical needs met No well-child visits (D) 1 Indicator 2-3 Parent
Physical Failure to provide (FTP) FTP: food, clothing, shelter, medical,
hygiene (E) 5 Count 0-4 Community
Physical Lack of supervision LOS: leaves alone, unsupervised
(LOS) outside, substitute care (E) 3 Count 0-4 Community
Psychological Stimulating environment Stimulation (A) 5 Index 1 Interviewer
Psychological Residential stability Location Transitions Indexa (F) 6 Index 1-3 Parent
Psychological Relational stability Caregiver transitionsb (F) 5 Index 0-3 Parent
Psychological Relational stability Weeks separated from caregiver (G) 1 Single item 1 Parent
Psychological Relationship quality Verbal aggression (discipline) (H) 7 alpha = .62 1 Parent
Psychological Emotional neglect Emotional maltreatment allegations (E) 22 Count 0-4 Community
NOTE: Index refers to the sum of a set of unit-weighted items; indicator, to a dichotomous variable indicating one or more affirmative re-
sponses to a single item, or within a set of related items; alpha = Cronbach’s alpha statistic, a measure of internal reliability. (A) MRAA: Inter-
viewer Rating of Condition of Residence (LONGSCAN-developed, 1991); (B) ACCA: Child Injury Questionnaire (LONGSCAN-developed,
1991); (C) LECA: Child Life Events (LONGSCAN-developed, 1992); (D) CSUA: Service Utilization (LONGSCAN-developed, 1991); (E)
RNA: Coding of Maltreatment Referrals (LONGSCAN-developed, 1997); (F) LESB: Life Experiences Survey (Sarason, Johnson, & Siegel,
1978); (G) SEPA: Separation from Caregiver (LONGSCAN-developed, 1991); (H) CTSB: Conflict Tactics Scale—Discipline Methods
(Straus, 1979).
a. This is the count of the number of times the child moved with his or her family to a new place, the number of times the child moved away
from family, and whether the child was homeless or lived at a homeless shelter.
b. This is the count of the number of times a parent-caregiver married, went away (moved out, separated, or divorced), or died.
a. Alpha, if scale is variable.

Independent Variables vide (FTP), and lack of supervision (LOS). Each

In the course of discussion and theoretical consid-
eration, two domains were chosen to represent the
physical and emotional/psychological needs of
young children (i.e., birth through age 4). Physical
safety and security was defined by the following con-
structs: clean and safe abode; medical needs met; fail-
ure to provide food, clothing, shelter; and lack of
supervision. Psychological safety and security was defined
by constructs related to: a stimulating environment,
residential stability, relational stability, relationship
quality, and emotional neglect. During the review
process, we identified 20 variables or scales from the
LONGSCAN interview protocol to operationalize
these constructs within the two domains of children’s
basic need for safety and security. Each of the vari-
ables was constructed using measures from the
LONGSCAN interview protocol or from our coding
of maltreatment referrals using the Modified Mal-
treatment Coding System (MMCS). The MMCS is a
modification of the maltreatment classification sys-
tem (MCS) originally developed by Barnett, Manly,
and Cicchetti (1993), including the addition of codes
for scoring various subtypes of neglect, failure to pro-
allegation of maltreatment contained within every
maltreatment referral to CPS is coded for date of
referral, subtype of maltreatment, and severity. This
reclassification of maltreatment allegations provides
a more accurate representation of concerns regard-
ing child safety and security sufficient to cause some-
one in the community (friends, family, or neighbors)
or community professionals (doctors, law enforce-
ment, day care providers) to make a report to CPS.
Table 2 presents a summary of the independent
variables; it includes the domain of safety or security,
the basic need or issue involved, independent vari-
ables and their source measure, number of items on
which the variables were based, type of variable,
child’s age at time of data collection, and source of
data (parent, interviewer, or community). Table 3
presents descriptive statistical information about the
independent variables, including their minimum and
maximum values, mean and standard deviation, or
(in the case of indicator variables or counts of allega-
tions) the number and percentage of children for
whom the variable was greater than zero (indicating
presence of the problem or allegation). Information

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196 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN

TABLE 3: Descriptives of Predictor Variables, Including Mean or Incidence (N>0)

Physical Safety and Security Predictors N Min. Max. Mean (SD) or N>0 (%)

Residence Problems Index 209 3 15 Mean = 8.26 (3.24)

Any accident or injury 212 0 1 N>0 = 71 (33.5%)
Any medically untreated injuries 212 0 1 N>0 = 13 (6.1%)
Any untreated behavioral/emotional problems 205 0 1 N>0 = 30 (14.6%)
No place for regular medical care 212 0 1 N>0 = 20 (9.4%)
No well-child visits 212 0 1 N>0 = 31 (14.6%)
FTP: food (no. allegations) 212 0 3 N>0 = 17 (8.0%)
FTP: clothing (no. allegations) 212 0 2 N>0 = 8 (3.8%)
FTP: shelter (no. allegations) 212 0 3 N>0 = 15 (7.1%)
FTP: medical (no. allegations) 212 0 5 N>0 = 41 (19.3%)
FTP: hygiene (no. allegations) 212 0 3 N>0 = 17 (8.0%)
LOS: leaves alone (no. allegations) 212 0 3 N>0 = 21 (9.9%)
LOS: unsupervised outside (no. allegations) 212 0 2 N>0 = 19 (9.0%)
LOS: substitute care (no. allegations) 212 0 3 N>0 = 22 (10.4%)
Stimulation Index 212 0 5 Mean = 3.04 (1.54)
Location Transitions Index 212 0 12 Mean = 1.83 (2.07)
Caregiver Transitions Index 212 0 4 Mean = 0.74 (0.90)
Weeks separated from caregiver 212 0 116 Mean = 3.06 (11.52)
Verbal aggression 209 0 7 Mean = 1.41 (1.56)
Emotional neglect (no. allegations) 212 0 4 N>0 = 27 (12.7%)
NOTE: FTP = failure to provide; LOS = lack of supervision.

regarding the reliability and validity of the original Data Analysis

source data are available from the LONGSCAN Web
site (http://www.sph.unc.edu/iprc/longscan).
Dependent Variables
Two established instruments were used for mea-
suring child physical, cognitive, emotional/
psychological, and behavioral functioning at age 4:
the Battelle Developmental Inventory Screening Test
(BDST; Newborg et al., 1984) and the Child Behav-
ioral Checklist (CBCL; Achenbach, 1991). Both
instruments were administered during age-4 inter-
views. The BDST was designed for use with children
from birth to 8 years old. LONGSCAN coordinators
were centrally trained to competency in administer-
ing the BDST by the CSCC, and site interviewers were
then either trained by the site coordinator with com-
petency tapes approved by the core or trained by the
coordinating center staff themselves. From the BDST,
we used the total score as well as measures of nine
domains or subdomains. From the CBCL, we used the
three broadband measures (externalizing, internaliz-
ing, and total) and eight syndrome scales. As recom-
mended by Achenbach (1991), standard scores were
used for the broadband measures and raw scores were
used for the syndrome scales. Table 4 provides basic
descriptive statistical information on the measures
used for each outcome, gives examples of items, and
briefly summarizes research on the reliability and
validity of the outcome measures.
Other than site, which was entered as a possible
covariate, demographic covariates were not included
in the models of the present study so that outcome
variance explained by the neglect indicators would be
attributed to those indicators rather than to demo-
graphic factors with which a predictor might be asso-
ciated. The rationale for this decision was that, given
the aims of this study, it would be best to examine the
relations between potential predictors of interest and
outcomes, which could have explanatory value
regarding demographic differences, instead of exam-
ining those demographic differences in terms of child
outcomes. See Briere (1988) for a detailed descrip-
tion of problems in abuse effects research that result
from partialling out the effects of covariates corre-
lated with the independent variables used to repre-
sent maltreatment.
Ordinary linear regression with forward selection
(Miller, 1990; SPSS, 1997) was used to develop predic-
tive models, which were then tested for overall signifi-
cance, and unadjusted R2 of each final model was
computed. Unadjusted R2 allows for interpretation in
terms of proportion of variance accounted for regard-
ing a predicted outcome. Holm-adjusted p values
were then computed with respect to the final mod-
els, to correct for experiment-wise error (Aickin &
Gensler, 1996; Holm, 1979; Wright, 1992).

CHILD MALTREATMENT / MAY 2005

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 TABLE 4: Scales and Psychometrics of Dependent Measures
Measures (Mean, SD)
Battelle Developmental Screening Inventory
(BDSI), standard scores.
Domains and Subdomains:
• Personal-social domain (1.3, 0.8)
• Adaptive domain (0.9, 0.8)
• Gross motor subdomain (0.9, 1.0)
• Fine motor subdomain (1.2, 0.8)
• Motor domain (1.0, 0.9)
• Receptive subdomain (0.7, 0.7)
• Expressive subdomain (1.0, 0.6)
• Communication domain (1.0, 0.8)
• Cognitive domain (1.4, 0.9)
• Total score (1.3, 0.8)
Child Behavior Checklist (CBCL 2/3)
Child Behavior Checklist (CBCL 4/18)
Broadband and Syndrome Scales:
• Broadband: External (54.4, 10.6)
• Broadband: Internal (48.1, 8.1)
• Broadband: Total (52.0 10.1)
• Withdrawn (2.1, 1.9)
• Somatic complaints (0.5, 0.9)
• Anxious/depressed (2.1, 2.4)
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• Social problems (2.0, 1.8)
• Thought problems (0.4, 1.0)
• Attention problems (2.9, 2.9)
• Delinquent behavior (1.8, 1.8)
• Aggressive behavior (10.5, 6.8)
197
Examples of Items
• Responds to his/her name
• Buttons 1-2 buttons with no assistance
• Copies numerals 1 to 5
• Uses 10 or more words
• Identifies simple objects by touch
In last 2 months, not true, sometimes true,
very true:
• Cries a lot
• Defiant
• Nightmares
• Punishment doesn’t change his/her
behavior
• Too fearful or anxious
Reliability
Test-retest reliability correlation coefficients
from .84 to .99 have been found for the
BDST across the five domains and ages,
from 0-5 months to 60-71 months
(Newborg et al., 1988). In the NW
LONGSCAN sample (N = 238), Cron-
bach’s alpha (overall) was found to be
.91. Cronbach’s alphas of the 5 domains
ranged from .71-.78.
Ages 2-3 Test-retest (7.7 days, n = 61)
Mean r = .87. Stability (1 year, n = 73) mean
r = .69.
Cronbach’s alphas ranged from .79 to .92
across six scales (see Achenbach, 1991;
Achenbach, Edelbrock, & Howell, 1987).
For the CBCL 4/18, Cronbach’s alphas for
scales ranged from.40 (activities) to .93
(externalizing).
Across the syndromes, Cronbach’s alpha val-
ues ranged from .76 to .92.
NW LONGSCAN sample Cronbach’s alphas
(N = 232): Internalizing = .83
Externalizing = .90
Validity
Convergent validity: 164 children in the
norming and clinical samples of (Newborg
et al., 1988) were given the BDSI prior to
administration of the complete Battelle
Developmental Inventory (BDI). Corre-
lations between the BDSI subdomain,
domain, and total scores were all higher
than .90, and all but the Cognition
Domain (.92) were ³ .96. LONGSCAN:
Association of communication and cogni-
tive domains and total scores (for ages 2-3)
with the Peabody Picture Vocabulary Test
(PPVT) ranged from .31 to .54, p < .05).
For the Seattle sample (N = 240): r (total
PPVT with BDSI) = .31. r (communication
total with BDST) = .49. r (cognition with
BDSI) = .42 (see also Guidubaldi & Perry,
1984).
The CBCL is widely used, and its content,
construct, and criterion-related validity are
extensively documented as well as its reli-
ability (for details, see chapter 6 of the
Manual for the Child Behavior Checklist
and Revised Child Behavior Profile;
Achenbach, 1991). The CBCL has been
used with both clinical and non-clinical
populations of children (Achenbach,
1991). Concurrent validity: Achenbach
et al. (1987) compared 96 children
referred for mental health services against
a matched normative sample of 96 chil-
dren (Total N = 192). They found effects
(p < .001) ranging from 5% of variance
accounted for (social withdrawal) to 32%
(total problem score). Predictive validity
(Achenbach et al., 1987): 1 year (r from
ages 3-4) = .63 2 years (r from ages 3-5) =
.56 3 years (r from ages 2-5) = .49
198 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
RESULTS
Model Building
The basis of estimating effects of the proposed
alternative indicators of neglect was development of
regression models regarding the various child out-
comes. These are presented in Tables 5 and 6. For
each model, the extent of multicollinearity was
assessed, and for all predictors it was found to be weak
(e.g., all condition indices were less than 15). Table 5
presents regression models that resulted for the
Battelle domains and subdomains. Table 6 presents
regression models for CBCL broadband and subscale
measures. Both tables show only predictors for physi-
cal safety and security and for psychological safety and
security that were included in one or more of the final
models (note: excluded predictors are noted at the
bottom of each table). Regression coefficients, R2 val-
ues, and Holm-adjusted p values also are presented
for each model. Even prior to Holm adjustment of p
values, no significant models were developed for two
of the outcomes: the Battelle gross motor subdomain
and the Battelle motor domain as a whole.
Predictive Value of Indicators of Neglect
Because the focus of these analyses was on the util-
ity of indicators of physical and psychological safety
and security in predicting child outcomes, the results
of the regression analyses are organized by domain of
predictor, rather than outcome. Thus, results are dis-
cussed involving both Table 5 and Table 6 together.
First, the results involving physical safety and security
are presented, followed by the results involving psy-
chological safety and security. Because of the possibil-
ity that site differences in recruitment frame or other
variables might affect outcomes, site was entered as a
possible predictor in the models. In all cases, in-
cluded predictors continued to significantly predict
the outcome of interest in the final regression model,
including other possible predictors as well as site.
As noted in Tables 5 and 6, some of the candidate
physical safety and security variables were not
included in any of the models: accident or injury,
medically untreated injuries, counts of neglect allega-
tions of failure to provide clothing, leaving child
alone, not supervising child outside, and question-
able substitute care. Each of the remaining candidate
physical safety and security variables was related to at
least one of the Battelle or CBCL outcomes. Specifi-
cally, the Residence Problems Index predicted devel-
opmental delay in the expressive communication sub-
domain and the communication domain of the
Battelle as well as predicting fewer externalizing prob-
lems on the CBCL. Untreated behavioral/emotional
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problems predicted developmental delay in the
receptive communication subdomain of the Battelle
as well as externalizing problems, internalizing prob-
lems, total problems, anxious/depressed problems,
social problems, attention problems, and aggressive
problems on the CBCL. No place for regular medical
care predicted less developmental delay on the
Battelle adaptive domain, fine motor subdomain,
receptive communication subdomain, and total prob-
lems. No well-child visits predicted externalizing
problems on the CBCL as well as less developmental
delay in the expressive communication subdomain
and the communication domain of the Battelle. Fail-
ure to provide food predicted internalizing problems
on the CBCL, withdrawn problems, social problems,
and thought problems as well as delinquent and
aggressive behaviors. Failure to provide shelter pre-
dicted developmental delays on the Battelle personal-
social domain, the expressive language subdomain,
and total problems. Failure to provide medical care
predicted fewer internalizing problems on the CBCL.
Failure to provide hygiene predicted anxious/
depressed problems and attention problems on the
CBCL.
As noted in Tables 5 and 6, some of the candidate
psychological safety and security variables were not
included (i.e., they were not significant) in any of the
models: weeks separated from caregiver and emo-
tional neglect. Each of the remaining candidate psy-
chological safety and security variables significantly
predicted outcomes on at least one Battelle or CBCL
domain. The Stimulation Index predicted less devel-
opmental delay on the Battelle cognitive domain and
more problems on the CBCL internalizing problems,
total problems, and anxious/depressed problems as
well as more delinquent and aggressive behaviors.
Location transitions predicted externalizing prob-
lems on the CBCL. Caregiver transitions predicted
less developmental delay on the Battelle adaptive
domain and the expressive language subdomain. Ver-
bal aggression predicted problems on most CBCL
scales: externalizing problems, internalizing prob-
lems, total problems, somatic problems, anxious/
depressed problems, thought problems, attention
problems, delinquent behaviors, and aggressive
behaviors.
DISCUSSION
In this section, we first review selected findings
from the physical safety and security predictors, fol-
lowed by the psychological safety and security predic-
tors. This section concludes with a brief discussion of
CHILD MALTREATMENT / MAY 2005
 TABLE 5: Battelle Models Resulting from Ordinary Linear Regression—Unstandardized Regression Coefficients (B)

Battelle Developmental Screening Inventory

Predictors and Model Results Personal/Social Adaptive Fine Motor Receptive Expressive Communication Cognitive Total Score

Site (MW = 1, NW = 2) –0.77 –0.48 –0.47 –0.72 –0.52 –0.80 –0.75

Physical safety/security
Residence Problems Index 0.04 0.04
Any untreated behavioral/emotional problems 0.33
No place for regular medical care –0.40 –0.39 –0.35 –0.44
No well-child visits –0.36 –0.48
Failure to provide shelter 0.39 0.33 0.40
Psychological safety/security
Stimulation Index –0.09
Caregiver Transitions Index –0.14 –0.14
R2 (Site) .097 .070 .053 .000 .171 .084 .115 .102
R2 (safety and security predictors) .019 .051 .021 .082 .090 .066 .026 .041
R2 (final model) .116 .121 .074 .082 .261 .150 .141 .143
Holm-adjusted p value (of final) < .001 < .001 < .005 < .005 < .001 < .001 < .001 < .001
NOTE: Ordinary linear regressions with forward selection were conducted; the resulting models include only predictors that are significantly related to each dependent variable, and empty cells
in the above table indicate no relationship. Predictors not included for Battelle outcomes are: any accident or injury; any medically untreated injuries; number of neglect allegations of failure to
provide food, clothing, medical care and hygiene; leaving child alone; not supervising child outside; questionable substitute care; location transitions index; weeks separated from caregiver; ver-

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bal aggression (discipline); and emotional neglect. No variables were selected for gross motor subdomain or the motor domain. Holm adjustment of p values was based on there being 19 outcome
models tested.

199
 200
TABLE 6: CBCL Models Resulting from Ordinary Linear Regression—Unstandardized Regression Coefficients (B)

Somatic Anxious/ Social Thought Attention Delinquent Aggressive

Predictors and Model Result Withdrawn Complaints Depressed Problems Problems Problems Behavior Behavior Externalizing Internalizing Total

Site (MW = 1, NW = 2) 0.40

Physical safety/security
Residence Problems Index –0.62
Any untreated behavioral/emotional
problems 1.29 0.70 1.47 4.40 4.99 5.17 5.87
No well-child visits 5.05
Failure to provide food 0.69 0.65 0.63 0.80 3.01 3.86
Failure to provide medical –2.18
Failure to provide hygiene 0.94 1.63
Psychological safety/security
Stimulation Index 0.24 0.20 0.62 1.19 0.42
Location Transitions Index 0.88
Verbal aggression (discipline) 0.14 0.44 0.13 0.31 0.34 0.76 1.39 1.46 1.61
R2 (site) .000 .000 .000 .000 .020 .000 .000 .000 .000 .000 .000
R2 (safety and security predictors) .030 .059 .188 .053 .173 .153 .146 .152 .215 .184
R2 (final model) .030 .059 .188 .053 .193 .153 .146 .152 .152 .215 .184
Holm-adjusted p value (of final) < .05 < .005 < .001 < .01 < .001 < .001 < .001 < .001 < .001 < .001 < .001
NOTE: Ordinary linear regressions with forward selection were conducted; the resulting models include only predictors that are significantly related to each dependent variable, and empty cells

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in the above table indicate no relationship. Predictors not included in any CBCL model are any accident or injury, any medically untreated injuries, no place for regular medical care, number of
neglect allegations of failure to provide clothing and shelter, leaving child alone, not supervising child outside, questionable substitute care, caregiver transitions index, weeks separated from
caregiver, and emotional neglect. Holm adjustment of p values was based on there being 19 outcome models tested.
 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
the broader implications of the findings and of this
methodological approach.
Physical Safety, Security, and Child Well-Being
The neglect indicators developed for the purpose
of this article, based on the conceptualizations of chil-
dren’s needs at early developmental stages, were suc-
cessful in predicting child outcomes. Overall, the
neglect indicators within the physical safety and secu-
rity domain were related to child development and
behavioral functioning. The relationship between the
items and/or indices within the physical safety and
security domain had differential predictive power
depending on the subdomains of child devel-
opment assessed. Problems with the residence—
specifically, it being dirty, unsafe, and/or dilapidated,
for example—predicted impairments in the expres-
sive language subdomain and the overall communica-
tion domain. Similarly, untreated behavioral or emo-
tional problems were associated with receptive
language impairments. Moreover, CPS reports of fail-
ure to provide shelter were associated with problems
in functioning overall as well as specific problems in
the expressive language and social domains. These
effects may be of considerable import, especially
given that the scale of the Battelle measures used indi-
cates categories of developmental delay relative to the
mean (from less than one to more than two standard
deviations below the mean). Furthermore, regression
coefficients are estimates of effect for every unit
increase of an independent variable. Thus, a regres-
sion coefficient of .40 (as is the case with the relation-
ship between FTP-shelter and total scores) indicates
additional effect for every allegation counted. Two or
three FTP-shelter allegations (and they range to up to
three in our sample) could be enough for the child to
move from the normal or borderline ranges into the
severe clinical category.
Some of the physical safety findings, however,
seemed less intuitive. Families that did not have a reg-
ular place for medical care had fewer impairments in
receptive language skills, adaptive language, and/or
fine motor functioning. It should be noted that lack of
a regular place for medical care does not necessarily
mean that the child did not receive medical care.
Many low-income families may have access to some
medical care (e.g., emergency rooms), especially with
young children in the family, but may not have a regu-
lar “place” where they receive that care (Elixhauser
et al., 2002).
When examining child behavioral functioning, the
cleanliness and safety of the child’s residence was
inversely related to child externalizing behavior and
not related to the child’s internalizing behavior. Pre-
CHILD MALTREATMENT / MAY 2005
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201
vious research has found a negative relationship
between the safety of a child’s environment with
externalizing and social problems (e.g., Bolger et al.,
1995), but this research was on older, school-age chil-
dren. It is possible that the effect of a disorganized life-
style on behavior problems does not manifest until
later stages of development or may be a marker for
other parenting behaviors that affect different aspects
of child development. In contrast to the physical/
developmental outcomes, lack of well-child visits is
significantly associated with child externalizing
behavior problems as measured by the CBCL, though
it is inversely related to problems in expressive lan-
guage development and communication as measured
by the Battelle Screener.
Three additional types of physical safety and secu-
rity findings emerged. Untreated behavioral and
emotional problems were associated with broadband
and specific problems of emotion and behavior. CPS-
reported failure to provide food was associated with a
mix of internalizing/withdrawn, social, aggressive,
and delinquent behaviors and thought problems.
Moreover, failure to provide adequate hygiene was
associated with some symptoms of anxiety and depres-
sion as well as attention problems.
Clearly, the strongest relationships found for the
physical safety and security domain are caregiver
reports of child internalizing and externalizing prob-
lems (total and subscale scores) and not having access
to services to treat these identified problems. This
raises interesting questions about this item as a mea-
sure of “neglect” and the controversy about whether
neglect should be constructed based on parenting
behavior regardless of child outcome or based on
child outcome regardless of parental intent. These
data suggest that the caregivers recognized that their
child had some functional problems and that they
were sufficient to require treatment; however, they
also had no regular place for medical care and proba-
bly limited, if any, access to mental health treatment
for their child. In contrast, the findings related to FTP
(food and hygiene) could be markers for more seri-
ous and pervasive caregiver omissions that result in
significant emotional/behavioral problems in young
children. Failure to provide food and hygiene are
both indicators of, at best, disorganized caregiving
detrimental to healthy child growth and develop-
ment. However, the overwhelming majority of
neglect referrals (on which the FTP indices are
based) are not generally considered imminent risk
and would not warrant ongoing, post-investigation
CPS involvement (English, Marshall, Brummel, &
Coghlan, 1988a). Yet these indices predict significant
problems in child emotional/behavioral functioning.
202 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
Moreover, child well-being is one of three federal
outcomes measures related to child welfare services.
These data suggest a potential disconnect between
CPS services and child outcomes associated with
well-being and healthy emotional and physical
development.
Psychological Safety and
Security and Child Well-Being
A stimulating home environment is associated with
fewer impairments in cognitive functioning but more
behavior problems. One possible explanation for this
finding is that although a home can be stimulating
because of factors such as adult-child conversation, if
the quality of the conversation is negative, it may lead
to child behavior problems, as indicated by our find-
ings regarding the effects of caregivers’ verbally ag-
gressive discipline.
The findings related to the stability of environment
are some of the most interesting in this study. Chil-
dren who experience multiple caregiver transitions
appear to have fewer adaptation problems and fewer
receptive language problems. This is a counterintu-
itive finding that requires further investigation. One
possible explanation might be that changes in care-
giver may often result in improvements in the nature
of the caregiving experienced by the children in our
sample. Conversely, the more location transitions, the
more likely the child is to exhibit externalizing behav-
ior problems. Although the children who have multi-
ple location transitions may remain with the same
caregiver, that caregiver may not be providing the
consistency of nurturance the child needs for healthy
growth and development, so that location transitions
functions as a marker variable for other caregiver
issues.
The role of verbal aggression on child develop-
ment also is interesting. As expected, children
exposed to verbally aggressive discipline show more
behavior problems overall. Specifically, verbally
aggressive discipline is significantly associated with
caregiver reports of both externalizing and internaliz-
ing behaviors, including reports that the child is anx-
ious/depressed, has attention problems, exhibits
delinquent and aggressive behaviors and has somatic
complaints. However, because we included no mea-
sures of the child’s behavior independent of the care-
giver’s report, it is not clear to what degree these dif-
ferences reflect actual functional impairment rather
than, possibly, caregivers’ misperceptions of child
behavior. On the other hand, effects of verbal aggres-
sion on children’s behavior, internalizing problems
in particular, may be underestimated with use of the
parent-report CBCL; it has been noted that caregivers
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are less accurate at perceiving child internalizing
problems compared with externalizing problems
(Bird, Gould, & Staghezza, 1992; Stanger & Lewis,
1993). We also acknowledge that the direction of cau-
sality underlying the association of verbal aggression
with behavior problems is not known; not only might
problem behaviors be caused by verbal aggression,
but also problem behaviors on the part of a child may
provoke aggressive verbal reactions from caregivers.
Limitations of the Study
In general, these data suggest that alternative
methods of conceptualizing neglect, focusing on
physical and psychological safety, as developed in this
study, are predictive of a range of adverse child out-
comes. However, the measures of neglect included in
this study were constructed from preexisting mea-
sures from an ongoing longitudinal study of maltreat-
ment. As such, measures available in the LONGSCAN
protocol were used, rather than what may have been
the ideal assessment for each construct. However,
design of the LONGSCAN study was based on an eco-
logical model of maltreatment, with selected mea-
sures being used to examine numerous aspects of
parenting as well as factors associated with the socio-
ecological environment in which the child lives
(Runyan et al., 1998).
The present study combined maltreatment refer-
ral information, caregiver report, and interviewer
observations to construct measures for child need.
These measures may not be ideal; for example, in
some cases, physical neglect was assessed very briefly
(e.g., in the case of “residence problems”) or relied
solely on official CPS reports (e.g., provision of ade-
quate food). In the Introduction, it was argued that
the use of CPS data is biased in terms of who has been
identified as neglected and the types of neglect behav-
iors that subsequently are substantiated, especially in
relationship to neglect. However, although reports to
CPS were used, reliance on CPS classification of these
reports was not. Reclassification of type of neglect, uti-
lizing the MMCS provides a more accurate portrayal
of caregiver behaviors by utilizing information about
the subtypes of neglect related to unmet child needs
of interest in this study (see Runyan et al., in press).
Relatively comprehensive assessments of child
psychosocial functioning and cognitive development
were available in the LONGSCAN protocol. Future
research regarding alternative constructions of
neglect could focus on more comprehensive mea-
sures. Multiple measures of child outcomes reported
by multiple respondents would also be useful to verify
the relationship of these “neglect” constructs to cross-
reporter outcomes.
CHILD MALTREATMENT / MAY 2005
 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
For example, measurement of child emotional and
behavioral functioning used the CBCL, which,
although well-validated and widely used, relies on par-
ent reports of child functioning. It is possible, particu-
larly in the case of caregivers engaging in neglectful
behaviors, that caregivers may overestimate or over-
state the psychosocial functioning of their children.
This would have served to mute findings of the effects
of neglect on psychosocial functioning and might
help explain some of the counterintuitive findings.
However, as mentioned above, research also indicates
that some caregivers underestimate child function-
ing, especially internal states, so these results may
underestimate the relationship between child func-
tioning and neglect constructs. Despite these limita-
tions, data from all three sources of information on
which the neglect constructs were based—interviewer
observations, caregiver report, and community-at-
large reports—were significant in the prediction
models.
Taken at face value, it would come as good news
that by our measures (see Table 3) most of the chil-
dren (more than 85%) in this at-risk sample were
reported to have received the medical and psycholog-
ical care that their caregivers felt they needed. One
might be concerned that such a low incidence of
unmet needs might work against discovering effects
resulting from a lack of treatment, but, as we have
seen, even variables with relatively low incidence
(e.g., any untreated behavioral/emotional problems,
failure to provide food, shelter, hygiene) can be pow-
erful enough when present to be significantly asso-
ciated with child problems.
Policy and Practice Implications
CPS is more likely to evaluate allegations of neglect
from the perspective of imminent risk of harm or
after a pattern of referrals (English et al., 1998a;
English, Marshall, Brummel, Novicky, & Coghlan,
1998b; Rose & Meezan, 1995). The basis for a decision
to investigate and/or substantiate a CPS report can be
the specific circumstances or the presence of serious
risk factors such as parental substance abuse or men-
tal illness. It is unlikely that factors associated with sta-
bility of caregiver, stability of living situation, quality
of adult-child communication, or a dirty house
(unless there is observable injury or risk of imminent
harm) will be officially classified as neglect. And yet
data from this study indicate that these and other
markers of potentially neglectful behaviors are re-
lated to child functioning.
Findings from this study suggest that failure to pro-
vide for the basic needs of children (clean and safe
environment, adequate hygiene, adequate food, sta-
CHILD MALTREATMENT / MAY 2005
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203
bility of living environment, medical needs met) and
caregiver’s verbally aggressive behavior toward a child
predict significant developmental delays related to
language development and communication as well as
socioemotional and behavioral problems. From a
child development perspective, these delays in age-
salient developmental domains can have potentially
significant detrimental long-term effects on later
development. Although the child is not deemed to be
at “imminent” risk of immediate harm, at least at the
time of the investigation, these data suggest the poten-
tial for significant long-term harm in terms of healthy
child growth and development.
One question emerging from these results: Are the
data from this and other studies sufficient to argue for
a change in current CPS policy and practices related
to neglect? This study was designed to explore the
relationship between different conceptualizations of
“neglectful” behaviors to determine whether there
was a significant relationship to child outcomes. The
findings suggest that, at the very least, these factors are
important to consider in terms of child well-being,
which is a mandate for CPS. Although the conceptual-
izations of neglect examined in this article might not
constitute “imminent risk of harm,” they do suggest
that these concepts are markers for a disorganized
caregiving environment that has consequences for
healthy child growth and development. From a pre-
vention perspective, even if these families do not
enter the formal CPS system, CPS workers have an
opportunity to facilitate their “prevention” mandate
by being aware of the relationship between these care-
giver omissions and child well-being and by referring
families for community-based services to address their
needs.
In the meantime, these data suggest that conceptu-
alizing neglect from the perspective of the impact of
omissions in caregiving behaviors related to age-
salient developmental needs of young children
warrants further investigation. From a research per-
spective, it is insufficient to rely solely on CPS classifi-
cations of neglect for a whole host of reasons (see,
e.g., Runyan et al., in press). Rather, data from CPS
can be used along with other data representing omis-
sions in caregiver behavior that might represent
neglect. Furthermore, additional research needs to
be done to examine alternative conceptualizations of
neglect longitudinally. Other research suggests the
full impact of omissions of various caregiver behaviors
may not be evident until later developmental stages
(Rutter & Quinton, 1984; Sroufe, 1989; Sroufe &
Rutter, 1984). When additional data on this issue
accrue, it may then be time to revisit the discussion of
legal and practice definitions of neglect.
204 English et al. / DEFINITION OF NEGLECT IN YOUNG CHILDREN
In closing, we wish to recognize the perspective of
those who advocate for a general focus of child wel-
fare on the need to reduce child poverty generally,
rather than simply implicating parents as the locus of
problems of neglect (e.g., Roberts, 2003). It is argued
that a punitive model that makes poor parents the
scapegoats for the societal ills of poverty misplaces the
problem and that child welfare has a more general
mandate to improve the welfare of children, beyond
cases of specific parental negligence or malfeasance.
Golden et al. (2003) contended that neglect arising
from structural issues needs a more redemptive inter-
vention than that arising from parental negligence,
and this is part of a more general argument casting
such issues as ones needing support and intervention,
rather than criminal proceedings (Southall, Samuels,
& Golden, 2003). We reiterate, however, that the
focus of the present research is not on parent culpa-
bility but on child needs. We acknowledge that in
terms of investigation and substantiation, there needs
to be a multi-tier approach: If a child’s needs are not
being met, intervention is necessary, but if the prob-
lem is a structural one, rather than parental negli-
gence, the response should not be child removal but
the provision of services. It is our view that better
understanding the variety of child needs and specific
types of failures to meet them, at any level, will encour-
age provision of the kinds of services that are best
suited to meeting the needs of the children and fami-
lies being served.
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Diana J. English, Ph.D., is the office chief of research, Children’s
Administration, Washington State Department of Social and
Health Services. She is the principal investigator of the Northwest
site of LONGSCAN. The Office of Research is a public child welfare
research center conducting research on the identification of child
abuse and neglect, decision making in Child Protective Services,
effective interventions for child maltreated victims, foster care ser-
vices, independent living, and adoption. Dr. English completed her
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national and state child welfare related commissions and
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committees and published numerous articles and reports on child
welfare issues.
Richard Thompson, Ph.D., is director of research at the Juvenile
Protective Association and assistant professor in the Department of
Psychiatry at the University of Illinois at Chicago. He is the princi-
pal investigator for the Midwest site of LONGSCAN. He received his
Ph.D. in clinical psychology from McGill University in 2000 and
did postgraduate work at the University of Pennsylvania. He has
authored more than 25 peer-reviewed journal articles on psycho-
pathology and its assessment, access to mental health services, and
the relationship between family interactions and mental health.
J. Christopher Graham, Ph.D., is statistician and research
supervisor for the Office of Children’s Administration Research,
State of Washington Department of Social and Health Services. In
this position, he researches the conditions and developmental conse-
quences of child maltreatment, studies caseworker decision making,
and participates in program evaluations. In 1997 he received his
doctoral degree from the University of Texas at Austin, where he
studied social psychology and organizational management. He is a
contributing author of numerous reports and articles related to child
maltreatment and service provision to children and families.
Ernestine C. Briggs, Ph.D., is a faculty member in the Depart-
ment of Psychiatry and the Behavioral Sciences at Duke University
Medical Center. She is also director of the Trauma Treatment and
Research Program at the Center for Child and Family Health-NC
and a co-investigator at the Coordinating Center of LONGSCAN.
Her research and clinical interests include child maltreatment,
domestic violence, traumatic stress, and anxiety disorders.
CHILD MALTREATMENT / MAY 2005