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The DfE published chapter and verse research on the impact of neglect in 2014 (Brandon et al – Childhood Wellbeing Centre). Of particular interest to adopters and special guardians are the long term consequences of childhood neglect as it is us who must live with them. Neglect has far reaching consequences, which must be factored into support for us by policymakers and legislators, who need to ensure we receive it. Instead of support however it can seem that children’s services suffer with ‘organisational amnesia’ and ‘silo approaches’ are taken where information is not shared and used throughout the organisation. It is a shame, and perhaps indicative of the skewed priorities of government and the DfE, that no consideration is given in this DfE report as to what sort of support will actually be needed for those parenting and caring for previously looked after children – where the problems arising from neglect may manifest, sometimes years later in adolesence, as attachment disorder, PTSD, anxiety, depression, ADHD or child to parent violence.

The system is failing us and we need the Adoption and Special Guardianship Leadership Board to let us in, so we can tell them about the problems we are experiencing and the gaps we fall through. Enough of political hyperbole and the rhetoric of ‘positivity’, we need formal policy evaluation that service users can feed into, which asks the right questions. We need to be able to learn from where the system is not working in order to improve it.

Of course the system may fail children who go into care too. With no one to look out for a child – who will fight to ensure they receive the help and therapy they need? As Dame Christine Lenehan pointed out in the recent SCIE project on Mental Health of Children in Care, which she co-chaired, there is often no commissioning for children in care because no one commissions into a vacuum. So there can be very serious corporate neglect.

The way to resolve a silo organisational culture is with better transparency and the development of shared goals. Therein lies the problem. The DfE and various Regional Boards offer no transparency at all and it seems their priorities may not be focused on supporting families in the years that follow the Adoption Order and on into the child’s adulthood.  Match funding from LAs with the Adoption Support Fund is far too low to suggest any real commitment to post adoption support. Just one child re- entering care, or going into secure accommodation, may involve expenditure that is greater than all adopted children have received throughout England. This makes no sense.

An Adoption Order is permanent but the Special Guardian Order ends when the child is 18, which is when children’s services cease being involved. The Adoption Support Fund finishes at 21, or 25, if there are special educational needs/ an EHC Plan. There is a gap here where support services are not in synch.  What does this mean for the child and family?  We are extremely concerned also that special guardians seem to get very little attention – none in this report on neglect – and are so often an afterthought or ‘add on’.

With no requirement for Local Authorities to do anything other than assess us, when we ask for help, we can end up in big trouble as families – as we are so often on the verge of crisis by the time support is requested, and an assessment may take several months or more to complete. Assessment is not support and may not lead to it either, especially if there is a ‘silo mindset’ and a solely ‘child focused’ approach, instead of  the organisation properly getting behind us and providing whole family support. We suggest that a more holistic approach is needed. We would like to see the DfE and children’s services becoming more long term and more family centred in their focus.

When considering the impact of neglect, it is not sufficient to simply ignore the past and expect adopters and special guardians to battle for support, be unable to access respite without our children having to re-enter care (with the destabilisation and added trauma this brings), worry about being blamed and overly critical approaches, and struggle to be heard at all by the Adoption and Special Guardian leadership and Regionalisation Boards – not when there is so much knowledge about the harm neglect does. Here is an excerpt from pages 7-9 of the Brandon Report commissioned by the DfE:

“Neglect is considered to be at least as damaging, if not more so, than other forms of maltreatment because its impact is the most far-reaching and difficult to overcome (Gilbert et al., 2009). Neglect in the early years may be the most damaging from the point of view of long-term mental health or social functioning.

Impact of neglect on children’s development

Neglect is rarely life threatening but has the potential to compromise a child’s development significantly, across multiple domains. Because neglect frequently coexists with other forms of maltreatment, it can be difficult to disentangle its unique consequences. Nevertheless, there is now a relatively robust consensus based on a range of empirical evidence that demonstrates its adverse impact on all the seven dimensions of development identified in the Assessment Framework: health, education, identity, emotional and behavioural development, family and social relationships, social presentation and self-care skills (see Tanner and Turney, 2003; Norman et al., 2012; Hildyard and Wolfe, 2002; Manly et al., 2001).

While neglect is thought to be particularly damaging in the first two to three years of life – a formative period for social, emotional and neurobiological development – it can compromise development throughout childhood and adolescence. There is good evidence from animal studies and increasing evidence from human studies that exposure to neglect, often alongside other forms of maltreatment, is associated with alterations in the development of the hypothalamic-pituitary-adrenal (HPA) axis stress response and differences in brain structure and function. Importantly it is thought that such changes serve to biologically embed vulnerability that may only later manifest in mental health problems (see for instance McCrory et al., 2010; McCrory et al, 2012).

Persistent, severe neglect indicates a breakdown or a failure in the relationship between parent and child. This may be reflected in maladaptive attachment patterns; for example, neglected children are as likely as children maltreated in other ways to develop disorganised attachment styles (Barnett, Ganiban and Cicchetti, 1999). However, they differ from other maltreated children in that they show more evidence of delayed cognitive development, poor language skills, and poor social skills and coping abilities (Hildyard and Wolfe, 2002). They may also present as dependant and unhappy, and display a range of pathological behaviours (see Egeland et al, 1983; Ward, Brown and Westlake, 2012). Children who are neglected from early infancy may find that as their need for nurturing or responsive relationships goes ignored, they withdraw from relationships, feel a greater sense of failure and may even blame themselves for the neglect they experience (Manly et al, 2001).

There is some evidence that children who experience neglect without other forms of maltreatment have worse outcomes than those who are both neglected and physically abused (Egeland and Sroufe, 1981). Later in this paper we explore the observable indicators which signal impairment in pre-school aged children who are experiencing neglect.

Cumulative impact

The impact of neglect is not only widespread, affecting a wide range of developmental domains, it is also cumulative. Neglected infants and toddlers show a dramatic decline in overall developmental scores between the ages of 9 and 24 months (Egeland and Sroufe, 1981; Naughton et al, 2013). They also show a progressive decline in their cognitive function throughout the pre-school years (Strathearn et al, 2001). Neglected infants who initially display secure attachments increasingly develop insecure and disorganised attachment styles as they grow older (Howe, 2005). These findings imply that the longer pre-school children are exposed to neglect, the greater will be the harm. Longer duration of neglect has also been associated with an increased pattern of neural reactivity to social threat (McCrory et al., 2012).

Hindley and colleagues’ systematic review of risk factors for the recurrence of maltreatment highlights the cumulative nature of neglect since it is the most likely form of maltreatment for a child to re-experience (Hindley et al, 2006).

Long-standing consequences

Finally, neglect in the early years has long-standing consequences that can endure throughout childhood, adolescence and well into adulthood (Stein et al, 2009; Rees et al, 2011). Neglected babies and toddlers may develop both internalising (depressed, withdrawn, lacking in self-confidence) and externalising (acting out, aggressive, impulsive) behavioural problems in later childhood (English et al., 2005). Kotch and colleagues (2008) for example, have noted that ‘child neglect in the first two years of life may be a more important precursor of childhood aggression than later neglect or physical abuse at any age’ (p.725). Childhood aggression in turn is closely associated with adolescent violence and delinquency (Broidy et al., 2003). Anti-social behaviour and ADHD symptoms displayed by neglected and physically abused children may endure into adulthood, and both groups are significantly more likely to be arrested for violent offences than their peers (Widom, 1989).

Neglect in childhood is also associated with a range of mental health problems in adulthood. As adults, neglected children are more likely to develop major depressive disorders (Widom et al., 2007) and post-traumatic stress disorder (Widom et al., 1999). Physical neglect in childhood is associated with greater functional and social impairment in adults with schizophrenia (Gil et al., 2009). Robust evidence has also been found for relationships between childhood neglect and anxiety disorders, suicide attempts, substance misuse, risky sexual behaviours and sexually transmitted infections in adulthood (see Norman et al., 2012 for further details). There are also long term physical consequences of neglect in adulthood which can include an increased risk of hypertension, and chronic pain syndromes (Anda et al., 2006).