Neglect and Adolescent Mental Health: Testing Competing Longitudinal Hypotheses

Background: Neglect remains understudied despite being the most common form of child maltreatment with comparable harms to psychosocial wellbeing that are comparable to other forms of maltreatment, including physical and sexual abuse (Vachon et al., 2015). For resource-strapped child protective services, neglect cases are often deprioritized, including cases in which neglect may be ongoing over long periods of child development. This contradiction makes it critical to understand both the impacts of neglect and how it imparts harm. This study will test two competing hypotheses: 1) that there is a critical period in which neglect is most damaging to mental health; 2) the cumulative hypothesis that chronic neglect over multiple developmental periods erodes mental health more. We hypothesized that early childhood experience of neglect would impact mental health the most.

Methods: We utilized LONGSCAN data, a collaboration between six sites that collected prospective data from early childhood through adolescence to examine the effects of child maltreatment. To test our hypotheses, we followed a rigorous model-testing method proposed by Gita Mishra et al. (2009) that uses combinations of dummy variables for experiences of neglect (failure to provide, lack of supervision; FTP, LOS) between ages 0-4, 4-8, 8-12, and 12-16. Model statistics are then compared for nested models (with and without control variables, e.g., gender, race, poverty, abuse, foster care) representing the competing hypotheses for two outcomes assessing mental health symptoms: depression (CESD) and post-traumatic stress symptoms (TSC) at ages 12 and 16.

Results: A complex picture of neglect’s effect on mental health emerged based on age of outcomes, symptom, type of neglect, and covariates. For depression, results for FTP neglect supported the critical period of 4-8 and the critical period of 0-4 for LOS. At age 16, the best models for FTP was accumulated risk for FTP and the critical period of 12-16 for LOS. Post-traumatic stress symptoms were more consistent. For both types of neglect at age 12, the best model was the critical period of 0-4. For age 16, the same model fit best for the effects of LOS neglect, whereas the accumulated risk model for FTP neglect for ages 0-12 was the best-fitting model. These results were largely consistent with covariates.

Discussion: Neglect imparted significant harm on MH symptoms for all outcomes, even when controlling for other forms of abuse. In some cases, accumulated effects of chronic neglect over multiple developmental periods were most harmful, contrary to our hypotheses. However, critical period effects of early childhood were seen for some models, especially of post-traumatic symptoms and depression at age 12. Interestingly, adolescence emerged as a critical period for depression at age 16, underscoring the importance of continued parental engagement during adolescence. For child welfare, these results show the importance of intervening in neglect across all time periods, especially in cases where chronic neglect has been occurring throughout childhood. While this study yields nuanced results, they clearly indicate the negative impact of ongoing neglect and highlight the importance of addressing neglect throughout development stages from birth through adolescence.