Effects of the Nurturing Environment in Maltreating Families

(Originally published April 2019)

All child maltreatment has an emotional dimension which both reflects and shapes the relationships in which various types of abuse and neglect occur. Caregivers may intend to punish and suppress specific misbehaviors without doing emotional harm to children, but this is a virtual impossibility when physical abuse or neglect is severe and/or chronic. Sexual abuse is both a physical and emotional violation and, as such, indicates a disregard for the well being of victims.  Consequently, the emotional harm and developmental harm resulting from child maltreatment is often more serious and long lasting than physical injuries; and emotional harm, in turn, can have negative effects on physical health and mental/emotional functioning throughout the life span.

 

The emotional milieu in which child maltreatment occurs varies greatly. Consider the differences in caregivers’ feelings about children between and among the following types of physical abuse:

 

  • Excessive punishment – a child receives a “hard” spanking for misbehavior; the child understands that the spanking is discipline; the caregiver’s intended message to the child is that “this behavior is not acceptable and deserves punishment.”

  • Excessive punishment combined with rejection – a child is harshly punished and verbally attacked as well; harsh punishment conveys the caregiver’s belief that the child is bad, not deserving of love and nurturing care. Physical abuse in these circumstances is an attack on the child’s character and self-esteem; and includes the message that the family would be better off without the child.  

  • Excessive punishment with rejection and scapegoating – a child may be physically and emotionally attacked by all family members, including siblings, and blamed for all the ills of the family. The family becomes emotionally cohesive, i.e., purges internal tensions, through pervasive physical abuse and emotional abuse of the victim.

  • Torture – a child is physically abused and/or starved, humiliated and demeaned to break the child’s will, and because caregivers derive enjoyment from hurting the child. All torture includes a determined attempt to humiliate and “break” the victim regardless of any rationale offered for perpetrators’ actions.

  

Rejection in childhood has been found to increase children’s hostility and aggressive behaviors in cultures around the world, a theme explored in-depth by James Garbarino in some of his early books.

 

Some physical abuse and emotional abuse of children is not discipline. Spanking, shaking, slapping or pinching a baby for crying is not discipline; ditto for punishing a toddler for falls, or a school age child for curiosity and initiative, or an adolescent for an interest in sex. Punishing children for developmentally appropriate activities is abusive, even when the punishments are mild, and more so when punishment is harsh and emotionally hurtful.  

 

The Science of Neglect

 

In 2012, The Center for the Developing Child at Harvard issued a report titled The Science of Neglect that summarizes several decades of research regarding the effects of neglect on early brain development. The authors emphasize young children’s need for consistent “serve and return” responsive relationships with care-givers. The report asserts that “Because responsive relationships are developmentally expected and biologically essential, their absence signals a serious threat to child well-being, especially during the earliest years …” The report warns that the combination of unresponsive parenting with traumatic stress in early childhood has physiological effects “which can have lifelong consequences.” These consequences include cognitive delays, impairments in executive functioning, disruption of the body’s stress response, difficulty in trusting caregivers and compromised physical health. Chronically neglected children have “difficulty in regulating attention” and in willingness to persist in problem solving when faced with frustration. Emotion regulation is as much a challenge for severely neglected children as it is for children traumatized by violence, according to trauma experts such as Bruce Perry, Deborah Gray and Anne Gearity.  Many foster children have been both severely neglected during their early years and physically abused and/or sexually abused as well before they enter kindergarten.   

 

The Science of Neglect utilizes a typology of neglect:

 

  • Occasional inattention

  • Chronic under-stimulation

  • Severe neglect in a family context

  • Severe neglect in an institutional setting

 

Severe neglect in a family context usually includes inadequate physical care across multiple child care domains, and an absence of responsive parent-child interactions due to substance abuse, a parent’s chronic mental illness or a pattern of family violence. Some readers may have seen “blank face” videos in which a parent is instructed to present her baby with a blank face when the child reaches out for attention and affection. Babies in these videos sometimes become physiologically dysregulated as indicated by drooling and other signs of distress in less than a minute!  Nevertheless, substance abusing parents and mentally ill parents vary greatly in their capacity for emotionally responsive interactions with their children.  When these “serve and return” interactions between a parent and baby or toddler child become infrequent (or non-existent) the risk of serious long-lasting emotional harm and physical harm to a young child greatly increases.  Conversely, when a troubled parent can consistently maintain affectionate and responsive interactions with their child during periods of sobriety or when mood disorders recede, this is a tremendously encouraging sign that should be recognized, praised and rewarded by practitioners and other professionals. These parents deserve all the help and emotional support caseworkers and other professionals have at their disposal.

 

The Science of Neglect maintains that “severe neglect appears to be at least as great a threat to health and development as physical abuse, possibly even greater ….”  The last thing any knowledgeable person should be doing is minimizing the effects of chronic neglect on children to promote an ideological agenda. The authors of this report comment that “Despite … advances in scientific knowledge about the short term and long-term consequences of significant deprivation and the importance of prompt intervention, most child welfare agencies have limited capacity to address the developmental needs of young children who have been reported for neglect.”

 

The deficiencies of child welfare intervention with chronically neglected children in Washington State go beyond a lack of resources. Washington State’s neglect statute does not even explicitly mention or define emotional abuse or neglect, an unusual omission among state statutes reflecting a serious lack of understanding of child maltreatment.

 

How children perceive the nurturing environment

 

By age 1, babies have a well-developed attachment style, i.e.,

secure, anxious, ambivalent or disorganized, that is both a survival strategy and a way of interacting with caregivers that maximizes rewards and minimizes punishment and disappointment.  It may seem a stretch to maintain that children as young as 1 year old embody an assessment of their caregivers’ nurturing capacities in an attachment style, but it is a mistake to underestimate the emotional sensitivity and cognitive capacity of young children.  Securely attached children expect caregivers to be available and responsive while anxiously attached children seek to be self-reliant; they do not view their caregivers as consistent and responsive when they are in pain or feel insecure.  Children with an ambivalent attachment style may “dog” the steps of caregivers every waking moment when possible because they lack confidence a caregiver will remember to check in with them frequently.

 

Children who have been repeatedly abused or neglected by caregivers often display disorganized attachment, sometimes alternating between physical attacks on caregivers and infantile cuddling behavior with the caregiver they just attacked. According to Deborah Gray, “children with disorganized attachments tend to have a sense of helplessness in their relationship with their parents.” These children easily become “fearful, frozen, and disoriented” and “are often more upset by the arrival of the parent than comforted.”  (p.133, Nurturing Adoptions)  

 

Children of all ages have vivid impressions of family life that includes the good, the bad and the ugly. The ‘Three Houses’ tool

was developed in New Zealand in 2003. It is widely utilized in Signs of Safety, a child protection practice model developed in Australia and implemented in many child welfare agencies around the world, to elicit children’s views of Worries, Strengths and Good Things and Hopes and Dreams regarding their family. Experts in the use of ‘Three Houses’ caution that “It is important to remember that the … tool is about creating an opportunity for the child’s views to be heard, not for information gathering needs to be met.”  In other words, the ‘Three Houses’ is not a fact-finding investigative tool.

    

 

                                     

 

 

 

 

 

 

 

 

 

 

 

Children may be asked to draw houses or be presented with three houses as above. Children then fill the houses with drawings or words that describe their worries, experiences of well- being and hopes and dreams for their family.                                                           

 

House of Worries

 

The following is a drawing by two Dutch children (ages 7 & 10).  On the roof, they depict their mother crying in distress. They also describe being locked by their mother’s boyfriend in cold stables outside the home with a scary black dog.  

 

 

 

 

 

 

 

 

                     

House of Good Things  

The children describe spending enjoyable time with their biological father. The boy is kicking a soccer ball. They have a bedroom in the attic which they like.                        

  

 

 

 

 

 

 

 

 

 

 

 

 

House of Hopes & Dreams

 

The oldest child’s drawing shows her and her brother living with their mother in a home with lots of toys and activities. Her younger brother’s drawing (not shown below) includes 2 large dogs for protection.      

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The ‘Three Houses’ is a powerful way of communicating with parents regarding the experiences of their children associated with substance abuse and family violence. It is next to impossible for parents to continue in denial regarding the emotional effects of drug/alcohol abuse and family violence on their children when they view the stories outlined in ‘Three Houses’. In addition, there is a bridge between the House of Good Things and the House of Hopes and Dreams. Solutions come from family strengths, though an emotion laden House of Worries created by a child may sometimes motivate parents to change their lives in a fundamental way.

 

In my experience, the ‘Three Houses’ is one of very few tools

whose use caseworkers frequently enthusiastically endorse. Helping maltreated children reveal their inner lives can be a revelation to caseworkers ordinarily focused on child behavior and safety planning that ignores the child’s perspective.  

 

Effects of the Nurturing Environment on Children’s Beliefs

 

All children form deep seated beliefs regarding themselves, their caregivers and the world around them based on their early experiences. Severely and/or chronically maltreated children develop beliefs about themselves and about other people that have long term consequences and are often difficult to undo. Maltreated children may also be deeply affected by the mistreatment of their siblings. Capernaum (2018), is an extraordinary movie about a destitute refugee family in Beirut, Lebanon.  The oldest child of several siblings, Zain (12 years old), sues his parents for giving him life after the death of his 11-year-old sister during pregnancy. The movie shows this boy unsuccessfully attempting to prevent his parents from marrying off his sister in exchange for rent.  After her death, Zain stabs his sister’s husband and denounces his parents for exploiting their children.  At age 12, Zain has concluded that “life is shit”, but his words are not as eloquent as his facial expression toward the end of the movie, a combination of anger, disgust, disillusionment and resignation. Zain’s reflections on the world of his family and community seem as well founded as they are dysfunctional. Zain has a strong nurturing streak, but he is also vengeful and violent. The beliefs of severely maltreated children are unlikely to change unless their experience of family life changes, but their beliefs regarding the unworthiness of caregivers often undermine the capacity for intimacy.

 

Some children and adults who have been severely maltreated are beaten down and deeply ashamed rather than angry and violent. The main character in Marilynne Robinson’s novel, Lila (2014), was a neglected child who has no memory of her biological parents. She is stolen from a home where she is on the verge of death by a drifter and raised by this woman (named Doll) in abject poverty.  She spends three years in a whorehouse doing menial chores. Lila can hardly tolerate being noticed by others, much less being the center of attention at a baptism or wedding. Lila marries an elderly preacher who treats her with loving kindness, yet Lila believes she is unlovable, as close to nothing as a person can be. She expects her elderly husband to come to his senses at any moment and send her away. Lila defends herself from disappointment in the only way she knows how, i.e., through painful self-reflection. Lila thinks that “I don’t want to live in some town where people know about me and think I’m like an orphan left on the church steps, waiting for someone to show some kindness … I got shame like a habit, the only thing I feel except when I’m alone.” Lila’s belief that she is unworthy of love must be repeatedly disconfirmed by her compassionate husband, who himself believes he may be abandoned by his much younger wife.

 

It is not enough to manage and reshape the behavior of maltreated children. Caseworkers, therapists and foster parents need to discern the beliefs of children and youth that underlie their challenging behaviors, make these beliefs explicit to the child and repeatedly dis-confirm them. Evidenced based programs can begin this process but they cannot complete it. Children and youth will stubbornly hang on to dysfunctional beliefs, and often attempt to provoke foster parents, adoptive parents and professionals into confirming that “it would have been better if I was never born.”  

 

In my next Sounding Board, I will discuss emotional maltreatment.

 

References  

Garbarino, J.& Eckenrode, J., Understanding Abusive Families: An Ecological Approach to Theory and Practice (1997), Jossey-Bass, San Francisco, California. This book was first published in 1980.   

 

Gray, D., Nurturing Adoptions (2007), Perspectives Press, Indianapolis, Indiana. There is a more recent edition of this book.

 

Labaki, N., Director, Capernaum (2018), Les Films des Tournelles & Doha film Institute.

 

Robinson, M., Lila (2014), Farrar, Straus & Giroux, New York, NY.

 

Weld, N. & Parker, S. (?), Using the ‘Three Houses’ Tool: Involving Children and Young People in Child Protection Assessment and Planning, SP Consultancy; available on line w permission to use its materials   

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