Interventions to Support Children’s Recovery From Neglect: A Systematic Review

Child neglect involves a consistent failure to meet a child’s basic physical, medical, supervisory, emotional, or educational needs. Research overwhelmingly shows neglect impedes development in cognitive skills, self-regulation, learning, mental and physical health, and relationships.

These impacts arise from the absence of essential stimulation and nurturing during sensitive brain growth periods. Children affected struggle with disruptive behaviors, depression, attachment issues, and chronic diseases extending into adulthood.

This review aimed to identify any interventions used to help children recover from the negative sequelae of neglect in any of its forms. It was hoped this would shed light on possible mechanisms leading to recovery and inform a theory of change to support the development and use of interventions.

Jackson, A. L., Frederico, M., Cleak, H., & Perry, B. D. (2023). Interventions to Support Children’s Recovery From Neglect - A Systematic Review. Child Maltreatment, 0(0), 1-14. https://doi.org/10.1177/10775595231171617

Key Points

• Child neglect is extremely common globally with deeply concerning impacts, yet few studies exist on helping children recover.
• This systematic review found very limited research on interventions for children after neglect, despite extensive prevention focus.
• Of six reviewed studies, four tentative approaches showed some benefits: foster care, attachment parenting, community-based support and behavioral modification.
• Positive impacts were found in areas like mental health symptoms, cortisol regulation, neuroconnectivity, and disruptive behaviors.
• There remains an urgent need to prioritize research on interventions to ameliorate harm after children experience neglect.

Rationale

Child neglect has severe emotional, physical, cognitive, and social consequences, requiring major public health focus (Jackson et al., 2022; Krug et al., 2002).

However, past reviews found gaps in research testing interventions to help children after neglect, compared to prevention studies (Allin et al., 2005; Taussig et al., 2013).

Additionally, neglected children frequently experience other adversities like poverty, parental mental illness, or abuse. Disentangling specific developmental pathways requires considering the timing and interactions of cumulative risks (Lanier et al., 2018).

Trauma from chronic neglect may also show different brain patterns compared to acute violence (Lim et al., 2022).

This systematic review revisited the state of knowledge on existing or emerging efforts to support children following neglect, to elucidate ideas toward a theory of change.

The premise was understanding causal mechanisms behind children’s difficulties can optimize targets and techniques in interventions (Bush et al., 2016; Center on the Developing Child, 2016).

Understanding complex pathways to functional impairments is essential to build evidence-based recovery approaches for this prevalent child welfare challenge.

Both social justice and economic arguments compel investing in research and services focused on ameliorating neglect’s marked human and societal costs.

Method

This systematic review followed PRISMA guidelines (Preferred Reporting Items for Systematic Review and Meta-Analysis Statement) (Page et al., 2021), registering its protocol publicly.

Search terms were based on a past seminal review by Allin et al. (2005), but expanded beyond their searched databases.

The final search occurred in May 2022, with 3897 initial records distilled down to 8 reports meeting all inclusion criteria through a systematic screening process involving multiple independent coders.

Five key databases were searched for English studies from 2003-2022 reporting interventions and child outcomes after neglect.

Search Terms

• Primary search terms: “child* AND neglect* AND (treatment OR therapy OR intervention)”
• Additional search terms from past seminal review by Allin et al. (2005): ‘child neglect’, ‘treatment’, ‘therapy’, ‘intervention’
• Did not use ‘maltreatment’ due to being overly broad

Databases

• MEDLINE
• PsycINFO
• ERIC
• Sociological Abstracts
• EMBASE
• Cochrane Library
• Campbell Library

Inclusion criteria

• Published in English
• Published between 2003-2021
• Primary study using any research design
• Includes any subtype of neglect alone or with other maltreatment
• Distinguishes outcomes for neglected children
• Children 0-18 years old
• Living in any setting
• Intervention involves child and/or family
• Reports child-specific outcomes

Exclusion criteria

• Not published in English
• Not human research
• Does not distinguish neglect from other maltreatment
• Focuses only on neglect prevention
• Editorials, commentaries, literature reviews
• Conference presentations

Sample

Samples ranged from 10 kindergarteners (Pino et al., 2019) to 351 youths (Scivoletto et al., 2011) in Brazil. Most were young, vulnerable children in foster care or institutions.

Neglect definitions varied, frequently lacking detail on subtypes.

Results

Bucharest Early Intervention Program (BEIP) – 3 studies

• Children who received enriched foster care showed more secure attachments, fewer symptoms of reactive attachment disorder, and fewer internalizing difficulties compared to standard institutional care (Bos et al., 2011).
• Children in enriched foster care scored higher in verbal comprehension and overall IQ, especially if placed before 26 months old (Fox et al., 2011).
• Children who received enriched foster care showed more typical neural connectivity patterns involving cognitive functioning than standard care (Stamoulis et al., 2017).

Attachment and Biobehavioral Catchup (ABC) – 1 study

• Neglected children whose parents received attachment coaching showed more typical/healthier cortisol regulation patterns compared to standard parent training (Bernard et al., 2015).

The Equilibrium Project (TEP) – 1 study

• 63.5% of homeless youth completed this tailored community intervention, with 68.3% reuniting with family, attending school, avoiding drugs and behavior problems (Scivoletto et al., 2011).

Fostering Healthy Futures (FHF) – 1 study

• No evidence that skills training and mentoring were more effective for severely physically neglected foster youth (Taussig et al., 2013).

Incredible Years (IY) and Collaborative Co-Parenting – 1 study

• Trend for fewer behavior problems when biological and foster parents received IY parenting training and coparenting support, but not statistically significant (Linares et al. 2006).

Say-Do-Say Correspondence Training – 1 study

• Teachers rapidly reduced neglected kindergarteners’ classroom disruption through correspondence training at peer levels (Pino et al., 2019).

Insight

The review confirms an alarming gap in quality research on interventions to help children overcome developmental, emotional, relational, and other harms from neglect.

Very few studies exist that test ways to help children recover from neglect. However, early findings suggest things like high-quality foster care, attachment coaching for parents, intense support services, and simple behavior skills training show some benefits.

What’s missing is research that tracks different types of neglect and other hardships these children face. Understanding these differences can help match the best help to the specific needs.

Overall, the review shows an urgent need to prioritize research investment and policy focus on the lives of children affected by this prevalent issue. Both prevention and recovery approaches are essential to support healthy development.

Strengths

• Established systematic review methodology with registered protocol
• Breadth of inclusion criteria on interventions, outcomes and neglect types
• Multiple independent coders and bias assessment
• Built on past seminal review of the topic

Limitations

• Did not search all relevant databases like Cochrane or Sociological Abstracts
• Excluded potentially relevant non-English reports
• Did not search reference lists for additional sources
• Lacked in-depth critical analysis on methodology factors

Implications

Findings provide a rationale to continue studies on enriched caregiving, neurobiology-informed interventions, tailored community approaches, and simple behavioral modification following neglect. The key will be parsing impacts and mechanisms specific to neglect subtypes and co-occurring adversities.

Involving communities in participatory research can optimize the cultural relevance of interventions with marginalized groups.

1. Consider enhanced foster care placements prioritizing stable, nurturing caregiver relationships and enrichment activities tailored to the child’s developmental needs. The multiple studies on the Bucharest Early Intervention Program model showed significant cognitive, attachment, and neural benefits compared to regular institutional care.
2. Attachment-informed parenting programs like Attachment and Biobehavioral Catchup (ABC) seem promising for helping young children regain biological regulation capacities through explicit coaching of caregivers on responsive, synchronous behaviors. Assessing stress reactivity via cortisol sampling could track impacts.
3. Explore intensive wraparound community services drawing on multiple disciplines for older youth, perhaps with mentors who have lived experience. Scivoletto et al. showed such approaches may reconnect marginalized teens with family and education, reducing risk behaviors.
4. Even brief, focused interventions like Say-Do-Say Correspondence Training in classrooms could swiftly remediate disruptive conduct in neglected students to peer norms. This minimizes the need for family coordination while problems persist.
5. In the future, routinely track and report intervention impacts specific to neglect subtypes and co-occurring adversities. This parsing will sharpen recommendations on which approaches work best for whom. Tracking recovery using biometric markers, neuroimaging and epigenetics may further elucidate change mechanisms.

References

Primary reference

Jackson, A. L., Frederico, M., Cleak, H., & Perry, B. D. (2023). Interventions to Support Children’s Recovery From Neglect – A Systematic Review. Child Maltreatment, 0(0), 1-14. https://doi.org/10.1177/10775595231171617

Other references

Allin, H., Wathen, C. N., & MacMillan, H. (2005). Treatment of child neglect: A systematic review. Canadian Journal of Psychiatry Revue Canadienne de Psychiatrie, 50(8), 497-504.

Arruabarrena, M. I., de Paúl, J., & Torres, B. (1993). Criterios de valoración de riesgo en situaciones de maltrato y/o abandono Infantil. Dirección General de Protección Jurídica del Menor Ministerio de Asuntos Sociales.

Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining child maltreatment: The interface between policy and research. In D. Cicchetti & S. L. Toth (Eds.), Child abuse, child development, and social policy (Vol. 8, pp. 7-73). Ablex Publishing.

Bernard, K., Dozier, M., Bick, J., & Gordon, M. K. (2015). Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial. Development and Psychopathology, 27(3), 829-841.

Bos, K., Zeanah, C. H., Fox, N. A., Drury, S. S., McLaughlin, K. A., & Nelson, C. A. (2011). Psychiatric outcomes in young children with a history of institutionalization. Harvard Review of Psychiatry, 19(1), 15-24.

Brunk, M., Henggeler, S., & Whelan, J. P. (1987). Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of consulting and clinical psychology, 55(2), 171–178.

Bush, N. R., Lane, R. D., & McLaughlin, K. A. (2016). Mechanisms underlying the association between early life adversity and physical health: Charting a course for the future. Psychosomatic medicine, 78(9), 1114-1119.

Center on the Developing Child at Harvard University (2016). From Best Practices to Breakthrough Impacts: A Science-Based Approach to Building a More Promising Future for Young Children and Families. http://www.developingchild.harvard.edu

Committee for Children (2001). Second Step. Committee for Children.

Culp, R. E., Heide, J., & Richardson, M. T. (1987). Maltreated children’s developmental scores: Treatment versus nontreatment. Child Abuse & Neglect, 11(1), 29–34.

Daniel, B., Taylor, J., & Scott, J. (2011). Recognizing and helping the neglected child: Evidence-based practice for assessment and intervention. Jessica Kingsley Publishers.

DePanfilis, D. (2006). Child neglect: A guide for prevention, assessment, and intervention. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, Office on Child Abuse and Neglect.

Di Cola, K., & Clayton, M. (2017). Using arbitrary stimuli to teach say-do correspondence to children with autism. International Journal of Psychology and Psychological Therapy, 17(2), 149–158.

Dubowitz, H., Pitts, S.C., Litrownik, A.J., Cox, C.E., Runyan, D., & Black, M.M. (2005). Defining child neglect based on child protective services data. Child Abuse & Neglect, 29(5), 493-511.

Fallon, B., Lefebvre, R., Filippelli, J., Joh-Carnella, N., Trocmé, N., Carradine, J., & Fluke, J.D (2021). Major findings from the Ontario incidence study of reported child abuse and neglect 2018. Child Abuse & Neglect, 111.

Fantuzzo, J. W., Sutton-Smith, B., Atkins, M., Meyers, R., Stevenson, H., Coolahan, K., Weiss, A., & Manz, P. (1996). Community-based resilient peer treatment of withdrawn maltreated preschool children. Journal of Clinical and Consulting Psychology, 64(6), 1377-1386.

Fox, N. A., Almas, A. N., Degnan, K. A., Nelson, C. A., & Zeanah, C. H. (2011). The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: findings from the Bucharest Early Intervention Project. Journal of Child Psychology and Psychiatry, 52(9), 919–928.

Frederico, M., Jackson, A., & Jones, S. (2006). Child death group analysis: Effective responses to chronic neglect. Office of the Child Safety Commissioner, Melbourne.

Funnell, S.C. & Rogers, P.J. (2011). Purposeful program theory: Effective use of theories of change and logic models. John Wiley & Sons.

Gershater-Molko, R.M., Lutzker, J.R., & Wesch, D. (2003). Project SafeCare: Improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence, 18(6), 377-386.

Gunnar, M. R., Morison, S. J., Chisholm, K., & Schuder, M. (2001). Salivary cortisol levels in children adopted from Romanian orphanages. Development and psychopathology, 13(3), 611-628.

Herman, J. L. (1992). Trauma and recovery: The aftermath of violence–from domestic abuse to political terror. Basic Books.

Horwath, J. (Ed.). (2013). Child neglect: Planning and intervention. Springer.

Jackson, A. L., Frederico, M., Cleak, H., & Perry, B. D. (2022). Childhood neglect and its implications for physical health, neurobiology and development—a scoping review of the literature. Developmental Child Welfare, 4(2), 114-135.

Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (Eds.). (2002). World report on violence and health. World Health Organization.

Kusché, C. A., & Greenberg, M. T. (1994). The PATHS Curriculum. Developmental Research and Programs.

Lanier, P., Maguire-Jack, K., Lombardi, B., Frey, J., & Rose, R. A. (2018). Adverse childhood experiences and child health outcomes: Comparing cumulative risk and latent class approaches. Maternal and Child Health Journal, 22(3), 288-297.

Lederman, N. G., & Lederman, J. S. (2016). Publishing findings that are not significant: Can non-significant findings be significant?. Journal of Science Teacher Education, 27(4), 349-355.

Linares, L. O., Montalto, D., Li, M., & Oza, V. S. (2006). A promising parenting intervention in foster care. Journal of Consulting and Clinical Psychology, 74(1), 32–41.

Lipsey, M. W., & Pollard, J. A. (1989). Driving toward theory in program evaluation: More models to choose from. Evaluation and Program Planning, 12(4), 317-328.

Maguire, S. A., Williams, B., Naughton, A. M., Cowley, L. E., Tempest, V., Mann, M. K., Teague, M., & Kemp, A. M. (2015). A systematic review of the emotional, behavioural and cognitive features exhibited by school-aged children experiencing neglect or emotional abuse. Child: Care, Health and Development, 41(5), 641-653.

Naughton, A. M., Cowley, L. E., Tempest, V., Maguire, S. A., Mann, M. K., & Kemp, A. M. (2017). Ask Me! Self-reported features of adolescents experiencing neglect or emotional maltreatment: A rapid systematic review. Child: Care, Health and Development, 43(3), 348-360.

Nelson, C.A., Fox, N.A., & Zeanah, C.H. (2014). Romania’s abandoned children. Harvard University Press.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372.

Perry, B. D. & Pollard, R. (1998) Homeostasis, stress, trauma, and adaptation. A neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 7(1), 33-51.

Pino, M. J., Herruzo, J., & Herruzo, C. (2019). A new intervention procedure for improving classroom behavior of neglected children: say do say correspondence training. International journal of environmental research and public health, 16(15), 2688.

Proctor, L. J., & Dubowitz, H. (2014). Child neglect: Challenges and controversies. In J. E. Korbin & R. D. Krugman (Eds.), Handbook of child maltreatment (pp. 27-61). Springer.

Reams, R., & Friedrich, W. (1994). The efficacy of time-limited play therapy with maltreated preschoolers. Journal of Clinical Psychology, 50(6), 889-899.

Sanders, M. R., Pidgeon, A. M., Gravestock, F., Connors, M. D., Brown, S., & Young, R. W. (2004). Does parental attributional retraining and anger management enhance the effects of the Triple P-Positive Parenting Program with parents at risk of child maltreatment?. Behavior therapy, 35(3), 513-535.

Scivoletto, S., da Silva, T. F., & Rosenheck, R. A. (2011). Child psychiatry takes to the streets: A developmental partnership between a university institute and children and adolescents from the streets of São Paulo, Brazil. Child Abuse & Neglect, 35(2), 89-95.

Semsar, N., Mousavi, Z., Tran, M.-L. M., & Kuhlman, K. R. (2021). Dysregulated arousal as a pathway linking childhood neglect and clinical sleep disturbances in adulthood. Child Abuse & Neglect, 122.

Stamoulis, C., Vanderwert, R. E., Zeanah, C. H., & Nelson, C. A. (2017). Early psychosocial deprivation negatively impacts brain development: A quantitative magnetic resonance imaging study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 80, 113-119.

Tanner, K., & Turney, D. (2006). Therapeutic interventions with children who have experienced neglect and their families. In C. McAuley, P. J. Pecora, & W. Rose (Eds.), Enhancing the well-being of children and families through effective interventions. Jessica Kingsley Publishers.

Taussig, H. N., & Culhane, S. E. (2010). Impact of a mentoring and skills group program on mental health outcomes for maltreated children in foster care. Archives of pediatrics & adolescent medicine, 164(8), 739-746.

Taussig, H. N., Weiler, L. M., Garrido, E. F., Rhodes, T., Boat, A., & Fadell, M. (2019). A positive youth development approach to improving mental health outcomes for maltreated children in foster care: replication and extension of an RCT of the fostering healthy futures program. American journal of community psychology, 64(3), 411-422.

Taussig, H. N., Culhane, S. E., & Petrenko, C. L. M. (2013). Does severity of physical neglect moderate the impact of an efficacious preventive intervention for maltreated children in foster care? Child maltreatment, 18(1), 56-64.

Tinker, E. C. (2019). Exploring the mechanisms of a family-centered behavioral intervention for behavioral sleep problems in young children [Doctoral dissertation, Loyola University Chicago]. Loyola eCommons Dissertations.

Udwin, O. (1983). Imaginative play training as an intervention method with institutionalised preschool children. British Journal of Educational Psychology, 53(1), 32–39.

Webster-Stratton, C. (2001). The Incredible Years: Parents, teachers and children training series. Carolyn Webster-Stratton.

Webster-Stratton, C., & Reid, M. J. (2010). Adapting the Incredible Years, an evidence-based parenting programme, for families involved in the child welfare system. Journal of Children’s Services, 5(1), 25-42.

Widom, C. S. (2013). Translational research on child neglect: Progress and future needs. Child Maltreatment, 18(1), 3-7.

Keep Learning

• What theories of change show most promise in guiding interventions for different neglect subtypes?
• How can technology like mobile apps or telehealth improve access and quality of interventions with neglected children?
• What unique ethical dilemmas exist in conducting experimental research with neglected youth compared to other clinical trials?
• How might concepts like structural competency or antiracism be incorporated into interventions with marginalized families?
• What role can lived experience play in research codesign and peer delivery models for child neglect support services?