The specific problems that you may see will vary depending upon the nature, intensity, duration and timing of the neglect and abuse.  They may also differ from child to child.  Some children will have profound and obvious problems, while some will have very subtle problems that you may not realize are related to early life neglect.  Sometimes, these children do not appear affected by their experiences.  However, it is important to remember the reason you are working with the children and that they have been exposed to terrible things.  There are some clues that experienced clinicians consider when working with these children. 

Developmental delays: Children experiencing emotional neglect in early childhood often have developmental delays in other domains as well.  The bond between the young child and caregivers provides the major vehicle for a child’s development.  It is in this primary context that children learn language, social behaviors, and many other key behaviors and skills required for healthy maturation.  Lack of consistent and enriched experiences in early childhood can result in lags in physical, motor, language, emotional, social, and cognitive development.

Eating:  Atypical eating behaviors are common, especially in children with severe neglect and attachment problems.  They will hoard food, hide food in their rooms, eat as if there will be no more meals--even if they have had years of consistent available foods.  They may have failure to thrive, rumination (throwing up food), swallowing problems and, later in life, unusual eating behaviors that are often misdiagnosed as anorexia nervosa.

Soothing behavior: These children will use very primitive, immature, and seemingly bizarre soothing behaviors.  For example, they may scratch or cut themselves, bite themselves, head bang, rock, or chant.  These symptoms will increase during times of distress or threat.

Emotional functioning: A range of emotional problems is common among these children, including symptoms of depression and anxiety.  One common behavior is “indiscriminant” attachment.  All children seek safety.  Keeping in mind that attachment is important for survival; children may seek attachments-- any attachments--for their safety.  Non-clinicians may notice abused and neglected children are “loving” and hug virtual strangers.  Children do not develop a deep emotional bond with relatively unknown people; rather, these "affectionate" behaviors are actually safety-seeking behaviors.  Clinicians become concerned because these behaviors contribute to the abused child’s confusion about intimacy and are not consistent with normal social interactions.  Furthermore, although the child seeks safety, these inappropriately affectionate behaviors can, ironically, put the child in very dangerous situations.

Inappropriate modeling:  Children model adult behavior--even if it is abusive.  They learn abusive behavior is the “right” way to interact with others.  As you can see, this potentially causes problems in their social interactions with adults and other children.  For children that have been sexually abused, they may become more at-risk for future victimization.  Males that have been sexually abused may become sexual offenders.

Aggression:  One of the major problems with neglected, poorly attached children is aggression and cruelty.  This is related to two primary problems in neglected children: (1) lack of empathy and (2) poor impulse control.  Empathy, or the ability to emotionally "understand" the impact of your behavior on others, is impaired in these children.  They really do not understand or feel what it is like for others when they do or say something hurtful.  Indeed, these children often feel compelled to lash out and hurt others-- most typically something less powerful than they are.  They will hurt animals, smaller children, peers, and siblings.  One of the most disturbing elements of this aggression is that it is often accompanied by a detached, cold lack of empathy.  They may show regret (an intellectual response) but not remorse (an emotional response) when confronted about their aggressive or cruel behaviors.

IMPORTANT NOTE: