Dubowitz, Howard MD, MS; Black, Maureen M. PhD; Kerr, Mia A. MS; Starr, Raymond H. Jr PhD; Harrington, Donna PhD
Objective: To examine the association between father involvement and child neglect.
Design: Cohort study.
Setting: Participants were recruited
from an inner-city pediatric primary care clinic and a clinic for children
at risk for human immunodeficiency virus infection in a teaching hospital.
Participants: Mothers and fathers or father figures, and 244 five-year olds participating in a longitudinal study.
Main Outcome Measures: Child neglect
measured via home observation, a videotaped mother-child interaction, and
child protective services reports.
A father or father figure was identified for 72% of the children. Rates of
neglect ranged between 11% and 30%. Father absence alone was not associated
with neglect. However, in families with an identified and interviewed father,
a longer duration of involvement (P<.01), a greater sense of parenting efficacy (P<.01), more involvement with household tasks (P<.05), and less involvement with child care (P<.05) were associated with less neglect. The overall model explained 26.5% of the variance in neglect.
Conclusions: There is substantial
involvement of fathers in a subset of this high-risk sample, although more
than a quarter of the children lacked a father or father figure. The mere
presence of a father did not significantly influence the neglect of the children;
rather, the nature of his involvement did. Fathers who felt more effective
as parents were less likely to have neglected their children. A greater sense
of efficacy may reflect parenting skills and be important in enhancing the
contribution of fathers to their children's well-being. Pediatric health
care providers can play a valuable role in enhancing the involvement and
skills of fathers.
Arch Pediatr Adolesc Med.2000;154:135-141
THE NEW morbidity" in the 1970s 1 and "Bright Futures" in the 1990s 2
have drawn health care providers' attention to psychosocial problems confronting
many families. However, there has been little attention to the specific roles
of family members, in particular fathers, in the pediatric literature. To
our knowledge, the issue of child neglect, a major problem for many families,
has also been ignored. 3
Concern has been expressed about the roles fathers play, or do not play, in their children's lives. 4
There are no clear expectations of what fathers' roles should be, and many
children live in fatherless homes. In 1987, 16% of all white children and
50% of African American children in the United States lived with single mothers.
5 At the same time, many fathers have taken increasingly active roles in their children's lives, 6 including many who do not live with their children. 7 We must consider the roles of the nonbiological fathers who may act like fathers through their involvement with a child.
The involvement of African American
fathers in their families has received increasing attention. Many African
American teenaged fathers are involved in their children's lives, even though
the fathers are not married to the mothers and are not living in the home.
8 Nevertheless, the breadwinner role is an important
function of all fathers, and high rates of joblessness among low-income fathers
may strain their role as providers. 9 Additionally, McAdoo 10
takes issue with stereotypes of African American fathers based on studies
of those at the lowest economic level. He suggests there is a need for more
observational studies of fathers and children. In spite of increasing study,
the role of African American men in families "... is one of the most conspicuously
neglected areas of family research." 11
Studies on the effects of a father's
presence or absence have yielded mixed results; some have not found the father's
presence to affect children. 7, 12 In general, however, the father's involvement does influence the lives and development of their children, 13 although much of the research in this area has been done on middle-class white families. 14 Paternal involvement enhances the development of preschool-aged 15-17 and school-aged children, 18
and children in single-parent families are more likely to grow up in poverty,
less likely to finish high school, and more likely to have children as teenagers.
19 Black et al 20
found that while presence of the father was not associated with a child's
behavior and development, the nature of the father's involvement was. Fathers
who were satisfied with parenting, who contributed financially to the family,
and who were nurturing during play had children with better cognitive and
has described ways in which fathers may influence their children's lives.
First, they are usually the primary breadwinner. Second, fathers interact
directly by caring for, teaching, and playing with their children. Third,
fathers provide emotional and material support to mothers, which affects
children indirectly. 21 These relationships
are complex; a reciprocal relationship may also exist whereby paternal involvement
is facilitated by a positive marital relationship. Yet, increased paternal
involvement may not always be beneficial. 22
For example, a child's emotional adjustment may improve when contact with
an abusive or neglectful father is reduced or eliminated. 23
has also called attention to the context of paternal involvement. A father's
motivation to be involved, his evaluation of his parenting, and the mother's
perception of his involvement may all affect a child's well-being. If father
involvement can enhance children's health and well-being, it may also protect
them from an important form of child maltreatment—neglect.
Neglect is usually defined as a significant
omission in care by a parent or caregiver. It is the most prevalent form
of child maltreatment, accounting for approximately two thirds of identified
maltreatment cases. For example, almost 2 million children, or 3% of children
in the United States, were estimated to have been neglected in 1993. 24 Neglect has serious consequences. 25 It is associated with dysfunctional interpersonal relationships, 25 speech and language disorders, 26-27 academic problems, 28 and mental health problems. 29 In addition, approximately half of the estimated 2000 annual fatalities from child maltreatment are due to neglect. 30
In the field of child abuse and neglect,
very little research has been conducted on fathers, and the report on the
status of child maltreatment research by the National Research Council recommended
that this gap be addressed. 31 This lack of
research is particularly striking, given the acceptance of the ecological
model in the conceptualization of abuse and neglect. 32 Fathers should not be ignored in analyses of the multiple, interacting factors contributing to child maltreatment. 33 Involved fathers may protect their children against adverse circumstances.
To our knowledge, this is the first
study examining the association of father involvement and child neglect.
We have focused on low-income, urban, African American fathers and their
5-year-old children. We have used a broad definition of father to include
"someone who is like a father to this child," regardless of their biological
relationship, in recognition of the important roles father figures play.
34 This study expands on the issue of child
neglect, and on our earlier work on fathers' influence on children's development,
behavior, and home environment. 20 In this study,
we tested the hypothesis that greater involvement of fathers (living in the
home, contributing financially, nurturing, and participating in household
tasks and child care) protects children from neglect, with less involvement
being associated with neglect. We also examined if the fathers' contributions
were significant after taking the mothers' parenting into account.
The sample of 244 five-year-old African
American children and their families were participants in a longitudinal
study of child health and development, among families at risk for maltreatment.
The families were recruited from pediatric clinics when the children were
younger than 2 years on the basis of nonorganic failure to thrive, risk for
human immunodeficiency virus infection, or low income without other specific
Mothers consented to participate following
institutional review board–approved procedures. When the children were 5
years old, mothers were asked about their child's contact with their biological
father. If contact occurred at least monthly, permission was requested to
interview the father. If he was not involved, mothers were asked if the child
had "someone like a father" and the same procedure was followed. Unless otherwise
stated, "father" refers to both biological fathers and father figures.
After informed consent was obtained,
fathers were interviewed in the laboratory. The interview assessed health,
satisfaction with parenting, involvement with their child, relationship with
the child's mother, perception of the child and the neighborhood, and supports
and stresses. Fathers were also videotaped playing with their child. The
men were paid $25 for participation.
A similar maternal interview was usually
conducted on the same day. There was also a 40-minute home visit, usually
involving only mother and child. In 1997, computerized child protective services
(CPS) records were searched for any past relevant record data concerning
maltreatment and were coded by a trained abstractor unaware of other aspects
of the study.
Four measures were used to assess paternal
roles: (1) demography (whether the father or father figure lived with the
child), (2) relationship to the child, (3) employment, and (4) contribution
to child support.
A modified version of the "Who Does What" 35-36
scale was used; the 24 items yielded 2 scales measuring involvement in child
care and household tasks, with Cronbach [alpha]s of.92 and.77, respectively.
Respondents rated each item on a 9-point scale ranging from "I do it all"
(1), to "shared" (5), to "partner does it all" (9). Scores were averaged
to obtain an overall score.
Paternal nurturing was coded from videotapes
of fathers playing with their children. The videotapes were coded by research
assistants who were unaware of the children's risk status. A schema based
on parenting style 37 was used to rate the interaction of parent and child. 38
Individual items were coded using behaviorally anchored, ordinal scores.
High scores represent the most positive interactions. The raters were trained
until percent agreement exceeded 90%, and reliability was maintained through
weekly reviews. Four factors were derived: warmth, engagement, structure,
and negative emotion, each with a Cronbach [alpha] greater than.80. The first
3 were highly correlated and were averaged to form a construct of parent
Fathers' views of their parenting were rated on the Parenting Sense of Competence Scale. 39-40
This 16-item scale has 2 subscales—parenting satisfaction and parenting efficacy.
Scores were summed and high scores represent greater satisfaction and sense
As recommended by the National Research Council, 31 we used 6 measures of neglect, with data from 5 different sources. We developed a composite Neglect Index:
These scales measure child neglect. 41-42
Research assistants used 14 scales that were completed after a home visit.
Three dimensions were assessed: the home (furnishings, overcrowding, sanitation,
utilities, and safety), observations of the child (clothing and hygiene),
and maternal behavior toward the child (supervision, child care, acceptance,
approval, expectations, discipline, and stimulation). We considered a seriousness
score of less than 60 (on a 0-100 scale) on any scale as inadequate care
or neglect, except for safety, where the cutoff was 50 to adjust for the
children's age. These scales (eg, utilities) include conditions experienced
by the children without inferring parental responsibility, in keeping with
a child-focused definition of neglect. 43
This was also completed after the home visit. 44
This 45-item scale covers 6 aspects of the home environment relevant to the
well-being of young children (eg, emotional and verbal responsivity of mother).
Interrater reliability, assessed by having 2 research assistants jointly
code 25% of the visits, was greater than.90. The lowest quartile (25%) on
the overall score in our sample reflected the least adequate home environments
and was construed as a form of neglect.
The Maryland central computer files
for CPS reports on the study children were searched in 1997. Neglect was
determined from abstracted records for each child between the ages of 4 and
6 years who was the subject of a CPS report, whether substantiated or not.
Eight families with a report for abuse only were excluded; those who had
been abused and neglected were included.
The videotapes of the mothers playing
with their 5-year-old children were coded in the same way as for the fathers.
The average score of the same 3 scales was used, with the lowest quartile
This factor was measured by a maternal
questionnaire regarding aspects of the neighborhood, particularly safety,
drug use, and violence. A factor analysis using maximum likelihood extraction
with oblimin rotation yielded an 11-item scale with adequate internal consistency
(Cronbach [alpha] =.92). This measure was used as a continuous variable with
low scores reflecting a less adequate environment.
Finally, a 3-point composite Neglect
Index was developed based on the the Child Well-Being Scales, Home Observation
for Measurement of the Environment scale, CPS, and videotaped mother-child
interaction. Dimensions were "probable neglect" (CPS and 2 other measures
or no CPS but 3 other measures indicating neglect), "possible neglect" (CPS
and either no or one other measure or no CPS but 2 other measures indicating
neglect), and "unlikely neglect" (no CPS and either no or one other measure
indicating neglect.) Environmental neglect was not included.
There were 3 categories of father involvement:
father identified (by mother) and interviewed, no father identified, and
father identified but not interviewed. Demographic characteristics of families
by father availability were examined by [chi]2 and
1-way analyses of variance. The relationship between father availability
and neglect was examined with factorial analyses of covariance for each measure
of neglect, controlling for the number of adults in the home, the only variable
that was significantly different by father availability.
Next, we focused on only those fathers
who were interviewed (n = 117), examining the hypothesis that greater paternal
involvement protected children from neglect. We used hierarchical multiple
regression analyses and, after controlling for group status (failure to thrive,
human immunodeficiency virus risk, and comparison), maternal age, maternal
education, child's sex, the number of adults in the home, and the number
of children in the home, the following variables were examined for their
association with neglect: whether the child lived with the father, the father's
involvement in years, father's marital status, father's education, whether
the father was the biological father, father's employment status and financial
contribution, paternal parenting effectiveness, paternal involvement in child
care and household tasks, and paternal nurturing. Nonsignificant variables
were removed and the model was rerun. We also examined the role of maternal
parenting and its association with neglect to assess what the father added
after controlling for maternal parenting, using the 2 maternal subscales
of the Parenting Sense of Competence Scale. Of the 2 subscales, only parenting
satisfaction was associated with neglect, so the above regression analyses
were repeated controlling for it.
Of the 244 families, 176 fathers were
identified by the mothers (72%) and 117 (66%) were interviewed. Demographic
characteristics of the families are summarized in Table 1.
Approximately half of the children were male and there were an average of
almost 4 children in each household. The only significant demographic difference
according to the availability of a father figure was that the families in
which the father was interviewed had more adults in the household compared
with the other 2 groups (no father identified or father identified but not
interviewed). There were no significant differences in any of the neglect
measures according to the presence of fathers (Table 2).
In addition, 72% of the men had daily contact with the children. As expected,
rates varied across the 6 measures. Associations of child, maternal, household,
and demographic characteristics with child neglect were examined for families
of interviewed fathers. Table 3 provides the findings using the Neglect Index. Child, maternal, and household characteristics did not differ.
Hierarchical multiple regression analyses
predicting the Neglect Index revealed that after controlling for maternal
education, age, and parenting satisfaction, child sex and group, and the
number of adults in the home, several father involvement variables were associated
with neglect. Neglect was less likely when the father was involved for a
longer period (P<.01), expressed more parenting effectiveness (P<.05), and was more involved in household tasks (P<.05), but was less involved in child care (P<.05). The overall model explained 26.5% of the variance (Table 4).
Paternal cohabitation with the child, marital status, education, financial
contribution, and biological status were not associated with the Neglect
Index. The other measures of neglect were not significantly associated with
Fathers or father figures are actively
involved in the lives of many of the high-risk 5-year-old children in this
study. Among families in which a father was identified and interviewed, approximately
two thirds lived with the child. Indeed, Furstenburg and Harris 45
reported that while only 11% of their African American sample of children
in Baltimore, Md, resided with a male adult throughout childhood, only 8%
never lived with a father or father figure. However, in one fourth of the
families, mothers did not identify either a father or father figure involved
in the child's life.
The study also found relatively high
rates of neglect occurring between 4 and 6 years of age—16% based on CPS
records. This is substantially higher than the 2.9% rate based on community
professionals' assessment. 24 Given the limitations
of any single neglect measure, the 4 measures combined in the Neglect Index
may be a useful indicator. Using this index, approximately one third of families
had "probable" or "possible" neglect. Although caution is warranted in generalizing
these findings, rates may be similar in comparable communities.
Is paternal involvement in children's
lives associated with reduced neglect? In the broadest sense, the findings
suggest that the father's role might be filled by another adult in the household.
Neglect rates did not differ by father or father figure presence or absence.
There were no group differences in number of adults in the household; mothers
not living with a man were more likely to be living with another major support
provider. 46 Other research concludes that
having a father at home enhances child development, but absence is not harmful
if a grandmother is present. 47
There were, however, significant findings
within the group of families in which a father was identified and interviewed,
presumably a select subgroup of the most involved fathers. Father involvement
over an extended period was associated with less neglect, suggesting that
a stronger relationship may have developed over time. The longer duration
may also be a marker of family stability and consistency in caregivers. In
addition, women may be less likely to remain involved with men who do not
treat their children well. One might expect that the longer period reflects
the involvement of biological fathers instead of father figures, but this
relationship did not differ significantly, illustrating that nonbiological
father figures often play stable roles in this population. Fathers' sense
of efficacy regarding their parenting was associated with less neglect, suggesting
that their rating reflected a more successful role in nurturing their child.
The importance of fathers' positive view of their parenting roles in protecting
against neglect supports the emphasis by Lamb 6
on the context of paternal involvement. Aside from motivation, having relevant
skills and confidence may promote involvement, enjoyment, and sensitivity.
However, causality cannot be inferred; fathers may have felt more effective
because neglect had not been a concern. In the current study, fathers' contribution
was significant after controlling for mothers' satisfaction with parenting.
Greater father involvement in household
tasks was also associated with lower neglect risk. Helping with tasks could
ease mothers' workloads, 48 and could also
be a proxy for overall paternal family involvement, supporting other research
indicating fathers contribute to family and child well-being. 6
The association of greater father involvement in child care with more neglect
was unanticipated. Perhaps fathers played a greater role when mothers were
relatively unavailable, a conclusion supported by other research. 49
This study had a power of 80% to detect significance in variables that accounted for 5% of the variance. 50
It is interesting to consider the variables that were not significantly associated
with neglect. Employed fathers' financial contributions were not a factor,
perhaps because most of the families were living in poverty and the men made
meager financial contributions. Even though more than half of the men worked
and provided support, most families still received public assistance. Support
by noncustodial, low-income fathers typically is irregular, informal, 14 and less than $2000 a year. 51
It seemed likely that having a biological father involved would be more protective
than a father figure. However, neglect rates did not differ between these
2 groups. Furstenburg and Harris 45 also found
that the biological relationship of the father was unrelated to child outcomes.
Similarly, having the father living in the home was not significant. This
finding was also reported by Furstenburg and Harris, 45
although children benefited if the father or father figure lived in the home
and had a close relationship with the child. Similarly, when the children
in this sample were 3 years of age, child behavior and development improved
when fathers were more nurturing of their children. 20
The present findings are consistent with those results. In low-income communities,
many men may play important roles in their children's lives even if they
do not live in the home. 52 Both the quality
of the relationship and fathers' involvement seem to be more important than
the biological relationship of the father or where he resides.
The study has several limitations. First,
the men interviewed may not be representative of all African American fathers
or father figures. At the same time, there were few differences between families
in which a father was interviewed and those in which he was identified but
not interviewed. In addition, because the participants were from low-income,
inner-city families, generalizability to other groups is limited. Second,
the data are cross-sectional, precluding inferences of causality. We do not
know whether greater involvement of fathers protected children from neglect
or whether men were more likely to participate in better-functioning families.
Third, the children were 5 years old at the time of this study, restricting
the "opportunity" for maltreatment. Maltreatment could emerge as an even
larger problem in future years and the influence of fathers could become
Finally, the measurement of neglect
remains problematic. While direct observation seems promising, particularly
for assessing physical neglect, it is unlikely that psychological neglect
will occur during a brief observation. Child protective services data are
limited by the biases of who gets identified, reported, and substantiated.
The composite Neglect Index attempts to avoid these limitations.
The high rate of neglect in this population
is alarming and warrants serious attention to address children's needs and
prevent the sequelae related to neglect. Most of the children did have fathers
or father figures in their lives and this study suggests an association between
greater father involvement and a lower risk for neglect. The main question
may be how to encourage fathers to be more involved with their children in
ways that are optimally nurturing.
Major efforts have been made to ensure that fathers fulfill child support obligations. 14
Because economic security supports marriage and father involvement, tax code
reforms improving the financial benefits of marriage could aid families.
Similar improvements could come from allowing fathers to remain in the homes
of women receiving welfare. An array of programs to improve the educational,
parenting, and job skills of young fathers have been developed, but few have
been rigorously evaluated. 14 Theoretically
sound, promising interventions need to be evaluated. More modest interventions
may also be effective. For example, it is striking how professionals and
agencies serving children often focus on mothers and ignore fathers. Health
care providers should actively invite fathers to participate in visits and
nurture their involvement in their children's lives. In addition, men, especially
young men, may not know how to nurture their children, especially if they
were raised in fatherless households. We need more programs for fathers that
build specific skills to meet children's child care and developmental needs.
Pediatric health care providers should seek opportunities to impart parenting
knowledge and skills to fathers. In addition, pediatric health care providers
can facilitate fathers' emotional and material support of their children's
mothers. They can also encourage mothers to permit fathers to be more involved
in their children's lives by explaining the valuable roles that fathers can
Finally, tax code changes, child support
enforcement, and efforts to help men become good fathers are insufficient.
A cultural change acknowledging the roles fathers can play is needed. The
media increasingly show men as nurturing parents and men indicate that they
want more time with their children. 14 A concerted
public education campaign would include skill-building activities that teach
parents how to incorporate men into fathering roles.
Accepted for publication June 22, 1999.
This research was supported by grant
90CA1401 from the National Center on Child Abuse and Neglect, US Department
of Health and Human Services, Washington, DC (Dr Dubowitz).
It's important to have studies, like this, that emphasize the role of fathers
in the lives of children. It's a little disconcerting, however, to define
a father or father figure as someone who has contact at least monthly. I
guess we take what we can get.—Catherine D. DeAngelis, MD
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